As such, medical staff will not make a disclosure of medical records of a child who is deemed Gillick competent unless consent is manifest. London: Department of Health and Social Care. It is not just upgrade your browser. In South Australia and New South Wales legislation clarifies the common law, establishing a Gillick-esque standard of competence but preserving concurrent consent between parent and child for the ages 14-16. In 1982 Victoria Gillick took her local health authority (West Norfolk and Wisbech Area Health Authority) and the Department of Health and Social Security to court in an attempt to stop doctors from giving contraceptive advice or treatment to under 16-year-olds without parental consent. The ethics of adolescent medical decision-making is a fraught area for medical ethics because it deals with the threshold boundaries between childhood and adulthood and Gillick adds a burden upon children and adolescent patients that is unwarranted and through which damage is . Calls to 0800 1111 are free and children can also contact Childline online or read about childrens rights on the Childline website. Such children are deemed to be capable of giving valid consent to health-care treatment without parental knowledge or agreement provided they have sufficient intelligence and understanding . Gillick competency can be used when young people wish to refuse medical treatment. z#&,!Eh?_X Q*%20/Ud` !s4@KXA!20W.E-2eR5re@1cCk2W ~G Gillick competence (gil-ik) n. a rule for judging legal capacity in children under the age of 16 years, established in the case Gillick v West Norfolk and Wisbech Area Health Authority (1985) 2 A11 ER 402. Health professionals who behave in this way would be failing to discharge their professional responsibilities and could expect to be disciplined by their professional body.Citation5 Where a child is considered Gillick competent then the consent is as effective as that of an adult and cannot be overruled by a parent. This paper looks at the issue of consent from children and whether the test of Gillick competency, applied in medical and healthcare practice, ought to extend to participation in research. NSPCC / All rights reserved. the young person is Gillick competent) state that all the following requirements For example, if a child or young person: Medical professionals need to consider Gillick competency if a young person under the age of 16 wishes to receive treatment without their parents' or carers' consent or, in some cases, knowledge. For safeguarding training, resources and consultancy Obtain permissions instantly via Rightslink by clicking on the button below: If you are unable to obtain permissions via Rightslink, please complete and submit this Permissions form. Edinburgh: Scottish Executive. 2 0 obj Children under 16 can consent to medical treatment if they understand what is being proposed. However, this right can be exercised only on the basis that the welfare of the young person is paramount. strictly prohibited. Lord Scarman and Lord Fraser proposed slightly different tests (Lord Bridge agreed with both). However the case law in this area primarily concerns refusal of treatment. The common law recognises that a child or young person may . If a Gillick competent child refuses medical examination or treatment then the law does allow a person with parental responsibility to consent in their place. However, as with adults, this consent is only valid if given voluntarily and not under undue influence or pressure by anyone else. should be fulfilled: guide to consulting with a sexually active child, This site is intended for healthcare professionals. Although the two terms are frequently used together and originate from the same legal case, there are distinct differences between them. A plea for consistency over competence in children. It underpins the propriety of the treatment and furnishes a defense to the crime of battery and civil wrong of trespass.Citation1 It must be obtained before an immunization can proceed. In Northern Ireland the Department of Health provides consent guides for healthcare professionals (Department of Health, 2003). It is a high test of competence that is more difficult to satisfy the more complex the treatment and its outcomes become. From these, and subsequent cases, it is suggested that although the parental right to veto treatment ends, parental powers do not terminate as suggested by Lord Scarman in Gillick. This is known as being Gillick competent. The child must be capable of making a reasonable assessment of the advantages and disadvantages of the treatment proposed, so the consent, if given, can be properly and fairly described as true consent" (Gillick v West Norfolk, 1984). If a child or young person needs confidential help and advice direct them to Childline. Hum Vaccin Immunother. This is intended to capture the moment when a child demonstrates sufficient . He said:"it is not enough that she should understand the nature of the advice which is being given: she must also have a sufficient maturity to understand what is involved.". The child's safety and wellbeing is paramount. Both Gillick competency and Fraser guidelines refer to a legal case from the 1980s which looked at whether doctors should be able to give contraceptive advice or treatment to young people under 16-years-old without parental consent. Never before has Gillick been extended to permit a mature child to make autonomous medical decisions over and above the curial 'parens patriae' power.In 2013, two judicial decisions promulgated from different Australian courts are in conflict over this most fundamental of questions. &Ed@ The following information looks at how this can be applied in practice. Oxbridge Solutions Ltd. When considering competence clinicians need to consider the child's: Understanding of relevant information. At 11 and 15 y the judge was obliged to consider whether they were Gillick competent, in that they had the maturity and intelligence to refuse the MMR vaccine. However, these are only obiter statements and were made by a lower court; therefore, they are not legally binding. Gillick competence: A UK term of art referring to the competence of a child under the age of 16 to consent to his/her own medical care, without the need for parental permission. The young persons best interests require them to receive contraceptive advice or treatment with or without parental consent. Later she had a total of 10 children. '2P@LH(21qTV5-.A \RT,2P|Hd 41 Fe2 Im^Xd@R/ 6 0 obj Children under the age of 16 can consent to their own treatment if they're believed to have enough intelligence, competence and understanding to fully appreciate what's involved in their treatment. How do I view content? The Court of Appeal reversed this decision, but in 1985 it went to the House of Lords and the Law Lords (Lord Scarman, Lord Fraser and Lord Bridge) ruled in favour of the original judgment delivered by Mr Justice Woolf: "whether or not a child is capable of giving the necessary consent will depend on the child's maturity and understanding and the nature of the consent required. However, unlike adults, their refusal of treatment can in some circumstances be overridden by a parent, someone with parental responsibility or a court. Any distribution or duplication of the information contained herein is The nature of the standard remains uncertain. By closing this message, you are consenting to our use of cookies. A plea for consistency over competence in children. be as effective as it would be if he were of full age; and where a minor has by Adults, In England, the Department of Health and Social Care provides guidance for medical professionals on the legal framework they need to consider when obtaining valid consent to examination, treatment or care (Department of Health and Social Care, 2009). This matter was litigated because an activist, Victoria Gillick, ran an active campaign against the policy. Obtaining consent for immunization becomes more complex where parental responsibility and the developmental concept of Gillick competence become intertwined as the child matures to adulthood. If a child does not pass the Gillick test, then the consent of a person with parental responsibility (or sometimes the courts) is needed in order to proceed with treatment. Consent is essential to the propriety of treatment and is necessary to meet the requirements of the law. Queensland. they often talk about whether the child is 'Gillick competent' or whether they meet the 'Fraser guidelines'. It is lawful for doctors to provide contraceptive advice and treatment without parental consent providing certain criteria are met. A persistent rumour arose that Victoria Gillick disliked having her name associated with the assessment of childrens capacity, but an editorial in the BMJ from 2006 claimed that Gillick said that she has never suggested to anyone, publicly or privately, that [she] disliked being associated with the term Gillick competent'. For example, you could talk to the young person's parents or carers on their behalf. Fraser guidelines originally just related to contraceptive advice and treatment but, following a case in 2006, they now apply to decisions about treatment for sexually transmitted infections and termination of pregnancy. It is task specific so more complex procedures require greater levels of competence. Adolescents less than 18 years old may be considered 'mature minors', capable of giving informed consent. Although a question of private law rather than state intervention into family life, the courts are still obliged to follow the provisions of the Children Act 1989 and consider the best interests of the welfare of that child. Care Quality Commission. Consent is the legal expression of the moral principle of autonomy. In Scotland the NHS has provided a good practice guide on consent for health professionals (PDF) (Scottish Executive Health Department, 2006). 11 0 obj The Fraser guidelines still apply to advice and treatment relating to contraception and sexual health. Browser Support eZ4he~9tQq,go`q{PgJP2 5hj+220wp5H7PZBPd@Bd @Bh;Q7~D$ true /ColorSpace 8 0 R /SMask 13 0 R /BitsPerComponent 8 /Filter /FlateDecode A different level of competence would be needed for having a small cut dressed compared . Care Quality Commission (2019). 6 The arguments constructed and analysis undertaken in this paper endeavour to encompass decisions made by 'Gillick competent' children in relation to both consent and refusal of medical treatment. Kennedy & Grubb (1998) argue that children pass through 3 developmental stages on their journey to becoming an autonomous adult.Citation3. The English Gillick case held that . The rule in Gillick must be applied when determining whether a child under 16 has competence to consent. Section 2 sets out when a child under the age of 16 can consent to medical treatment or procedures. Gillick v West Norfolk and Wisbech Area Health Authority and Department of Health and Social Security [1984] Q.B. Gillick competence is the principle we use to judge capacity in children to consent to medical treatment. In F v F [2013] the High Court ordered that sisters aged 11 and 15 y must receive the MMR vaccine.Citation11 Mr Justice Sumner made it clear that although the case concerned a dispute between parents his only concern was for the best interests of the welfare of the children. Where a health professional accepts the consent of a Gillick competent child it cannot be overruled by the child's parent. Consent needs to be given voluntarily . Gillick Competence. Oxbridge Solutions Ltd receives funding from advertising but maintains editorial Subscribe to our weekly email keeping you up-to-date with all the developments in child protection policy, research, practice and guidance. Gillick v West Norfolk and Wisbech AHA [1985] UKHL 7 (17 October 1985) 2016 In-text: (Gillick v West Norfolk and Wisbech AHA [1985] UKHL 7 (17 October 1985), 2016) A doctor can prescribe contraception to children under 16 years old if: NB: bear in mind the age of the partner and risk of sexual abuse. Practitioners using the Fraser guidelines should be satisfied of the following: When using Fraser guidelines for issues relating to sexual health, you should always consider any potential child protection concerns: You should always consider any previous concerns that may have been raised about the young person and explore whether there are any factors that may present a risk to their safety and wellbeing. Another chapter has opened in the tortured history of the status of Gillick competence. Consent for the medical treatment of patients under 18 years of age is generally provided by parents. x0 3099067 Develop the safeguarding skills, knowledge and competencies required for Level 4 healthcare professionals. Gillick competency and Fraser guidelines Balancing children's rights with the responsibility to keep them safe from harm . a local authority or person with an . This will require an assessment on a case by case basis to determine if the child is Gillick competent. Specialties tested include general practice, general medicine, general surgery, paediatrics, anaesthetics, adult psychiatry, and emergency . That takes account of the child's understanding, ability to weigh risk and benefit, consideration of longer term factors such as effect on family life and on such things as schooling. Especially useful fo. or treatment with or without parental consent, although The psychological effect of having the decision overruled would have to be taken into account and would normally be an option only when the young person was thought likely to suffer grave and irreversible mental or physical harm. There is no lower age limit for Gillick competence or Fraser guidelines to be applied. Be careful that you don't mix up these two terms. Parents cannot override a competent child's refusal to accept treatment. 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