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5th February 2021
When it comes to consent and capacity in under 16s, you need to understand what Gillick competence is and how Fraser guidelines are used.

Written by Premela Kala

What Is Gillick Competence?

Gillick competence outlines whether a child (under 16) can consent to their own medical treatment without their parents having to know or give permission. If the child has enough intelligence, competence and understanding to truly be informed about their treatment, they would be considered Gillick competent.

If the child does not have the capacity to consent, someone with parental responsibility can do so on their behalf. Some examples include:

  • Parents
  • Legally appointed guardian
  • Local authority designated to care for the child
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How Is A Child Deemed Gillick Competent?

There aren’t any set questions that are used to assess Gillick competency. However, when assessing a child’s capacity to consent, healthcare professionals must keep in mind the following:

  • How old are they? How mature are they?
  • What’s their mental capacity?
  • Does the child understand what the treatment entails, including the pros, cons and long-term impact?
  • Does the child understand the risks, implications and consequences that could result from their decision?
  • Has the child understood the advice and information they’ve been given?
  • Is the child aware of alternative options, if available?
  • Does the child possess the ability to explain the rationale behind their decision making?

A child’s understanding of different treatments can vary, and capacity can fluctuate. This means decisions must be handled on a case by case basis, each time requiring assessment of Gillick competence.

What Are The Fraser Guidelines?

The Fraser guidelines outline the scenario in which advice can be given to an under 16 about contraception and sexual health without parental consent.

The five points are

  1. Is the child mature and intelligent enough to understand the nature and implications of the treatment proposed?
  2. Is it impossible to persuade the child to tell their parents, or let the Doctor tell them?
  3. Are they likely to begin or continue having sexual intercourse with or without contraception?
  4. Are their physical or mental health likely to suffer unless they get the advice or treatment?
  5. Is the advice or treatment in their best interest?

How Did Fraser Guidelines And Gillick Competency Arise?

Both were developed after Victoria Gillick tried to stop Doctors from providing advice on contraception and sexual health to under 16s without parental knowledge in the 1980s.

It was a lengthy legal battle – but it was during this that the test for Gillick competence was created. The Fraser guidelines were created to address the specific issue of contraception.

Key Difference

Be careful that you don’t mix up these two terms.

Gillick competence is used to assess a child’s capability to make and understand their decisions in a wider context. Fraser guidelines are applied specifically to advice and treatment that focuses on a young person’s sexual health and contraception.

Safeguarding According To Age

Whilst Frasers guidelines and Gillick competency apply to all children, there are certain differences in how they are applied depending on a child’s age. Here’s what you need to know:

Under 13

There isn’t a lower limit for either Gillick competence or Fraser guidelines to be applicable. Most children under the age of 13 have parent involvement when consent to treatment is concerned as it is not appropriate or safe.

When it comes to contraception and sexual health, any information about sexual activity would be acted on regardless of whether the child is competent or not – because a child under 13 is not legally able to consent to sexual activity.

Under 16

If someone under 16 discloses information that raises concerns about their safety, the following needs to be considered:

  • If they are Gillick competent and disclosure is thought to be essential to protect them from danger, the healthcare professional should escalate concerns through safeguarding measures
  • If they aren’t Gillick competent, the healthcare professional is obliged to escalate concerns through safeguarding measures
  • If it is both cases, the young person must be informed – unless doing would cause significant risk to their safety

If escalated, the police or local authority could be asked to decide whether it is in the best interest to inform parents of the concerns raised. Of course, sometimes there are cases where it is not in the best interest of the young person.

Between 16 and 17

Legally, those aged 16 to 17 have the capacity to consent to medical treatment. However, unlike adults, refusal of treatment can be overridden by either a court or someone who possesses parental responsibility. This exists because of the duty to act in a young person’s best interest, which involves situations where their refusal leads to death or irreversible damage, either mentally or physically.

How To Apply This Knowledge

You’ll probably be asked ethics questions in your Med School interview, so it’s important you understand these issues. They relate very closely to the four pillars of ethics, so you may find it appropriate to discuss Gillick competency and Fraser guidelines in order to solidify your reasoning.

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