In general, in English Law a minor is a person less than 18 years old. be as effective as it would be if he were of full age; and where a minor has by Victoria D. M. Gillick (ne Gudgeon; born 1946, in Hendon) is a British activist and campaigner best known for the eponymous 1985 UK House of Lords ruling that considered whether contraception could be prescribed to under-16s without parental consent or knowledge. 08/12/20. 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Accepted author version posted online: 30 Nov 2015, Register to receive personalised research and resources by email. This first came into effect in England when Mrs. Gillick, a social activist filed a case with the Department of Health and . Adolescents have the legal right to confidential health care. At paragraph 78, Sir James also noted that: Health professionals must be confident in assessing a child's Gillick competence in order to ensure that the child's rights are respected, this requires the health professional to evaluate the child's maturity and intelligence when seeking consent to immunization. The term "Gillick competence" comes from a landmark English case where the courts first recognised that a minor might be competent to make decisions without parental consent. NSPCC / All rights reserved. Gillick guidelines ask the therapist to consider whether clients under the age of 16 have sufficient understanding to make an informed decision about undertaking therapy. If you don't think a child is Gillick competent or there are inconsistencies in their understanding, you should seek consent from their parents or carers before proceeding. %PDF-1.3 When consenting children to medical treatment, the terms Gillick competence and Fraser guidelines are frequently used interchangeably despite there being a clear distinction between them. Immunization is voluntary and generally it is for those who have parental responsibility for a child or children who are Gillick competent to decide on immunization. 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). Gillick competence is a functional ability to make a decision. The rule in Gillick must be applied when determining whether a child under 16 has competence to consent. There is no set of defined questions to assess Gillick competency. these criteria specifically refer to contraception, the principles are deemed Consent is permission to touch and give the agreed treatment. Fast-forward 35 years and Gillick competence again comes to the fore - this time to assess whether under 16s can make their own decision whether to have the Covid-19 vaccination should their parents disagree and vice versa. If the nurse's judgement is that attempting to give the immunization in the face of continued resistance from the child then it is open to the nurse to refuse to proceed at that time. Anyone who gives him consent may take it back, but the [health professional] only needs one and so long as they continue to have one they have the legal right to proceed.Citation9. This matter was litigated because an activist, Victoria Gillick, ran an active campaign against the policy. Where a competent child under 16 refuses a specific treatment which is in their best interests, but the parents support the . This key principle is reflected in consent law applied to children. professionals, including nurses. An interesting aside to the Fraser guidelines is that many[weasel words] regard Lord Scarmans judgment as the leading judgement in the case, but because Lord Frasers judgement was shorter and set out in more specific terms and in that sense more accessible to health and welfare professionals it is his judgement that has been reproduced as containing the core principles, as for example cited in the RCOG circular. Gillick competence for children under 16 years old, Children under 16 years old can consent to medical treatment (but not necessarily refuse treatment) if they have sufficient maturity and judgement to enable them to fully understand what is proposed i.e. << /Length 5 0 R /Filter /FlateDecode >> The risks, intended benefits and outcomes of the proposed immunization and alternatives to immunization, including the option of not having or delaying the immunization. Gillick competency applies mainly to medical advice but it is also used by practitioners in other settings. the child's age, maturity and mental capacity, their understanding of the issue and what it involves - including advantages, disadvantages and potential long-term impact, their understanding of the risks, implications and consequences that may arise from their decision, how well they understand any advice or information they have been given, their understanding of any alternative options, if available. workers and health promotion workers who may be giving contraceptive advice and 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. endobj Abstract. Young person's 16 and 17 y old who are able to consent to treatment as if they were of full age.Citation4, The right of a child under 16 to consent to medical examination and treatment, including immunization was decided by the House of Lords in Gillick v West Norfolk and Wisbech AHA [1986] where a mother of girls under 16 objected to Department of Health advice that allowed doctors to give contraceptive advice and treatment to children without parental consent.Citation5 Their Lordships held that a child under 16 had the legal competence to consent to medical examination and treatment if they had sufficient maturity and intelligence to understand the nature and implications of that treatment.Citation5, Wheeler (2006) argues that something of an urban myth has emerged over the use of the term Gillick competence.Citation6 It suggests that Mrs Gillick wishes to disassociate her name from the assessment of children's capacity, thus carrying the implication that the objective test of a child's competence should be renamed the Fraser competence. If you do not want to receive cookies please do not The standard is based on the 1985 judicial decision of the House of Lords with respect to a case of the contraception advice given by an NHS . 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. Copyright 2023 p/ The courts do not adopt an unquestioning recommendation of immunization but give careful consideration to each case on its facts. Age of Legal Capacity (Scotland) Act 1991, consent to examination, treatment or care, consent guides for healthcare professionals, good practice guide on consent for health professionals (PDF), Brief guide: capacity and competence to consent in under 18s (PDF), Consent guides for healthcare professionals, Reference guide to consent for examination or treatment (second edition), The law reports (appeal cases) [1986] AC 112, A good practice guide on consent for health professionals in NHS Scotland (PDF), Harmful sexual behaviour in schools training, For safeguarding training, resources and consultancy, would like to have therapeutic support but doesn't want their parents or carers to know about it, is seeking confidential support for substance misuse. It is a high test of competence that is more difficult to satisfy the more complex the treatment and its outcomes become. Gillicks case involved a health departmental circular advising doctors on the contraception of minors (for this purpose, under 16s). The Australian High Court gave specific and strong approval for the Gillick decision in Marions Case, Secretary of the Department of Health and Community Services v JWB and SMB (1992) 175 CLR 189. In practice both remedies are unlikely to be sanctioned as their impact on the child's welfare would be detrimental. It is argued that Gillick competence is an unnecessary burden with an unethical foundation. Gillick competence for children under 16 years old Children under 16 years old can consent to medical treatment (but not necessarily refuse treatment) 'if they have sufficient maturity and judgement to enable them to fully understand what is proposed' - i.e. The court rejected a claim that not granting parents a right to know whether their child had sought an abortion, birth control or contraception breached Article 8 of the European Convention on Human Rights. The result of Gillick is that in England today, except in situations that are regulated otherwise by law, the legal right to make a decision on any particular matter concerning the child shifts from the parent to the child when the child reaches sufficient maturity to be capable of making up his or her own mind on the matter requiring decision. When prescribing contraception to children under 16 years, it is essential to assess for coercion or pressure , for example, coercion by an older partner. 6 0 obj The content herein is provided for informational purposes and does not replace the need to apply You must always share child protection concerns with the relevant agencies, even if a child or young person asks you not to. Any distribution or duplication of the information contained herein is The aim of Gillick competence is to reflect the transition of a child to adulthood. Fraser guidelines are applied specifically to advice and treatment that focuses on a young person's sexual health and contraception. However, as with adults, this consent is only valid if given voluntarily and not under undue influence or pressure by anyone else. But Gillick competency is often used in a wider context to help assess whether a child has the maturity to make their own decisions and to understand the implications of those decisions. Young people also have the right to seek a second opinion from another medical professional (General Medical Council, 2020). Engaging with and assessing the adolescent patient. Call Childline on 0800 1111, Weston House, 42 Curtain Road, London, EC2A 3NH. In this context, welfare does not simply mean their physical health. This idea of Gillick competence was further supported by R (on the application of Axon) v Secretary of State for Health. useGPnotebook. The standard is based on the 1985 judicial decision of the House of Lords with respect . They may be used by a range of healthcare professionals working with under 16-year-olds, including doctors and nurse practitioners. The Fraser guidelines still apply to advice and treatment relating to contraception and sexual health. What is Gillick competence? Since Parliamentary legislation is superior to common law, it is the terms of << /Type /Page /Parent 3 0 R /Resources 6 0 R /Contents 4 0 R >> endobj 11 0 obj This was clarified Childhood immunization was considered by the High Court.Citation10 and subsequently by the Court of Appeal.Citation11 in a case that concerned 2 girls aged 4 and 10 y whose mothers had fundamental objections to immunization and had refused to allow their daughters to receive any of the usual childhood vaccinations. ", > Find out more about assessing Gillick competency. Consent is essential to the propriety of treatment and is necessary to meet the requirements of the law. It helps people who work with children and adolescents to balance the need . Allan Gaw recounts the famous Gillick case and events leading up to a landmark decision on medical consent in children. This study of the ethical significance of childhood is situated within the context of adolescent decision-making and childhood is treated as a neglected topic of of ethical reflection. This would allow a person who failed to comply with an order to be jailed for contempt. The same child may be considered Gillick competent to make one decision but not competent to make a different decision. This would include circumstances where refusal would likely lead to death, severe permanent injury or irreversible mental or physical harm. Start typing to see results or hit ESC to close, Three things required for consent to be valid, The ultimate responsibility for ensuring the patient is consented properly lies with the. Gillick competence is therefore the correct term, still used by judges and health professionals, to identify children aged under 16 who have the legal competence to consent to immunization, providing they can demonstrate sufficient maturity and intelligence to understand and appraise the nature and implications of the proposed treatment, including the risks and alternative courses of actions. As Gillick was decided ultimately in the House of Lords 2, its authority extends to Scotland as well as to other parts of the UK. The young person will understand the professionals advice; The young person cannot be persuaded to inform their parents; The young person is likely to begin, or to continue having, sexual intercourse with or without contraceptive treatment; Unless the young person receives contraceptive treatment, their physical or mental health, or both, are likely to suffer; and. `ve-ej;U 73)_Qp6wS\Q3m&CTOg"!T LtPOh z#&,!Eh?_X Q*%20/Ud` !s4@KXA!20W.E-2eR5re@1cCk2W ~G has attained the age of sixteen years to any surgical, medical or dental treatment Childright, 22: 11-18. If a child passes the Gillick test, he or she is considered Gillick competent to consent to that medical treatment or intervention. 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. The judge concluded that immunization would be in the best interests of the welfare of each child. 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