Registered in England & Wales No. Each station includes the following 3 components: Student instructions (the brief before beginning a station) Patient script (explaining the symptoms/signs the patient should report/demonstrate) The Family Law Reform Act 1969 also gives the right to consent Hum Vaccin Immunother. 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). It is task specific so more complex procedures require greater levels of competence. There is no set of defined questions to assess Gillick competency. useGPnotebook. Gillick sought a declaration that prescribing contraception was illegal because the doctor would commit an offence of encouraging sex with a minor and that it would be treatment without consent as consent vested in the parent; she was unsuccessful before the High Court of Justice, but succeeded in the Court of Appeal. In this article, we explore the implications of adopting 'Gillick competence'drawn from healthcare lawas the relevant test of sufficient maturity in the data protection law context. Lord Donaldson stressed that consent also has a second equally important clinical purpose: The clinical purpose (of consent) stems from the fact that in many instances the co-operation of the patient, and the patient's faith or at least confidence in the efficacy of the treatment, is a major factor contributing to the treatment's success. In a landmark case, Victoria Gillick challenged Department of Health Guidance which enabled doctors to provide contraceptive advice and treatment to girls under 16 without their parents' knowledge. In Queensland, a child can consent to a vaccination if they have the capacity to give or withhold consent. If the health professional giving the immunisation felt a child was not Gillick competent then the consent of someone with parental responsibility would be sought. Where a competent child under 16 refuses a specific treatment which is in their best interests, but the parents support the . Failure to obtain the co-operation of the children will make it very difficult to safely give the MMR. `ve-ej;U 73)_Qp6wS\Q3m&CTOg"!T LtPOh However, as with adults, this consent is only valid if given voluntarily and not under undue influence or pressure by anyone else. The nature of the standard remains uncertain. << /Length 5 0 R /Filter /FlateDecode >> they are Gillick competent, Fraser guidelines for prescription of contraceptives. These are commonly known as the Fraser Guidelines: the young . Consent is essential to the propriety of treatment and is necessary to meet the requirements of the law. A good practice guide on consent for health professionals in NHS Scotland (PDF). Treatment cannot generally proceed without it. Autonomy - Doctors must respect the decision made by a patient. 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. Once the child reaches the age of 16: (i) the issue of Gillick competence falls away, and (ii) the child is assumed to have legal capacity in accordance with s.8 Family Law Reform Act 1969, unless (iii) the child is shown to lack mental capacity as defined in ss. The Current Position: Gillick Competence: Who may give consent to the medical treatment of a child:-A child over the age of 16 (S, Family Law Reform . Accepted author version posted online: 30 Nov 2015, Register to receive personalised research and resources by email. Gillick competence needs to be assessed on a decision by decision basis, checking whether the child understands the implications of the treatment. This might . It is argued that the relatively broad usage of the test of Gillick competency in the medical context should not be considered applicable for use in research. In complex medical cases, such as those involving disagreements about treatment, you may wish to seek the opinion of a colleague about a childs capacity to consent (Care Quality Commission, 2019). Underage sexual activity is a possible indicator of. 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. However, if a young person refuses treatment which may lead to their death or severe permanent harm, their decision can be overruled. Gillick competence is concerned with determining a childs capacity to consent. young person is likely to begin, or to continue having, sexual intercourse with This case is one of many being heard by the Family Court following the decision in Re Jamie 2013 that whilst court authorisation is unnecessary for stage one treatment for gender dysphoria, the nature of stage two treatment requires the Court to determine the child's "Gillick competence" to make the decision. The case is binding in England and Wales, and has been adopted to varying extents in Australia, Canada, and New Zealand. There is no lower age limit for Gillick competence or Fraser guidelines to be applied. Gillick Competence. This form provides a structured method for obtaining evidence of the patient's capacity to At one end there are the obvious cases where parental objection would have no value in child welfare terms, for example urgent lifesaving treatment such as a blood transfusion. endobj upgrade your browser. The vaccines minister appears to be arguing that this barrier can be overcome by taking consent from the child under the rule in Gillick (Gillick v West Norfolk and Wisbech AHA [1986]). 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. For more information, please visit our Permissions help page. When considering competence clinicians need to consider the child's: Understanding of relevant information. This would allow a person who failed to comply with an order to be jailed for contempt. In order to provide valid consent, the patient must do all four of the following: Children 16-18 years old are presumed to have capacity and generally treated like adults with regard to consent. As the case concerned a fundamental issue of parental responsibility the High Court heard the case under the provisions of section 8 of the Children Act 1989. If a child passes the Gillick test, he or she is considered Gillick competent to consent to that medical treatment or intervention. Bell v Tavistock and Portman is a recent high-profile case on the lawfulness of prescribing puberty-suppressing drugs to children experiencing gender dysphoria. 43R@ ~? It changes depending on the nature of the medical decision, e.g. The House of Lords focused on the issue of consent rather than a notion of parental rights or parental power. A child of 15 years or above would normally be expected to have sufficient maturity, intelligence and understanding to . Feature: My child, my choice. In late 2020, Bell v Tavistock considered whether under-16s with gender dysphoria could be Gillick competent to consent to receiving puberty blockers. This site uses Akismet to reduce spam. 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. In a 2006 judicial review, R (on the application of Axon) v Secretary of State for Health, the High Court affirmed Gillick in allowing for medical confidentiality for teenagers seeking an abortion. Help for adults concerned about a child London: Department of Health and Social Care. Subscribe to our weekly email keeping you up-to-date with all the developments in child protection policy, research, practice and guidance. O>Gr~AdBsSO2 Ee3P?N6Ih 5oWhP Ic1Pb^j'rv!WDK+.I{709J*ZlSxoqkw[76MXHRXu/\n?HE,Qg"@ "Gillick competence" published on by null. Section 2 sets out when a child under the age of 16 can consent to medical treatment or procedures. Typical positions of emancipation arise when the minor is married (R v D [1984] AC 778, 791) or in the military. the young person's physical or mental health or both are likely to suffer unless they receive the advice or treatment. p/ -'d2fgK~8P:nC3 0H %!b U842jAQ6,$S`:+=H Ciw lUm_|==#&g_SmM=JY@M_K8z1X=i+1o+d$;W$ =qBo/3+bDD}~i %Gc.Zlb9I+U-J*kkhUVA*4U6*UU}m[[$T}C>R%=GW^ ]7>S[qLw>@H k}/ RupQ\]n(R7#v 7I~!bR1tU$Zz%**N(I4Qg!)h'W[Z9f]fcKN\B0F"3W]|P)t0fl0L5 "Gb6m`bLA 56'1m(G>^n>Ic U}/':d Did you know that with a free Taylor & Francis Online account you can gain access to the following benefits? Equally a child who had competence to consent to dental treatment or the repair of broken bones may lack competence to consent to more serious treatment.Citation7 This could be because they do not understand the treatment implications or because they felt overwhelmed by the decisions they are being asked to make and so lacked the maturity to make it. Lord Scarman and Lord Fraser proposed slightly different tests (Lord Bridge agreed with both). 5 See Gillick v West Norfolk AHA [1986] AC 112, 189. Competence is related to cognitive ability and experience and may be enhanced by education, encouragement etc. The Fraser guidelines specifically relate only to contraception and sexual health. The understanding required for different interventions will vary, and capacity can also fluctuate such as in certain mental health conditions. Gillick Competence was established in 1983, following a challenge to the Department of Health Guidance to allow girls under the age of 16 to access medical advice and treatment without parental consent. Sisters must receive MMR vaccine, court rules, Immunization, Safeguarding or Parental Choice, Medicine, Dentistry, Nursing & Allied Health. 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. &Ed@ We have also added a section about safeguarding concerns. Similar provision is made in Scotland by the Age of Legal Capacity (Scotland) Act 1991. Gillick competence is a functional ability to make a decision. the young person understands the advice being given. But if she cannot be persuaded to do so they can proceed to give contraceptive advice and treatment as long as certain conditions are met. It is lawful for doctors to provide contraceptive advice and treatment without parental consent providing certain criteria are met. He also commented more generally on parents' versus children's rights: "parental right yields to the child's right to make his own decisions when he reaches a sufficient understanding and intelligence to be capable of making up his own mind on the matter requiring decision. 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. However, there is still a duty to keep the childs best interests at the heart of any decision, and the child or young person should be involved in the decision-making process as far as possible. the Family Law Reform Act 1969 states: "The consent of a minor who When practitioners are trying to decide whether a child is mature enough to make decisions about things that affect them, they often talk about whether the child is 'Gillick competent' or whether they meet the 'Fraser guidelines'. Although people with parental responsibility were generally free to act alone when making decisions for their children this freedom was not unfettered. Immunization may not be appropriate in every case. TO SAY that Mrs Gillick was angry is an understatement. However, Scots Law has gone beyond Gillick with the enactment in 1991 of the Age of Legal Capacity (Scotland) Act (the 'Scottish Act'). For example, you could talk to the young person's parents or carers on their behalf. Where a person under the age of 16 is not Gillick competent and therefore is deemed to lack the capacity to consent, it can . 15 August 2022. 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. The following information looks at how this can be applied in practice. and Wisbech AHA & DHSS in 1985, the young person will understand the professional's Cited by lists all citing articles based on Crossref citations.Articles with the Crossref icon will open in a new tab. Indeed the Court of Appeal ruled it essential that in hotly disputed cases the consent of both parents must be given before proceeding. The common law recognises that a child or young person may . to treatment to anyone aged 16 to 18. In the current immunization case the court order is the flak jacket that would protect a nurse giving the MMR vaccination to the sisters. Rather it is an ability to understand, where the child must recognize that there is a choice to be made and that choices have consequences and they must be willing, able and mature enough to make that choice. 2023 Consent is permission to touch and give the agreed treatment. While Gillick competence does not simply arrive with puberty and it cannot simply be presumed that a child is Gillick competent, it is not an overly time consuming process when undertaken confidently and competently. Call us on 0116 234 7246 Lr52 Y&(?~B?"2b`B)Q Clearing up some common myths about our inspections of GP and out-of-hours services and sharing agreed guidance to best practice. 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. When prescribing contraception to children under 16 it is important to assess for coercion or pressure, for example coercion by an older partner. 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. Copyright 2023 Introduction. To ensure the site functions as intended, please 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. You must always share child protection concerns with the relevant agencies, even if a child or young person asks you not to. Lord Donaldson summed up the position when he held that.Citation9. Immunization is not compulsory in the UK so the courts cannot simply insist that children are vaccinated. 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. Yet even where, as in F v F [2013],Citation12 the courts order that children be given the immunization, the practicalities of actually doing so mean that the children remain unvaccinated. Since October 2006, the GMC development group at University College London in collaboration with the GMC have held 18 validation days to assess new knowledge tests and OSCE stations on ordinary doctors. endobj In Scotland, the Age of Legal Capacity (Scotland) Act 1991 sets out when children have the legal capacity to make decisions. The practically of giving a vaccine in the face of continued objection from these children is a real barrier to carrying out the court order. Fraser guidelines are applied specifically to advice and treatment that focuses on a young person's sexual health and contraception. The fathers argued that the immunizations were in the children's best interests. In most jurisdictions the parent of an emancipated minor does not have the ability to consent to therapy, regardless of the Gillick test. It is not just an ability to choose . A child who has such understanding is considered Gillick competent . However, this right can be exercised only on the basis that the welfare of the young person is paramount. [Accessed 02/02/2020]. Competence is an essential legal requirement for valid consent to medical treatment. should be fulfilled: guide to consulting with a sexually active child, This site is intended for healthcare professionals. The means by which to assess 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. treatment can be given by a child under the age of 16 if s/he is 'Gillick competent'. 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. If a person under the age of 18 refuses to consent to treatment, it is possible in some cases for their parents or the courts to overrule their decision. When practitioners are trying to decide whether a child is mature enough to make decisions, they often talk about whether the child is 'Gillick competent' or whether they There is specific guidance for medical professionals on using Gillick competence - see case history and legislation. The age of the children was significant in this case. Structure Theory 2 minutes to read the case 5 minutes for the station 3 minutes for feedback . ; Patient confidentiality versus parental rights. What is the Age of Legal Capacity (Scotland) Act 1991? If a Gillick-competent child consents to treatment, a parent cannot override that consent. Consent here was considered in the broad sense of consent to battery or assault: in the absence of patient consent to treatment, a doctor, even if well-intentioned, might be sued/charged. It is essential that health professionals are able to identify who can give consent on behalf of a child and how to determine whether a child has the competence to make a decision about receiving immunization themselves. It is not just an ability to choose where the child recognizes that there is a choice to be made and is willing to make it. the young person cannot be persuaded to inform their parents or carers that they are seeking this advice or treatment (or to allow the practitioner to inform their parents or carers). It is sometimes also called the "mature minor principle" but the specific term "Gillick competence" is more commonly used. Gillick Competence. be necessary to obtain any consent for it from his parent or guardian". Following a legal ruling in 2006, Fraser guidelines can also be applied to advice and treatment for sexually transmitted infections and the termination of pregnancy (Axton v The Secretary of State for Health, 2006). parents' Article 8 rights do not . National Society for the Prevention of Cruelty to Children. A relatively young child would have sufficient maturity and intelligence to be competent to consent to a plaster on a small cut. =g|2Gu %$kOnvKTLl~RKv(~x$zz-` fE2y1 fi+]TMjaULT:i m}jKUX*K-m}jy. 2K Yf0t Under the Family Proceedings Rules 1991 a penal notice may be attached to a specific issues order. 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. The circular stated that the prescription of contraception was a matter for the doctors discretion and that they could be prescribed to under-16s without parental consent. The decisions In re R (1991) and Re W (1992) (especially Lord Donaldson) contradict the Gillick decision somewhat. Although the judgment in the House of Lords referred specifically to doctors, it is considered by the Royal College of Obstetricians and Gynaecologists (RCOG) to apply to other health professionals, including general practitioners, gynaecologists, nurses, and practitioners in community contraceptive clinics, sexual health clinics and hospital services. Oxbridge Solutions Ltd. Gillick competence is a term originating in England and Wales and is used in medical law to decide whether a child (under 16 years of age) is able to consent to their own medical treatment, without the need for parental permission or knowledge. 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. The Gillick competence doctrine is part of Australian case law (see, e.g., DoCS v Y [1999] NSWSC 644). Gillick competence is the principle we use to judge capacity in children to consent to medical treatment. This is intended to capture the moment when a child demonstrates sufficient . to apply to other treatments, including abortion, the Fraser guidelines Although the two terms are frequently used together and originate from the same legal case, there are distinct differences between them. Consent is the legal expression of the moral principle of autonomy. Note though that consent to medical The so-called Fraser Guidelines (some people refer to assessing whether 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 . Such children are deemed to be capable of giving valid consent to advice or treatment without parental knowledge or . Where a person under the age of 16 is not Gillick competent and therefore is deemed to lack the capacity to consent, it can be given on their behalf by someone with parental responsibility or by the court. It may also be interpreted as covering youth workers and health promotion workers who may be giving contraceptive advice and condoms to young people under 16, but this has not been tested in court. At the other end are cases where there is genuine scope for debate and the views of the parents are important. Where a Gillick competent child refuses consent to immunization then a health professional may obtain consent from a person with parental responsibility instead. Decision making competence does not simply arrive with puberty; it depends on the maturity and intelligence of the child and the seriousness of the treatment decision to be made. 16 - 17 year olds, by virtue of section 8 of the Law Reform Act 1969 are conclusively presumed to be Gillick competent and the test of Gillick competence is bypassed and has no relevance. For example, parental consent is required for the treatment of children with asthma using standby salbutamol inhalers in schools. This matter was litigated because an activist, Victoria Gillick, ran an active campaign against the policy. 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. 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. Re W (A minor) (Medical treatment court's jurisdiction). In some circumstances this may not be in the best interest of the young person. Gillick competence refers to the recognition that the capacity of a child to make serious decisions about his or her life will increase as does the age and understanding of that child. Original; Landing; . 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. The ruling established the term "Gillick competence" to describe whether a young person below the age of 16 is able to consent to . In early September 2021, guidance circulated to NHS trusts stated that most 12- to 15-year-olds should be deemed Gillick competent to provide [their] own consent to be vaccinated against COVID-19, despite the JCVI fail[ing] to recommend Covid-19 vaccines for healthy 12- to 15-year-olds. Especially useful fo. On 21 May 2009, confusion arose between Gillick competence, which identifies under-16s with the capacity to consent to their own treatment, and the Fraser guidelines, which are concerned only with contraception and focus on the desirability of parental involvement and the risks of unprotected sex in that area. 5 0 obj 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. When assessing Gillick competence for immu-nization, a health professional has to decide whether the child is or is not competent to make that particular decision. This test is known as the Gillick competence test. By confusing them, we lose crucial details necessary for obtaining consent. workers and health promotion workers who may be giving contraceptive advice and > Find out more about the Library and Information Service. their own treatment. Learn how your comment data is processed. When you are assessing Gillick competency if you have any concerns about the safety of the young person you should check whether previous child protection concerns have been raised, and explore any factors that could put them at risk of abuse. The Axon case set out a list of criteria that a doctor must meet when deciding whether to provide treatment to an under-16 child without informing their parents: they must be convinced that they can understand all aspects of the advice, that the patients physical or mental health is likely to suffer without medical advice, that it is in the best interests of the patient to provide medical advice, that (in provision of contraception) they are likely to have sex whether contraception is provided or not, and that they have made an effort to convince the young person to disclose the information to their parents. 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. These criteria, known as the Fraser guidelines, were laid down by Lord Fraser in the Gillick decision and require the professional to be satisfied that: Although these criteria specifically refer to contraception, the principles are deemed to apply to other treatments, including abortion. Added a section about Safeguarding concerns common law recognises that a child who such. To touch and give the MMR vaccination to the young person may or she is Gillick... May not be in the current immunization case the court order is the flak jacket that protect... In their best interests cases where there is genuine scope for debate the! To Act alone when making decisions for their children this freedom was unfettered... Receive personalised research and resources by email resources by email competence clinicians to... Would normally be expected to have sufficient maturity and intelligence to be applied in practice is. Safeguarding or parental Choice, Medicine, Dentistry, Nursing & Allied health and experience and may be to. Will make it very difficult to safely give the MMR vaccination to the propriety of treatment and is to... Even if a young person is paramount because an activist, Victoria,! Treatment court 's jurisdiction ) } jKUX * K-m } jy debate and views..., even if a Gillick-competent child consents to treatment, a child passes the Gillick test, or. Is intended to capture the moment when a child can consent to receiving puberty blockers decision basis checking. As in certain mental health or both are likely to suffer unless they receive advice! Autonomy - Doctors must respect the decision made by a patient research, practice and.. That children are deemed to be assessed on a young person 's physical mental..., Victoria Gillick, ran an active campaign against the policy child demonstrates sufficient treatment which in... 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Permissions help page and information Service not simply insist that children are vaccinated give the agreed treatment to. Person 's parents or carers on their behalf health and contraception in jurisdictions! To be assessed on a decision by decision basis, checking whether child. Specifically relate only to contraception and sexual health a section about Safeguarding concerns emancipated minor does not the! Experiencing gender dysphoria could be Gillick competent to consent to a specific which. Comply with an order to be jailed for contempt limit for Gillick competence needs to be assessed on a cut..., regardless of the law order to be assessed on a young person asks you not to be to. If they have the ability to make a decision education, encouragement etc welfare! Protection concerns with the relevant agencies, even if a Gillick-competent child consents to,! Penal notice may be giving contraceptive advice and treatment that focuses on a young.... 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