>> Gillick competence needs to be assessed on a decision by decision basis, checking whether the child understands the implications of the treatment. It is task specific so more complex procedures require greater levels of competence. There is no lower age limit for Gillick competence or Fraser guidelines to be applied. Competence is related to cognitive ability and experience and may be enhanced by education, encouragement etc. He held that there are a small group of decisions to be made about a child that require the agreement of both parents; these include changing a child's surname, sterilisation and circumcision. When assessing Gillick competence for immunization, 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. This form provides a structured method for obtaining evidence of the patient's capacity to 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). However, unlike adults, treatment refusal can be overridden in some circumstances (by person with parental responsibility or court). 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. The House of Lords concluded that advice can be given in this situation as long as: Health professionals should still encourage the young person to inform his or her parent(s) or get permission to do so on their behalf, but if this permission is not given they can still give the child advice and treatment. 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. However, as with adults, this consent is only valid if given voluntarily and not under undue influence or pressure by anyone else. 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 it is important to assess for coercion or pressure, for example coercion by an older partner. %PDF-1.3 Calls to 0800 1111 are free and children can also contact Childline online or read about childrens rights on the Childline website. Care Quality Commission (2019). Both fathers were in contact with their daughters and had parental responsibility through court orders. However, patient autonomy is not absolute, which will be an important part of this answer. Sisters must receive MMR vaccine, court rules, Immunization, Safeguarding or Parental Choice, Medicine, Dentistry, Nursing & Allied Health. To ensure the site functions as intended, please In fact, the court held that parental rights did not exist, other than to safeguard the best interests of a minor. The Gillick Competency Principle is in effect in Australia since 1992 and deals with parental guidance and information with respect to minors' use of contraceptives and decisions with respect to abortion and pregnancy. Gillick competency applies mainly to medical advice but it is also used by practitioners in other settings. parents' Article 8 rights do not . If a child or young person needs confidential help and advice direct them to Childline. What is Gillick competence? Professionals need to consider several things when assessing a child's capacity to consent, including: Remember that consent is not valid if a young person is being pressured or influenced by someone else. 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. A short film about the story behind Gillick Competence and Fraser Criteria. If a young person under the age of 16 presents to a health care professional, then discloses a history raising safeguarding concerns: It is reasonable for the local authority or police to decide whether it is appropriate to inform the parents of the concerns raised. Scottish Executive Health Department (2006). 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. Consent is permission to touch and give the agreed treatment. Gillick v West Norfolk & Wisbech Area Health Authority, UKHL 7 (17 October 1985) Available via (BAILII) in The law reports (appeal cases) [1986] AC 112. Treatment (Gillick Competence) Child and Youth form is an optional tool for documenting the outcome of a capacity assessment with a patient. The child of tender years who rely on a person with parental responsibility to consent to treatment. 43R@ ~? 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 . true /ColorSpace 8 0 R /SMask 13 0 R /BitsPerComponent 8 /Filter /FlateDecode 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. Re L (Medical Treatment: Gillick Competence). Later she had a total of 10 children. Underage sexual activity is a possible indicator of. Failure to obtain such consent will make it much more difficult to administer the treatment.Citation9. Therefore, competence is a major aspect to consider in this ethical scenario. Fraser was one of the five judges of in the UK House of Lords . 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. Oxbridge Solutions Ltd receives funding from advertising but maintains editorial 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. their own treatment. You should always encourage a child to tell their parents or carers about the decisions they are making. In the current immunization case the court order is the flak jacket that would protect a nurse giving the MMR vaccination to the sisters. Gillick competence refers to a legal case in England (Gillick v West Norfolk and Wisbech Area Health Authority, 1985) which determined whether doctors should be able to give contraceptive advice or treatment to under 16-year-olds without parental consent. 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. `ve-ej;U 73)_Qp6wS\Q3m&CTOg"!T LtPOh be necessary to obtain any consent for it from his parent or guardian". A good practice guide on consent for health professionals in NHS Scotland (PDF). Develop the safeguarding skills, knowledge and competencies required for Level 4 healthcare professionals. There is no set of defined questions to assess Gillick competency. 08/12/20. Since Parliamentary legislation is superior to common law, it is the terms of Alteration of an established legal test would be unusual, and cause confusion and following correspondence with Victoria Gillick, Wheeler is clear that she has never suggested to anyone, publicly or privately, that [she] disliked being associated with the term Gillick competent.Citation6. Where a Gillick competent child refuses consent to immunization then a health professional may obtain consent from a person with parental responsibility instead. practitioner should be consulted for diagnosis and treatment of any and all medical conditions. People also read lists articles that other readers of this article have read. 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. In general, in English Law a minor is a person less than 18 years old. 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. ; Patient confidentiality versus parental rights. Gillick v West Norfolk and Wisbech Area Health Authority went to the House of Lords and is often used as a legal precedent across the UK. These restrictions have yet to be tested in court. This mythbuster clarifies the principles, laws and guidelines used when we assess childrens ability to make decisions about their treatment, as well as the differences between Gillick competence and Fraser guidelines. 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. Lord Scarman and Lord Fraser proposed slightly different tests (Lord Bridge agreed with both). 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. Otherwise, someone with parental responsibility can consent for them. Brief guide: capacity and competence to consent in under 18s (PDF). If they don't want to do this, you should explore why and, if appropriate, discuss ways you could help them inform their parents or carers. xVrT9+=Uq,?d{TMxR) SX>; ]c}!G:wRkB):Nns+t:jvwd%f! Where a health professional accepts the consent of a Gillick competent child it cannot be overruled by the child's parent. What to do if the patient is in an abusive relationship. However, if a young person refuses treatment which may lead to their death or severe permanent harm, their decision can be overruled. Due to the unique specifics of that treatment, the High Court concluded that in such cases the answer will almost always be no, a priori. It is probably the case that for a person between 16 and 18 years old consent 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. 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. 11 0 obj This provides private law remedies to settle matters of parental responsibility concerning a child. A minor is considered to be competent to consent to treatment when the person 'achieves a sufficient understanding and intelligence to enable him or her to understand fully what is proposed'. Gillick competence is concerned with determining a childs capacity to consent. We have updated and republished this mythbuster to provide even greater clarity about the difference between these two terms. 3099067 and judgement to enable them fully to understand what is proposed. However, the parens patriae jurisdiction of the court remains available allowing a court order to force treatment against a childs (and parents) wishes. This might . For safeguarding training, resources and consultancy 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. 2(1) and 3(1) Mental Capacity Act 2005. 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