This includes making sure its in the girl's best interests for advice to be given and that she understands the advice. which, in the absence of consent, would constitute a trespass to his person, should Brief guide: capacity and competence to consent in under 18s (PDF). 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. Help for adults concerned about a child 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. The advice or treatment is in the young persons best interests. The issue before the House of Lords was only whether the minor involved could give consent. In some circumstances this may not be in the best interest of the young person. 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. 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. National Society for the Prevention of Cruelty to Children. ", > Find out more about assessing Gillick competency. Oxbridge Solutions Ltd. This matter was litigated because an activist, Victoria Gillick, ran an active campaign against the policy. 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. 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. A good practice guide on consent for health professionals in NHS Scotland (PDF). 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 courts do not adopt an unquestioning recommendation of immunization but give careful consideration to each case on its facts. Using the Skills of Mental Health First Aid, Some Important Facts about Mental Health Problems, Some Common Myths about Mental Health Problems, Causes of Anxiety & Stress-Related Disorders, Causes of Obsessive-Compulsion and Related Disorders, Causes of Schizophrenia and Related Disorders, Causes of Somatic Symptom and Related Disorders, Causes of Suicidal Behaviour and Self-Injury, Symptoms of Generalised Anxiety Disorder (GAD), Symptoms of Panic Attacks & Panic Disorder, Symptoms of Post-Traumatic Stress Disorder (PTSD), Symptoms of Depersonalisation/Derealisation Disorder, Symptoms of Dissociative Identity Disorder, Symptoms of Avoidant/Restrictive Food Intake Disorder, Symptoms of Body-Focused Repetitive Behavioural Disorder, Symptoms of Hair-Pulling Disorder (Trichotillomania), Symptoms of Obsessive-Compulsive Disorder (OCD), Symptoms of Skin Picking Disorder (Excoriation), Symptoms of Antisocial Personality Disorder, Symptoms of Avoidant Personality Disorder, Symptoms of Borderline Personality Disorder, Symptoms of Dependent Personality Disorder, Symptoms of Histrionic Personality Disorder, Symptoms of Narcissistic Personality Disorder, Symptoms of Obsessive-Compulsive Personality Disorder, Symptoms of Paranoid Personality Disorder, Symptoms of Schizoid Personality Disorder, Symptoms of Schizotypal Personality Disorder, Symptoms of Gender Dysphoria & Transsexualism, Symptoms of Factitious Disorder Imposed on Self, Outline of Personality & Behaviour Changes, Causes of Personality & Behaviour Changes, Evaluation of Personality & Behaviour Changes, Treatment of Personality & Behaviour Changes, Overview of Trauma- & Stress-Related Disorders, Generalised Anxiety Disorder (GAD) in Children, Post-Traumatic Stress Disorder (PTSD) in Children & Adolescents, Derpersonalisation/Derealisation Disorder, Avoidant/Restrictive Food Intake Disorder, Obsessive-Compulsive and Related Disorders, Body-Focused Repetitive Behavioural Disorder, Obsessive-Compulsive Personality Disorder (OCPD), Psychotic Disorder Due to Another Medical Condition, Substance/Medication-Induced Psychotic Disorders, Psychological Factors Affecting Other Medical Conditions, Medical Professionals Aid in Dying (aka Assisted Suicide), Suicidal Behaviour in Children and Adolescents, Diagnostic & Statistical Manual of Mental Disorders (DSM), International Classification of Diseases (ICD), Chinese Classification of Mental Disorders, Diagnosis of Generalised Anxiety Disorder (GAD), Diagnosis of Panic Attacks & Panic Disorder, Diagnosis of Post-Traumatic Stress Disorder (PTSD), Diagnosis of Depersonalisation/Derealisation Disorder, Diagnosis of Dissociative Identity Disorder, Diagnosis of Avoidant/Restrictive Food Intake Disorder, Diagnosis of Body Dysmorphic Disorder (BDD), Diagnosis of Body-Focusesd Repetitive Behavioural Disorder, Diagnosis of Hair-Pulling Disorder (Trichotillomania), Diagnosis of Obsessive-Compulsive Disorder (OCD), Diagnosis of Skin-Picking Disorder (Excoriation), Diagnosis of Antisocial Personality Disorder, Diagnosis of Avoidant Personality Disorder, Diagnosis of Borderline Personality Disorder, Diagnosis of Dependent Personality Disorder, Diagnosis of Histrionic Personality Disorder, Diagnosis of Narcissistic Personality Disorder, Diagnosis of Obsessive-Compulsive Personality Disorder, Diagnosis of Paranoid Personality Disorder, Diagnosis of Schizoid Personality Disorder, Diagnosis of Schizotypal Personality Disorder, Diagnosis of Gender Dysphoria & Transsexualism, Diagnosis of Factitious Disorder Imposed on Self, Mental Health First Aid (Higher Education), FAA Level 1 Award in Awareness of First Aid For Mental Health, FAA Level 2 Award in First Aid For Mental Health, FAA Level 3 Award in Supervising/Leading First Aid For Mental Health, First Aid For Mental Health Instructor Training, Applied Suicide Intervention Skills Training (ASIST), More Questions Than Answers (MQTA) Training, Professional Development Award (PDA) Mental Health Peer Support, COSCA Further Steps in Counselling Skills, COSCA Counselling Supervision Certificate & Skills Course, Mental Health Awareness for Sport & Physical Activity, Level 2 Certificate in Awareness of Mental Health Problems, Level 3 Certificate in Understanding Mental Health, Mental Health & Related Organisations in Scotland, Age of Legal Capacity (Scotland) Act 1991, What is the Age of Legal Capacity (Scotland) Act 1991? '2P@LH(21qTV5-.A \RT,2P|Hd 41 Fe2 Im^Xd@R/ 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'. The judge concluded that immunization would be in the best interests of the welfare of each child. That said, it would rarely be appropriate or safe for a child less than 13 years of age to consent to treatment without a parents involvement. their own treatment. they are 'Gillick competent' The fathers argued that the immunizations were in the children's best interests. 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. He required that a child could consent if he or she fully understood the medical treatment that is proposed: As a matter of law the parental right to determine whether or not their minor child below the age of sixteen will have medical treatment terminates if and when the child achieves sufficient understanding and intelligence to understand fully what is proposed. 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. 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. 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. 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. Bell v Tavistock and Portman is a recent high-profile case on the lawfulness of prescribing puberty-suppressing drugs to children experiencing gender dysphoria. The understanding required for different interventions will vary, and capacity can also fluctuate such as in certain mental health conditions. 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. A relatively young child would have sufficient maturity and intelligence to be competent to consent to a plaster on a small cut. It was determined that children under 16 can consent if they have sufficient understanding and intelligence to fully understand what is involved in a proposed treatment, including its purpose, nature, likely effects and risks, chances of success and the availability of other options. The courts have so far declined invitations to define rigidly Gillick competence and the individual doctor is free to make a decision, consulting peers if this may be helpful, as to whether that child is Gillick competent. For more information, please visit our Permissions help page. 2K Yf0t 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. The age at which a person becomes an 'adult' in Australia is 18. 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. 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. 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. By closing this message, you are consenting to our use of cookies. However, there are circumstances in which patients under the age of 18 can consent to their own medical treatment. Any other browser may experience partial or no support. -'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 However the case law in this area primarily concerns refusal of treatment. Lord Scarman and Lord Fraser proposed slightly different tests (Lord Bridge agreed with both). 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. Gillick competence is used to assess a child's capability to make and understand their decisions in a wider context. Adolescents less than 18 years old may be considered 'mature minors', capable of giving informed consent. How do I view content? However to treatment to anyone aged 16 to 18. Consent guides for healthcare professionals. Gillick Competency 'Gillick competence' is a term originating in England and is used in medical law to decide whether a young person (under 16 years of age) is able to consent to his or her own medical treatment, without the need for parental permission or knowledge. 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. Gillicks case involved a health departmental circular advising doctors on the contraception of minors (for this purpose, under 16s). The English Gillick case held that . 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. 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. has attained the age of sixteen years to any surgical, medical or dental treatment Department of Health (2003). =g|2Gu %$kOnvKTLl~RKv(~x$zz-` fE2y1 fi+]TMjaULT:i m}jKUX*K-m}jy. In 1985, Mrs Gillick brought her concerns regarding guidance on contraceptive advice and treatment for girls under the age of 16 to the courts. 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. Introduction. 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. Gillick Competence. or without contraceptive treatment, unless the young person receives contraceptive The Fraser guidelines still apply to advice and treatment relating to contraception and sexual health. This was clarified Mental Health Matters, What is Informed Consent? 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. They may be used by a range of healthcare professionals working with under 16-year-olds, including doctors and nurse practitioners. 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. 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. This form provides a structured method for obtaining evidence of the patient's capacity to They are named after one of the Lords responsible for the Gillick judgement but who went on to address the specific issue of giving contraceptive advice and treatment to those under 16 without parental consent. 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. 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) Failure to obtain such consent will make it much more difficult to administer the treatment.Citation9. Call us on 0116 234 7246 If a child or young person needs confidential help and advice direct them to Childline. As cited in Childrens Legal Centre (1985) Landmark decision for childrens rights. If a Gillick-competent child consents to treatment, a parent cannot override that consent. This might . 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. Children under 16 may be considered 'Gillick competent' to make treatment decisions, but may need to demonstrate this. More information about this is available in the guidance for medical professionals in each UK nation - see case history and legislation. ; there . Gillick v West Norfolk and Wisbech Area Health Authority and Department of Health and Social Security [1984] Q.B. In Queensland, a child can consent to a vaccination if they have the capacity to give or withhold consent. Call Childline on 0800 1111, Weston House, 42 Curtain Road, London, EC2A 3NH. stream {1XeJ v'cjt]aVfD9q$|rd[gNTM-P(Y"RUUbl{ U>CA%q\6h4; Assessment of Gillick competence requires an examination of how the child deals with the process of making a decision based on an analysis of the child's ability to understand and assess risks. advice to a child; and Gillick competence refers to the ability of the child to give consent and is used more broadly. Please note: Selecting permissions does not provide access to the full text of the article, please see our help page However, unlike adults, their refusal of treatment can in some circumstances be overridden by a parent, someone with parental responsibility or a court. Fraser guidelines, on the other hand, are used specifically to decide if a child can consent to contraceptive or sexual health advice and treatment. To date no court has found a child in need of life sustaining treatment competent to refuse that treatment.Citation8. 3099067 Although the original question was around the use of contraception, the ruling covers a child's own medical treatment without their parents . The degree of maturity and intelligence needed depends on the gravity of the decision. The right of younger children to provide independent consent is proportionate to their competence - a child's age alone is clearly an unreliable predictor of his or her competence to make decisions. 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. 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. Date: 27 February 2018. 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. Abstract. they are Gillick competent, Fraser guidelines for prescription of contraceptives. endobj The Gillick competence doctrine is part of Australian case law (see, e.g., DoCS v Y [1999] NSWSC 644). Parents cannot override a competent child's refusal to accept treatment. 2 0 obj You must always share child protection concerns with the relevant agencies, even if a child or young person asks you not to. 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. We have updated and republished this mythbuster to provide even greater clarity about the difference between these two terms. Unlike public law concerning child protection procedures, the threshold criteria for state intervention, namely a risk of significant harm, does not have to be met in private law cases and the court may settle any matter as long as it has to do with the parental responsibility of a child. For example, you could talk to the young person's parents or carers on their behalf. ; Patient confidentiality versus parental rights. 581. 4 0 obj In Northern Ireland the Department of Health provides consent guides for healthcare professionals (Department of Health, 2003). In this context, welfare does not simply mean their physical health. It is sometimes also called the "mature minor principle" but the specific term "Gillick competence" is more commonly used. these criteria specifically refer to contraception, the principles are deemed The aim of Gillick competence is to reflect the transition of a child to adulthood. This article considers the requirements for Gillick competence, it highlights the factors that must be considered when determining whether a child is competent to give consent to treatment. By confusing them, we lose crucial details necessary for obtaining consent. For example, parental consent is required for the treatment of children with asthma using standby salbutamol inhalers in schools. It changes depending on the nature of the medical decision, e.g. This is because we have an overriding duty to act in the best interests of a child. This website is owned and operated by the Boot Camp & Military Fitness Institute. 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. 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. Childright, 22: 11-18. 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. Lr52 Y&(?~B?"2b`B)Q 08/12/20. workers and health promotion workers who may be giving contraceptive advice and A different level of competence would be needed for having a small cut dressed compared . Gillick competence is a functional ability to make a decision. the young person understands the advice being given. However the Family Law Reform Act 1969 states: "The consent of a minor who has attained the age of sixteen years to any surgical, medical or dental treatment which, in the absence of consent, would constitute a trespass to his person, should be as effective as it would be if he were of full age; and . It is a high test of competence that is more difficult to satisfy the more complex the treatment and its outcomes become. What to do if the patient is in an abusive relationship. It is task specific so more complex procedures require greater levels of competence. 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. Where a Gillick competent child refuses consent to immunization then a health professional may obtain consent from a person with parental responsibility instead. , e.g, and capacity can also fluctuate such as in certain mental Health Matters, is... Complex procedures require greater levels of competence or withhold consent of healthcare professionals working under! To date no court has found a child or young person of can. Patient is in the best interests for advice to a plaster on a small cut an relationship. This website is owned and operated by the Boot Camp & Military Fitness Institute an active campaign against policy. 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