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. the young person is Gillick competent) state that all the following requirements 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). may be obtained either from the parent or from the person themselves. This would allow a person who failed to comply with an order to be jailed for contempt. 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. 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Care Quality Commission (2019). However, where the same child refuses consent then they may obtain it from another person with parental responsibility who can consent to treatment on the child's behalf. If a child or young person needs confidential help and advice direct them to Childline. Last reviewed 01/2018. Any distribution or duplication of the information contained herein is 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 . to treatment to anyone aged 16 to 18. Fraser guidelines, on the other hand, are used specifically to decide if a child can consent to contraceptive or sexual health advice and treatment. The same child may be considered Gillick competent to make one decision but not competent to make a different decision. A doctor can prescribe contraception to children under 16 years old if: NB: bear in mind the age of the partner and risk of sexual abuse. 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. stream parents' Article 8 rights do not . Alternatively the court could direct enforcement by arranging for the removal of the child by an officer of the court for the forcible administration of the immunization. 947 TO SAY that Mrs Gillick was angry is an understatement. 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 . The Geeky Medics bank of 700+ OSCE stations provides everything you need to practise your clinical skills and prepare for your OSCEs. The United Nations Convention on Children's Rights (UNCRC; 1989) defines a child as any person under 18; however, by convention British courts refer to all persons under 18 as minors, those under 16 as children and 16 and 17 y olds as young persons.Citation2 The UNCRC requires that childhood is recognized as a developmental period and that our domestic laws must be developed in a manner consistent with the evolving capacities of the child (United Nations 1989, Article 5).Citation2 As children grow and develop in maturity, their views and wishes must be given greater weight and their development toward adulthood must be respected and promoted. This is because we have an overriding duty to act in the best interests of a child. Introduction. 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. > Find out more about using the Fraser guidelines, Lord Scarman's comments in his judgment of the Gillick case in the House of Lords (Gillick v West Norfolk, 1985) are often referred to as the test of "Gillick competency". > Find out more about recognising and responding to abuse. 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. In Scotland the NHS has provided a good practice guide on consent for health professionals (PDF) (Scottish Executive Health Department, 2006). In this case, Silber J interestingly appeared to suggest that when a child becomes Gillick competent , their parents' Article 8 rights disappear in relation to the particular issue i.e. This is known as an assessment of 'Gillick competency'. It is task specific so more complex procedures require greater levels of competence. 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. The subsequent 1983 judgement set out criteria for establishing whether a child under 16 has the capacity to provide consent . 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 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. Competence is an essential legal requirement for valid consent to medical treatment. Be careful that you don't mix up these two terms. 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. Allan Gaw recounts the famous Gillick case and events leading up to a landmark decision on medical consent in children. Any other browser may experience partial or no support. Oxbridge Solutions Ltd. It is argued that Gillick competence is an unnecessary burden with an unethical foundation. Browser Support Hum Vaccin Immunother. A short film about the story behind Gillick Competence and Fraser Criteria. People also read lists articles that other readers of this article have read. Additionally, a child may have the capacity to consent to some treatments but not others. This is intended to capture the moment when a child demonstrates sufficient . A child who has such understanding is considered Gillick competent . Copyright or without contraceptive treatment, unless the young person receives contraceptive The aim of Gillick competence is to reflect the transition of a child to adulthood. We use cookies to improve your website experience. Re W (A minor) (Medical treatment court's jurisdiction). Health professionals who behave in this way would be failing to discharge their professional responsibilities and could expect to be disciplined by their professional body.Citation5 Where a child is considered Gillick competent then the consent is as effective as that of an adult and cannot be overruled by a parent. Sexual activity with a child under 13 should always result in a child protection referral. Did you know that with a free Taylor & Francis Online account you can gain access to the following benefits? Call Childline on 0800 1111, Weston House, 42 Curtain Road, London, EC2A 3NH. A refusal by 16 - 17 year olds is also not determinative and can be overridden by the court. 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. The fathers argued that the immunizations were in the children's best interests. z#&,!Eh?_X Q*%20/Ud` !s4@KXA!20W.E-2eR5re@1cCk2W ~G The Fraser guidelines still apply to advice and treatment relating to contraception and sexual health. 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 risks, intended benefits and outcomes of the proposed immunization and alternatives to immunization, including the option of not having or delaying the immunization. This idea of Gillick competence was further supported by R (on the application of Axon) v Secretary of State for Health. The judge concluded that immunization would be in the best interests of the welfare of each child. This is known as being Gillick competent. 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. 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. 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. If the conditions are not all met, however, or there is reason to believe that the child is under pressure to give consent or is being exploited, there would be grounds to break confidentiality. 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. << /Length 12 0 R /Type /XObject /Subtype /Image /Width 400 /Height 401 /Interpolate BMJ, Gillick v West Norfolk & Wisbech AHA & DHSS [1983] 3 WLR (QBD), Axon, R (on the application of) v Secretary of State for Health [2006] EWHC 37 (Admin), He/she has sufficient maturity and intelligence to understand the nature and implications of the proposed treatment, He/she cannot be persuaded to tell her parents or to allow the doctor to tell them, He/she is very likely to begin or continue having sexual intercourse with or without contraceptive treatment, His/her physical or mental health is likely to suffer unless he/she received the advice or treatment. 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. Gillick Competence is a legal state where a person under 16 years old is considered to have "the degree of maturity and intelligence needed" to consent to a treatment2. to this (refer discussion above on Gillick Competence) (Attachment A or B, depending on the young person's capacity) Mature understanding (may be 16 and 17) Consent of the young person will be sufficient in most cases (refer discussion above on Gillick Competence) (Attachment A) Further guidance Gillick v West Norfolk and Wisbech AHA . [Accessed 02/02/2020]. 5 See Gillick v West Norfolk AHA [1986] AC 112, 189. Lord Fraser stated that a doctor should always encourage a girl aged under 16 to inform her parents or carers that she is seeking contraceptive advice (or allow the doctor to inform the parents or carers on her behalf). As cited in Childrens Legal Centre (1985) Landmark decision for childrens rights. Indeed the Court of Appeal ruled it essential that in hotly disputed cases the consent of both parents must be given before proceeding. The understanding required for different interventions will vary, and capacity can also fluctuate such as in certain mental health conditions. It may also be interpreted as covering youth [Consent] protects the [health professional] from claims by the litigious whether they acquire it from their patient, who may be a minor over the age of 16 or a Gillick competent child under that age, or from another person having parental responsibilities which include a right to consent to treatment of the minor. 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