5 See Gillick v West Norfolk AHA [1986] AC 112, 189. This matter was litigated because an activist, Victoria Gillick, ran an active campaign against the policy. may be obtained either from the parent or from the person themselves. 11 0 obj More information about this is available in the guidance for medical professionals in each UK nation - see case history and legislation. There is no set of defined questions to assess Gillick competency. 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. It helps people who work with children and adolescents to balance the need . 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. There is no express authority in Australia on In re R and Re W, so whether a parents right terminates is unclear. 1 We adopt the familiar medico-legal language of the 'mature minor'. These restrictions have yet to be tested in court. Gillick competence is a term originating in England and Wales and is used in medical law to decide whether a child (a person under 16 years of age) is able to consent to their own medical treatment, without the need for parental permission or knowledge.. Axton v The Secretary of State for Health (The Family Planning Association: intervening) (2006) EWHC 37. Feature: My child, my choice. The Fraser guidelines refer to the guidelines set out by Lord Fraser in his judgment of the Gillick case in the House of Lords (Gillick v West Norfolk, 1985), which apply specifically to contraceptive advice. Lord Scarman and Lord Fraser proposed slightly different tests (Lord Bridge agreed with both). As of May 2016, it appeared to Funston and Howard that some recent legislation worked explicitly to restrict the ability of Gillick competent children to consent to medical treatment outside of clinical settings. Section 2 sets out when a child under the age of 16 can consent to medical treatment or procedures. endobj Therefore each individual decision requires assessment of Gillick competence. 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. their ability to explain a rationale around their reasoning and decision making. Typical positions of emancipation arise when the minor is married (R v D [1984] AC 778, 791) or in the military. TO SAY that Mrs Gillick was angry is an understatement. 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. Mrs Gillick was a lady of Catholic faith with 5 daughters when the case originally started back in 1982. At the other end are cases where there is genuine scope for debate and the views of the parents are important. 2K Yf0t Lord Donaldson summed up the position when he held that.Citation9. xVrT9+=Uq,?d{TMxR) SX>; ]c}!G:wRkB):Nns+t:jvwd%f! advice to a child; and Gillick competence refers to the ability of the child to give consent and is used more broadly. The following information looks at how this can be applied in practice. The fathers argued that the immunizations were in the children's best interests. Mental Health Matters. Allan Gaw recounts the famous Gillick case and events leading up to a landmark decision on medical consent in children. The child's safety and wellbeing is paramount. The child of tender years who rely on a person with parental responsibility to consent to treatment. 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. This lack of authority reflects that the reported cases have all involved minors who have been found to be incompetent, and that Australian courts will make decisions in the parens patriae jurisdiction regardless of Gillick competence. ; there . &Ed@ 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. 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. parents' Article 8 rights do not . CONSENT WHEN <16 YEARS OF AGE. % 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 . strictly prohibited. Adolescence is a transitional phase of growth and development between childhood and adulthood. People also read lists articles that other readers of this article have read. Any other browser may experience partial or no support. 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. 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. Where a health professional accepts the consent of a Gillick competent child it cannot be overruled by the child's parent. Gillick competence refers to the fact that some children under the age of 16 are able to give consent. 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 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. Young people also have the right to seek a second opinion from another medical professional (General Medical Council, 2020). A good practice guide on consent for health professionals in NHS Scotland (PDF). However, if a young person refuses treatment which may lead to their death or severe permanent harm, their decision can be overruled. Re W (A minor) (Medical treatment court's jurisdiction). A plea for consistency over competence in children. x0 What is the Age of Legal Capacity (Scotland) Act 1991? upgrade your browser. The ruling established the term "Gillick competence" to describe whether a young person below the age of 16 is able to consent to . Sufficient time for the assessment must be allowed by the health professional who needs to be satisfied that a child has fully understood the nature and consequences of the proposed immunization and is mature enough to take account of broader health and social factors when making their decision. Consent is essential to the propriety of treatment and is necessary to meet the requirements of the law. sometimes termed as Gillick Competence, is granted to a person under the age of 18 where they can demonstrate sufficient insight and understanding of major decisions . For example, parental consent is required for the treatment of children with asthma using standby salbutamol inhalers in schools. << /ProcSet [ /PDF /Text /ImageB /ImageC /ImageI ] /ColorSpace << /Cs1 8 0 R Re R (A minor) (Wardship Consent to Treatment). In Northern Ireland, although separate legislation applies, the then Department of Health and Social Services stated that there was no reason to suppose that the House of Lords decision would not be followed by the Northern Ireland courts. 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 a young person presents repeatedly about sexually transmitted infections or the termination of pregnancy this may be an indicator of. 5 Howick Place | London | SW1P 1WG. 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. You must always share child protection concerns with the relevant agencies, even if a child or young person asks you not to. Help for children and young people However, where parents are in dispute with each other over an issue of parental responsibility, that can include disagreement over immunization, then if negotiation fails they can go to court to resolve the matter. It does not compel nurses to provide the treatment. z#&,!Eh?_X Q*%20/Ud` !s4@KXA!20W.E-2eR5re@1cCk2W ~G 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. 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. Mental Health Matters, What is Informed Consent? 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 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 standard is based on a decision of the Lady Justice Purvis in the case Gillick v West Norfolk and . Engaging with and assessing the adolescent patient. `ve-ej;U 73)_Qp6wS\Q3m&CTOg"!T LtPOh 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. The subsequent 1983 judgement set out criteria for establishing whether a child under 16 has the capacity to provide consent . Introduction. 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. Although people with parental responsibility were generally free to act alone when making decisions for their children this freedom was not unfettered. A child who has such understanding is considered Gillick competent . Mental Health Matters, What is Informed Refusal? There are no potential conflicts of interest. The English Gillick case held that . If the young person still wants to go ahead without their parents' or carers' knowledge or consent, you should consider the Gillick and Fraser guidelines. Microsoft is encouraging users to upgrade to its more modern, children This idea of Gillick competence was further supported by R (on the application of Axon) v Secretary of State for Health. [Accessed 02/02/2020]. A relatively young child would have sufficient maturity and intelligence to be competent to consent to a plaster on a small cut. The content herein is provided for informational purposes and does not replace the need to apply 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. These are commonly known as the Fraser Guidelines: the young . Consent for the medical treatment of patients under 18 years of age is generally provided by parents. 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. or treatment with or without parental consent, although Childright, 22: 11-18. There is specific guidance for medical professionals on using Gillick competence - see case history and legislation. In sum, it is now legal to decide whether a child is able to give consent to medical treatment on the basis of an assessment of the child's maturity and understanding of what is being proposed. In Scotland the NHS has provided a good practice guide on consent for health professionals (PDF) (Scottish Executive Health Department, 2006). 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