It was found that Gillick did not apply directly to the issues before the court in this case but there is useful commentary and discussion in the judgement regarding the use of Gillick competence. Axton v The Secretary of State for Health (The Family Planning Association: intervening) (2006) EWHC 37. 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 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. Applied tests for competence are wide-ranging and context dependent. Date: 27 February 2018. What to do if the patient is in an abusive relationship. There is no set of defined questions to assess Gillick competency. Their fathers made an application to the court seeking the immunization of their children. The right to decide on competence must not be used as a license to disregard the wishes of parents whenever the health professional finds it convenient to do so. Section 2 sets out when a child under the age of 16 can consent to medical treatment or procedures. It is considered good practice for doctors and other health professionals to follow the criteria outlined by Lord Fraser in 1985 in the House of Lords' ruling in the case of Victoria Gillick v West Norfolk and Wisbech Health Authority and Department of Health and Social Security. However, if a young person refuses treatment which may lead to their death or severe permanent harm, their decision can be overruled. Campaigner Molly Kingsley, who had co-founded the campaign group UsForThem over the issue, warned that Were vaccination of children to happen on school premises without fully respecting the need for parental consent it would really prejudice parents trust in schools. Epidemiologist and SAGE member John Edmunds said that if we allow infection just to run through the population, thats a lot of children who will be infected and that will be a lot of disruption to schools in the coming months. Adults, Your information helps us decide when, where and what to inspect. This idea of Gillick competence was further supported by R (on the application of Axon) v Secretary of State for Health. 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 age at which a person becomes an 'adult' in Australia is 18. A refusal by 16 - 17 year olds is also not determinative and can be overridden by the court. 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) The Family Law Reform Act 1969 also gives the right to consent A patient under the age of 16 years can consent to medical treatment . 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. ; there . NSPCC / All rights reserved. The advice or treatment is in the young persons best interests. It helps people who work with children and adolescents to balance the need . 'Gillick competence' refers to a young person under 16 with capacity to make any relevant decision. professional clinical judgement when diagnosing or treating any medical condition. {1XeJ v'cjt]aVfD9q$|rd[gNTM-P(Y"RUUbl{ U>CA%q\6h4; For example, parental consent is required for the treatment of children with asthma using standby salbutamol inhalers in schools. In Scotland the NHS has provided a good practice guide on consent for health professionals (PDF) (Scottish Executive Health Department, 2006). Consent needs to be given voluntarily . It is task specic so more complex procedures require greater lev-els of competence. Gillick competence is the principle we use to judge capacity in children to consent to medical treatment. `ve-ej;U 73)_Qp6wS\Q3m&CTOg"!T LtPOh are offering contraceptive services to under 16's without parental knowledge or A plea for consistency over competence in children. By closing this message, you are consenting to our use of cookies. The child's safety and wellbeing is paramount. 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 in the young person's best interests to receive the advice, treatment or both without their parents' or carers' consent. advice to a child; and Gillick competence refers to the ability of the child to give consent and is used more broadly. Being aware of Gillick competence and Fraser guidelines is useful in a case like this. Although the original question was around the use of contraception, the ruling covers a child's own medical treatment without their parents . endobj Autonomy - Doctors must respect the decision made by a patient. If a Gillick competent child refuses medical examination or treatment then the law does allow a person with parental responsibility to consent in their place. For more information, please visit our Permissions help page. Indeed the Court of Appeal ruled it essential that in hotly disputed cases the consent of both parents must be given before proceeding. What is the Age of Legal Capacity (Scotland) Act 1991? Learn how your comment data is processed. Department of Health (2003). Registered charity in England and Wales (216401), Scotland (SC037717) and Jersey (384). 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). Gillick competence needs to be assessed on a decision by decision basis, checking whether the child understands the implications of the treatment. The decision to proceed with an intervention such as an injection is for the nurse to make based on their clinical judgement. > Find out more about the Library and Information Service. London: Department of Health and Social Care. However, Scots Law has gone beyond Gillick with the enactment in 1991 of the Age of Legal Capacity (Scotland) Act (the 'Scottish Act'). ; Prescribing contraception to patients under 16 poses several ethical issues for doctors, not least managing the apparent conflict between patient confidentiality and parental rights. Lord Scarman and Lord Fraser proposed slightly different tests (Lord Bridge agreed with both). 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 the case law in this area primarily concerns refusal of treatment. stream The case is binding in England and Wales, and has been adopted to varying extents in Australia, Canada, and New Zealand. In late 2020, Bell v Tavistock considered whether under-16s with gender dysphoria could be Gillick competent to consent to receiving puberty blockers. Kennedy & Grubb (1998) argue that children pass through 3 developmental stages on their journey to becoming an autonomous adult.Citation3. their ability to explain a rationale around their reasoning and decision making. Gillick Competence. ; Patient confidentiality versus parental rights. 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 judgment includes a useful analysis of factors to think about in assessing Gillick competence in children, as part of consenting them to any kind of treatment more generally. Gillick competence is a functional ability to make a decision. They may be used by a range of healthcare professionals working with under 16-year-olds, including doctors and nurse practitioners. 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. There is no express authority in Australia on In re R and Re W, so whether a parents right terminates is unclear. Fraser guidelines are used specifically for children requesting contraceptive or sexual health advice and treatment. 15 August 2022. Specialties tested include general practice, general medicine, general surgery, paediatrics, anaesthetics, adult psychiatry, and emergency . 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. in England and Wales by the House of Lords in the case of Gillick vs West Norfolk However You should always encourage a child to tell their parents or carers about the decisions they are making. In doing so they must, on balance, be satisfied that the child understands that there is a decision to be made and that decisions have consequences, also that the child understands the benefits and risks of immunization and the possible wider implications of receiving it against the wishes of their parents. Children under the age of 16 can consent to their own treatment if they're believed to have enough intelligence, competence and understanding to fully appreciate what's involved in their treatment. The standard is based on the 1985 judicial decision of the House of Lords with respect . 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. 6 0 obj 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. And is used more broadly when diagnosing or treating any medical condition 17 year olds also! Under 16 with capacity to make based on the application of Axon ) Secretary. You are consenting to our use of cookies is in the young persons best interests court. Ruled it essential that in hotly disputed cases the consent of both must! Adolescents to balance the need questions to assess Gillick competency for children requesting or. 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