What is the Gillick Competence?

In the world of health and social care, the concept of “Gillick competence” plays a crucial role in assessing whether children and young people can make their own decisions regarding medical treatment.

Originating from a landmark legal case, this principle addresses several considerations and implications for practitioners, children, and their families.

What is Gillick Competence?

Gillick competence refers to a legal standard set forth in the 1980s that determines when a child under the age of 16 can consent to their medical treatment without the need for parental permission or knowledge. Named after the pivotal case Gillick v. West Norfolk and Wisbech Area Health Authority, the principle is now a cornerstone of medical law and practice in the UK.

Background of Gillick Competence

In the early 1980s, Victoria Gillick sought a judicial review against the policy permitting doctors to give contraceptive advice and treatment to girls under 16 without parental consent or consultation. The House of Lords ultimately ruled against her, establishing what is now known as Gillick competence. This landmark decision acknowledged that children might possess sufficient maturity and understanding to make informed decisions regarding their care.

Determining Gillick Competence

Professionals do not assess Gillick competence through a fixed age threshold but through an evaluation process. Let’s delve into the factors considered:

Maturity and Understanding:

• The child’s ability to understand the nature, purpose, and possible consequences of the treatment.
• Their ability to weigh the benefits and risks of the proposed treatment.

Communication:

• Whether the child can appreciate the implications of receiving or refusing treatment.
• Willingness to communicate their decision freely and without coercion.

Emotional and Psychological State:

• The emotional and psychological maturity to manage the decision.
• Understanding of the broader context, including long-term impacts and lifestyle changes.

Practical Application

Healthcare professionals must use their judgment to assess each case individually. Here’s a step-by-step practical approach:

Initial Assessment:

• Begin with a discussion to gauge the child’s understanding of the treatment.
• Explain the procedure in simple, age-appropriate language.

Detailed Explanation:

• Discuss potential risks, benefits, and alternatives.
• Answer any questions the child may have, ensuring they fully understand every aspect.

Decision Making:

• Ask the child to explain the treatment back to you.
• Evaluate their reasoning for consenting or refusing treatment.

Documentation:

• Record the assessment process and the conclusions drawn.
• Inform the child that their maturity and understanding are key factors in the decision.

Examples of Gillick Competence in Action

Consider a 14-year-old girl seeking contraceptive advice. If she demonstrates a keen understanding of how contraception works, the risks, and the consequences of sexual activity, she may be deemed Gillick competent. The professional would document her ability to make an informed decision before providing the treatment.

Alternatively, imagine a 13-year-old boy refusing a life-saving surgery. If he cannot fully grasp the urgency and the potential outcomes of his refusal, he might not be considered Gillick competent. In such cases, healthcare providers would engage parents and consider legal routes to ensure the child’s welfare.

Ethical Considerations

Healthcare professionals face ethical dilemmas when a child’s decision conflicts with their parents’ wishes. Key considerations include:

• Child’s Autonomy: Respecting the child’s evolving capacity and right to make decisions.
• Parental Involvement: Balancing the child’s best interests with parental rights to be involved in significant health decisions.
• Confidentiality: Maintaining the child’s confidentiality while ensuring their safety and well-being.

Gillick Competence and the Fraser Guidelines

Although closely related, it’s essential to distinguish Gillick competence from the Fraser guidelines. Named after Lord Fraser, these guidelines specifically address contraceptive advice for young people. They provide criteria healthcare practitioners must meet before providing contraception to those under 16:

1. The young person understands the advice.
2. They cannot be persuaded to inform their parents.
3. They are likely to have sexual intercourse with or without contraceptive treatment.
4. Their physical or mental health may suffer without advice or treatment.
5. It’s in their best interest to receive contraceptive advice or treatment without parental consent.

While both concepts aim to safeguard young people’s well-being, Gillick competence is broader and applies to various medical treatments, not just contraception.

Importance in Modern Practice

Gillick competence is integral in modern medical practice, particularly with the rise of more autonomous, well-informed young people. It helps professionals navigate complex situations where a young person’s wishes might differ from those of their guardians. Understanding and applying this principle ensures that children and young people receive the respect and consideration they deserve in decisions about their health.

Resources and Support

For healthcare professionals seeking further understanding of Gillick competence:

• Training and Workshops: Many organisations offer training on applying Gillick competence in various medical contexts.
• Legal Advice: Consulting with legal professionals can clarify complex cases and ensure adherence to best practices.
• Professional Guidance: Guidelines from the General Medical Council (GMC) and other professional bodies provide comprehensive information.

Conclusion

Gillick competence is a testament to recognising young people’s capacity to make informed decisions about their health. While it requires careful, individual assessment, it empowers children and respects their autonomy. Health and social care professionals must remain vigilant, ensuring their evaluations are thorough, their documentation is precise, and their decisions always prioritise the child’s best interests.

Useful Resources and Further Reading

1. NSPCC Learning – Gillick competence and Fraser guidelines
2. Care Quality Commission – GP mythbuster 8: Gillick competence and Fraser guidelines