Consent for Children - Gillick v West Norfolk and Wisbech AHA 1986
The Case:
In 1982, Mrs Victoria Gillick launched legal proceedings against her local health authority (West Norfolk and Wisbech Area Health Authority) and the Department of Health and Social Security. She did so to attempt to stop doctors giving contraceptive advice to girls under the age of 16 without parental consent.
The Case was initially dismissed by the High Court before this ruling was overturned by the Court of Appeal. However, in 1985 it went to the House of Lords who deemed that children under the age of 16 could receive contraceptive advice without parental consent. This became known as Gillick competence and the guidelines which followed known as the Fraser Guidelines.
Gillick Competence:
"...whether or not a child is capable of giving the necessary consent will depend on the child’s maturity and understanding and the nature of the consent required. 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."
A child is said to be Gillick Competent regardless of their age if they can:
(I) Understand the nature, consequences and alternatives of the proposed treatment.
(II) Possess the ability to:
- Retain
- Use and weigh up the decision
- Communicate their decision.
The Fraser Guidelines:
Lord Fraser's guidelines in his judgement set out that: "...a doctor could proceed to give advice and treatment provided he is satisfied in the following criteria:
1) that the girl (although under the age of 16 years of age) will understand his advice;
2) that he cannot persuade her to inform her parents or to allow him to inform the parents that she is seeking contraceptive advice;
3) that she is very likely to continue having sexual intercourse with or without contraceptive treatment;
4) that unless she receives contraceptive advice or treatment her physical or mental health or both are likely to suffer;
5) that her best interests require him to give her contraceptive advice, treatment or both without the parental consent."
Summary:
The ruling of this case set it in law that a child under 16, if competent - Gillick Competent - to make a healthcare decision can consent to do so. It would be good practice to encourage the patient to discuss this with their parents or those with parental responsibility if possible but this is not compulsory for the patient if they are Gillick Competent.
Below is a video which goes through these core concepts: