Gillick or Fraser? A plea for consistency over competence in children

Abstract

Gillick and Fraser are not interchangeable

Judicial Bypass of Parental Consent for Abortion

“…Thus, society has accepted the premise that adolescents, even before the age of 18, can make decisions on their own of great importance and are already being held responsible for those decisions. Internationally, in the United Kingdom and the commonwealth, "Gillick competence" refers to whether a minor 16 years old and under is able to consent to her own medical treatment based on maturity and intelligence; specific "Fraser" guidelines are also given for contraception in minors (Wheeler, 2006). Discussion with trusted others is a critical finding, in light of the literature regarding adolescent decision-making being on par with that of adults when free of stress, time constraints, and when provided with adequate supports (Steinberg et al, 2009).…”

The particular needs of children and adolescents – not just little adults

“…However, a child with 'significant understanding and intelligence' may be felt to be 'Gillick competent' and able to consent. 4,5 Consent without involvement of those with parental responsibility If a competent child wishes to give consent and asks to keep this confidential from their family, this must be respected. Discussion with the child should encourage family input unless you feel that this will cause harm.…”

What is Gillick competence?

“…5 Their Lordships held that a child under 16 had the legal competence to consent to medical examination and treatment if they had sufficient maturity and intelligence to understand the nature and implications of that treatment. 5 Gillick or Fraser an Urban Myth Wheeler (2006) argues that something of an urban myth has emerged over the use of the term Gillick competence. 6 It suggests that Mrs Gillick wishes to disassociate her name from the assessment of children's capacity, thus carrying the implication that the objective test of a child's competence should be renamed the Fraser competence.…”

“…5 Gillick or Fraser an Urban Myth Wheeler (2006) argues that something of an urban myth has emerged over the use of the term Gillick competence. 6 It suggests that Mrs Gillick wishes to disassociate her name from the assessment of children's capacity, thus carrying the implication that the objective test of a child's competence should be renamed the Fraser competence. Alteration of an established legal test would be unusual, and cause confusion and following correspondence with Victoria Gillick, Wheeler is clear that she "has never suggested to anyone, publicly or privately, that [she] disliked being associated with the term 'Gillick competent'."…”

“…Alteration of an established legal test would be unusual, and cause confusion and following correspondence with Victoria Gillick, Wheeler is clear that she "has never suggested to anyone, publicly or privately, that [she] disliked being associated with the term 'Gillick competent'." 6 Gillick competence is therefore the correct term, still used by judges and health professionals, to identify children aged under 16 who have the legal competence to consent to immunization, providing they can demonstrate sufficient maturity and intelligence to understand and appraise the nature and implications of the proposed treatment, including the risks and alternative courses of actions.…”