Gillick Competence, Fraser Guidelines, & Consent For Children - Medicine Interviews
Capacity? Consent? Confidentiality? Similarly sounding terms with important and different meanings. A firm understanding of the most commonly used medico-legal principles will assist you in providing both well-reasoned and factual answers to ethical questions during your medical school interviews. This blog series is intended to provide a comprehensive guide to the medico-legal principles underpinning medical decision making.
This blog will cover the medico-legal principles surrounding capacity in children! This includes:
The key differences between consenting to treatment between children and adults.
Gillick competency.
The Fraser guidelines.
Consent in Children: Gillick Competency and Fraser Guidelines
Patients over the age of 16 can consent to their own treatment and can only be overruled in exceptional circumstances.
Children under the age of 16 can still consent to their own treatment if they are deemed to have enough competence, understanding and intelligence to fully appreciate what is involved in their treatment. This is known as being Gillick competent.
It is important to note that children under the age of 16 wishing to refuse treatment that may lead to their death or severe permanent harm can be overruled in the courts.
Gillick Competency:
A child under the age of 16 having the competence, understanding and intelligence to fully appreciate what is involved in their treatment. The existence of this principle emphasises the duty of a doctor to assess the maturity of children prior to allowing them to make decisions regarding their care.
If a child is not Gillick Competent:
· A person with parental responsibility and capacity to consent can decide for them as long as their decision is in the best interests of the child.
· If their decision is not in the best interests of the child, doctors can apply to the courts to have their decision overruled.
Fraser Guidelines
The Fraser guidelines apply to advice and treatment relating to contraception and sexual health. This includes the advice and treatment for sexually transmitted infections and for termination of pregnancy.
Practitioners using the Fraser guidelines should be satisfied that:
· The young person cannot be persuaded to inform their parents or carer that they are seeking treatment.
· They understand the advice being given.
· Their physical or mental health is likely to suffer if treatment is not provided.
· It is in their best interests.
· They are likely to continue having sex without treatment.
(Gillick v West Norfolk, 1985)
Child Protection Concerns: Medicine Interview
When using the Fraser guidelines for issues relating to sexual health, child protection concerns must always be considered:
· Underage sexual activity can be an indicator of exploitation. Children who are being groomed may not realise that they are being abused.
· Sexual activity with a child under the age of 13 should always result in a child protection referral.
· Repeated presentations for sexually transmitted infections or pregnancy termination could indicate sexual abuse.
Key Points For Medicine Interviews - Capacity and Consent For Under 18s
· Children are not deemed to have capacity unless proven to be Gillick competent, this differs from adults who are deemed to have capacity unless proven otherwise.
· When dealing with the question of capacity in children, safeguarding concerns should always be at the back of your mind – ensure the child is not at risk!
Check out our other blog posts on medical law and how to ace the medical law station at your medical school interview - https://www.mastermedprep.com/blog/categories/medical-ethics
Get in touch if you have any questions about medical ethics and law. Or if you would like to arrange tutoring or a mock interview!