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Gillick competency allows healthcare professionals to decide whether a young person is able to make their own treatment decisions without needing their their parents/carers involvement.
The term “Gillick competence” was named after Victoria Gillick. She began a legal battle because she didn’t want doctors to give the pill to children under 16 without their parents’ permission.
In 1985, the judged ruled against her. They decided that doctors and nurses can provide contraception to children under 16 without telling their parents.
One of the judges on the case, Lord Fraser, created some guidelines. These guidelines said that a young person can be provided with contraceptive care if they:
Doctors/nurses have to decide if it is in the young person’s best interest to get the treatment they ask for and that they would likely continue having sex even without the contraception they ask for.
Being ‘competent’ means:
Is Gillick competence just about contraception?
Although the original court case was about contraception for under 16s, the Department of Health later said that the same rules apply to giving abortion care and care for sexually transmitted infections (STIs).
Doctors and nurses use “Gillick competence” in all areas of health and social care. Ii is used to check if a young person can make their own decisions about their health or care when:
If a young person under 16 wants treatment without their parents’ or carers’ consent, it is the job and legal duty of the healthcare professional to decide if they are “competent”. They will do this by:
Some decisions are more complicated or riskier than others. This means that a young person may be considered “competent” to make some decisions, for example taking the pill to prevent pregnancy, but not for more complex decisions, like joining a clinical trial of a new cancer drug.
Why is it important for young people to be able to make their own decisions?
It is really important that young people can make their own decisions, especially if involving their parents might be a problem. This might happen if the parents are unhelpful or forceful about treatment choices or if sharing information (like the young person being sexually active) could make them unsafe at home.
Allowing young people to make their own decisions isn’t just about safeguarding and keeping them safe; it’s also about their rights and autonomy. The United Nations Convention on the Rights of the Child recognises that as children and young people grow and mature, they should have increasing rights to make decisions about things affecting their lives.
Since young people mature and understand things at different rates, each young person is assessed for competence on an individual basis.
Parents/carers can be a great source of information, advice and support for their children. In most cases, if a parent knows what’s going on in their child’s life it can help keep them safe. The younger someone is the most likely they are to benefit from involving their parent/carer.
Doctors/nurses aim to encourage rather than persuade the young person as some parents and carers are not supportive. Involving these parents in these decisions may be harmful or put the young person at risk. The healthcare professional will help the young person weigh up the risks and benefits (pros and cons) or talking to a parent/carer.
If the young person is competent to make their own decision and talking to a parent/carer isn’t needed to keep them safe, the doctor/nurse will let the young person make their decision. However, they might suggest talking to the parent/carer with the young person as this can be helpful.
Here are two examples:
If a young person wants treatment to stop smoking or drinking alcohol, refusing this treatment could mean they continue doing things that harm their health.
If a young person is sexually active or is planning to be, not giving them contraception puts them at risk of an unintended pregnancy.
The most important thing is keeping young people safe and well. In a situation where a young person’s choice (i.e. to choose a treatment or refuse a treatment) would put them at extreme risk of harm then their decision can sometimes be overruled by a healthcare professional or a parent/carer.
A young person has the right to confidentiality in healthcare even if they are not mature enough to make treatment decisions. If a young person asked for treatment and it was refused, they could then choose to involve a parent/carer to try to get the treatment they want.
A child’s safety and wellbeing is the top priority. Healthcare professionals know that some children and young people are sexually active not by choice, but as a result of abuse, coercion or exploitation.
They may be concerned about a young person because of something they have said about their relationship or partner, or because they have often asked for emergency contraception, have had repeated STIs or have become pregnant (more than once).
If a healthcare professional has to break confidentiality and tell someone, they would pass on the information to a safeguarding professional within their own organisation or in the local authority. The young person should be told about any reports being made and any actions taken.
By law someone under 13 cannot consent to sex. This means anyone is sexually active under 13, they are considered to be at risk of harm and their case would be discussed by child protection experts for further action.