Gillick competence and Fraser guidelines: consent in under 16s
RezzyThis is a classic UK medical law topic that pops up all the time in the AKT! It's all about balancing a young person's autonomy with their protection.
In the UK, while 16 and 17-year-olds are presumed to have the capacity to consent to treatment, those under 16 need to be assessed for Gillick competence.
Gillick Competence vs. Fraser Guidelines
A common point of confusion is the difference between these two. Here is the quick breakdown:
- Gillick Competence: Applies to any medical treatment or intervention (e.g., a vaccine, a cast for a broken arm, or a referral).
- Fraser Guidelines: Specifically apply to providing contraception, or advice on sexual health, to a child under 16 without parental consent.
I've put together a comparison table to help you keep the specific criteria for each straight in your head.
| Feature | Gillick Competence | Fraser Guidelines |
|---|---|---|
| Scope | All medical treatments/interventions. | Specifically contraception and sexual health advice. |
| Core Requirement | The child has sufficient understanding and intelligence to fully understand what is proposed. | The child understands the advice/treatment. |
| Key Criteria | Assessment of maturity, understanding of risks/benefits, and ability to weigh options. | 1. The doctor cannot persuade them to inform parents. 2. They are likely to begin/continue having sex without contraception. 3. Their physical/mental health will suffer without it. 4. It is in their best interest. |
| Parental Role | If competent, the child can consent without parental knowledge. | Efforts should be made to involve parents, but treatment can proceed if the child refuses. |
One thing to remember for the AKT is that competence is task-specific. A child might be Gillick competent to consent to a simple blood test but not for a major, life-altering surgery.
Let me see if I can find a helpful visual or flowchart to help you visualize the decision-making process for these cases.
That flowchart gives a good overview of the general safeguarding and consent mindset, but for the AKT, you really need to memorize the 5 specific Fraser Criteria.
The Fraser Criteria (for contraception/sexual health):
- The young person understands the professional's advice.
- The professional cannot persuade the young person to inform their parents.
- The young person is very likely to begin or continue having sexual intercourse without contraceptive treatment.
- Unless they receive contraceptive treatment, their physical or mental health (or both) are likely to suffer.
- The young person's best interests require them to receive contraceptive advice or treatment with or without parental consent.
I'll pull up some high-yield lessons and flashcards so you can practice these scenarios.
📚 Consent Lessons
Those lessons are great for getting the full context, especially the one on Consent for minors and adolescents.
To help you lock in those 5 Fraser criteria and the key differences, I've pulled some flashcards for you to test yourself.
🗂️ Consent Flashcards
Tap to study 11 flashcards in the Oncourse app
Those flashcards are perfect for a quick review before your exam!
One final "high-yield" tip for the AKT: Consent is not the same as refusal. While a Gillick-competent child can consent to treatment, they generally cannot refuse life-saving treatment if their parents or a court override that decision. This is a common trap in ethics questions!
If you're feeling confident, we could try a quick practice quiz on this topic, or I can help you with anything else on your mind!
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