Gillick competency and fraser guidelines

Gillick competence - children who are able to give their consent to matters other than medical matters without the consent of their parent

Both Gillick competency and Fraser guidelines refer to the legal case Gillick v West Norfolk & Wisbech Area Health Authority [1985] UKHL 7 (17 October 1985). This case was concerned specifically with looking at whether or not doctors could provide under 16 year olds with contraceptive advice or treatment without the consent of the parent.

The original case in 1982 concerned a Mrs Gillick going to court to try to stop doctors giving such advice without the parent's consent. The case went to the High Court and Mrs Gillick's claims were dismissed by Mr Justice Woolf. This decision was reversed by the Court of Appeal and finally went to the House of Lords in 1985 where the Law Lords, Lord Scarman, Lord Fraser and Lord Bridge, ruled in favour of Mr Justice Woolf's original decision that a child under the age of sixteen could, in certain circumstances, give consent to medical treatment, including receiving contraceptive advice and contraceptive aids or have an abortion without the knowledge or agreement of the parent. Lord Scarman commented that " is not enough that she should understand the nature of the advice which is being given: she must also have a sufficient maturity to understand what is involved." these comments are referred to as the test of “Gillick competency”.

Since that time these guidelines have been used to help ascertain the maturity of a child and whether they are able to make decisions for themselves and that they understand the significance of the decisions they make. A child under the age of 16 is said to be a “Gillick competent” child if they are able to show a level of maturity and understanding that enables them to be able to assess the nature, risks and the outcome of any proposed course of action. “Gillick competence” has a broader meaning than “Fraser competence” and describes children who are able to give their consent to matters other than medical matters without the consent of their parents.

The term “Fraser competence” is more specifically used to refer to contraceptive advice and describes a child under the age of sixteen who is believed to have the ability to understand the significance of the contraceptive advice they are given without the parents being advised or giving their consent. The Fraser guidelines, set out below, refer to the guidelines set out by Lord Fraser in his judgement of the Gillick case in the House of Lords (1985), and apply specifically to contraceptive advice:

"...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."

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