Gillick Competence is a term originating from the case of Gillick v West Norfolk and Wisbech Area Health Authority and Department of Health and Social Security  3 All ER 402 and is used in medical law to decide whether a child under 16 is able to consent to his/her own medical treatment, without the need for parental consent. This case concerned the lawfulness of a doctor giving contraceptive advice/ treatment to a girl under 16, without her parents’ knowledge or consent. The girl’s mother objected to Department of Health guidance to doctors and made sought a declaration from the Court that the Guidance was unlawful. The case went up to the House of Lords where, on majority judgement, the Lords ruled in favour of the original judgment delivered by Mr Justice Woolf:
"...whether or not a child is capable of giving the necessary consent will depend on the child’s maturity and understanding and the nature of the consent required. The child must be capable of making a reasonable assessment of the advantages and disadvantages of the treatment proposed, so the consent, if given, can be properly and fairly described as true consent."
This case determined that provided a child had sufficient understanding of the proposed medical treatment and they had expressed their wishes clearly, they could give a valid consent to it despite the fact that they were under the age of 16. He or she must have sufficient understanding and intelligence to enable them to understand fully what is proposed. This case means that there is no specific age under 16 when a child becomes competent to consent to treatment. It will depend both on the child and the seriousness/ complexity of the treatment being proposed. Although the case centred around consent to receiving contraception, the concept of Gillick Competence has evolved to cover any situation where a professional is being asked to provide treatment to a child or young person.
However, competence is not something that is either there or not, it can be developed if as a practitioner you build the relationship and trust with the child and their family. You can begin to do this by involving them from an early stage in decisions and encouraging them to take an increasing part in the decisions about their care.
If the child is under 16 and is competent enough to consent for themselves, it is still good practice to involve the family in all the decision making processes, unless the child asks for you not to share the information with them and you cannot persuade them otherwise. As with an adult, you must respect the decision of a child to keep their treatment confidential unless you can justify disclosure on the grounds that you have reasonable cause to suspect that the child is suffering or is likely to suffer significant harm.
The Fraser Guidelines
More recently, the phrase “Fraser guidelines” has been used to replace Gillick Competence. The Frasier guidelines refer specifically to contraceptive advice and the following guidelines Lord Fraser gave in the Gillick case:
"...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."