Medical Ethics - Fraser vs Gillick
Fraser vs Gillick
Both Gillick competence and the Fraser guidelines come from the same UK legal case (Gillick v West Norfolk and Wisbech AHA, 1986), but they are used in different ways in clinical practice.
Core difference
- Gillick competence = general rule for all medical decisions
- Fraser guidelines = specific rule for contraception and sexual health only
Gillick competence (broad application)
A child under 16 can consent to any medical treatment if they are deemed to have enough:
- Understanding
- Intelligence
- Maturity
to fully understand the decision and its consequences.
👉 If Gillick competent, they can consent without parental involvement.
Used in:
- Surgery
- Medications
- Investigations
- Any healthcare decision
Fraser guidelines (narrow application)
Used ONLY for:
- Contraception
- Sexual health advice/treatment (e.g. STIs)
A clinician can give treatment without parents if ALL criteria are met:
- Patient understands advice
- Cannot be persuaded to involve parents
- Likely to continue sexual activity
- Risk to physical/mental health without treatment
- Treatment is in their best interests
Even if Fraser criteria are met, focus is specifically sexual health care.
Key comparisons
Feature | Gillick competence | Fraser guidelines |
Scope | Any medical decision | Sexual health only |
Applies to | Under 16s | Under 16s |
Focus | Capacity to consent | Conditions for providing contraception |
Parental involvement | Can be excluded if competent | Can be excluded if criteria met |
Origin | Gillick case | Gillick case (Lord Fraser judgment) |
Summary
“Gillick competence is the general principle that under-16s can consent to any treatment if they understand it, whereas Fraser guidelines are a specific set of criteria allowing doctors to give contraceptive advice or treatment without parental consent.”
 In UK paediatrics and medico-legal interviews, “Gillick competence” and the “Fraser guidelines” are often tested together because they’re closely related but not identical.
They originate from the same legal case background: Gillick v West Norfolk and Wisbech Area Health Authority. From this, two linked but distinct concepts emerged.
Core distinction (what interviewers want you to say)
- Gillick competence = broader principle
→ Can a child under 16 demonstrate sufficient understanding and intelligence to make their own medical decisions? - Fraser guidelines = specific application
→ A structured test used mainly for contraception advice/treatment without parental involvement.
Eight Questions and Answers
1. “What is Gillick competence?”
They’re testing:
- Understanding of consent in minors
- Clinical judgement vs age-based thresholds
Expected points:
- Under 16s may consent if they fully understand treatment
- Assessment is decision-specific, not age-based
- Capacity includes understanding risks, benefits, consequences
2. “What are the Fraser guidelines and when are they used?”
They’re testing:
- Knowledge of specific legal safeguards in sexual health
Expected points:
- Derived from Lord Fraser’s judgment in the Gillick case
- Specifically applies to contraception/sexual health advice
- Allows clinicians to give contraception without parental consent if criteria met
3. “List the Fraser criteria”
Classic viva question:
You should mention:
- Young person understands advice
- Cannot be persuaded to inform parents
- Likely to continue or start sexual activity with or without treatment
- Physical/mental health likely to suffer without advice/treatment
- Best interests require treatment without parental knowledge
4. “How do Gillick and Fraser differ in practice?”
They’re testing conceptual clarity:
Good answer:
- Gillick = general competence test for any medical decision
- Fraser = subset of Gillick focused on contraception advice
- Fraser includes additional safeguarding-style criteria
5. “A 14-year-old requests contraception and refuses parental involvement. What do you do?”
They’re testing applied ethics + safeguarding:
Key structure:
- Assess Gillick competence first
- If competent → can proceed
- Apply Fraser criteria if contraception-specific
- Document carefully
- Consider safeguarding if coercion, exploitation, or risk
6. “Does Gillick competence override parental responsibility?”
They’re testing legal hierarchy understanding:
Key answer:
- Yes, if a child is Gillick competent, they can consent independently
- Parental responsibility does not override competent refusal/consent
- But clinicians still consider best interests and safeguarding duties
7. “Can a Gillick-competent child refuse treatment?”
This is a subtle one.
Strong answer:
- They may refuse treatment if competent
- However, courts can override refusal in serious or life-threatening cases
- Always escalate if refusal risks significant harm
8. “How would you assess Gillick competence in clinic?”
They’re testing practical application:
You should say:
- Tailor explanation to child’s level
- Check understanding of:
- condition
- treatment options
- risks/benefits
- consequences of no treatment
- Assess consistency of decision
- Consider emotional maturity and external influence
One-liner summary (good viva closer)
- Gillick = capacity-based autonomy for under-16s
- Fraser = specific criteria allowing confidential contraception provision within Gillick framework
Useful Links
https://learning.nspcc.org.uk/research-resources/briefings/gillick-competency-and-fraser-guidelines
https://learning.nspcc.org.uk/child-protection-system/gillick-competence-fraser-guidelines