What It Is

Gillick competence is a legal principle allowing children under 16 to consent to medical treatment without parental knowledge or permission, provided they demonstrate sufficient maturity and understanding of what's proposed.

It originates from Gillick v West Norfolk and Wisbech Area Health Authority (1985), a House of Lords case concerning whether doctors could prescribe contraception to under-16s without parental consent.

The Core Legal Principle

A child is Gillick competent if they can:

Understand the nature, purpose, and consequences of the proposed treatment
Retain that information long enough to make a decision
Weigh the risks and benefits
Communicate their decision

Competence is decision-specific and time-specific—a child may be competent to consent to one treatment but not another, and their competence can fluctuate.

What Gillick Competence Allows

A competent child can consent to treatment
A competent child cannot refuse treatment if refusal would lead to serious harm or death—courts can override this (contrast with competent adults, whose refusal is absolute)

The Fraser Guidelines

Often confused with Gillick competence, but specifically apply to contraception and sexual health. A doctor can provide contraceptive advice/treatment to an under-16 if:

The young person understands the advice
They cannot be persuaded to inform their parents
They are likely to begin or continue having sex with or without contraception
Their physical or mental health will suffer without treatment
It is in their best interests to receive treatment without parental consent

Common Interview Scenarios

Scenario 1: A 14-year-old requests the contraceptive pill

Strong answer structure:

Assess Gillick competence through careful questioning
If competent, apply Fraser guidelines
Encourage (but don't insist on) parental involvement
Respect confidentiality if the young person declines
Prescribe if in her best interests and she meets criteria

Scenario 2: A 15-year-old with appendicitis refuses surgery

Key distinction: Even a Gillick-competent child's refusal can be overridden when life is at risk. You would:

Explore reasons for refusal
Involve parents and multidisciplinary team
Seek court order if consensus cannot be reached
Act in the child's best interests

Scenario 3: A 13-year-old wants a tattoo removed without telling parents

Consider:

Is this a medical treatment? (Yes, if laser removal)
Assess competence for this specific decision
No urgency—encourage family communication
Competence threshold may be lower for simpler, lower-risk procedures

Ethical Tensions to Discuss

Principle	How It Applies
Autonomy	Respecting a young person's developing capacity for self-determination
Beneficence	Acting in the child's best interests, which may conflict with their stated wishes
Confidentiality	Owed to competent minors just as to adults
Parental rights	Diminish as the child's competence increases—parental responsibility, not ownership

What Interviewers Want to See

Nuanced thinking—acknowledge that competence exists on a spectrum
Awareness of limits—consent yes, refusal of life-saving treatment no
Patient-centred approach—the child's welfare is paramount
Practical judgment—when to involve parents, safeguarding teams, or courts
Legal accuracy—distinguish Gillick (general competence) from Fraser (contraception-specific)

How Gillick Competence is Assessed

There is no formal test. Clinicians assess competence through structured discussion and judgement.

A child must demonstrate the ability to:

1. Understand information

Can explain the treatment in their own words
Understands purpose and procedure

2. Retain information

Can remember key facts long enough to make a decision

3. Weigh up risks and benefits

Can describe advantages and disadvantages
Shows balanced reasoning

4. Communicate a choice

Can clearly express a consistent decision

One-Paragraph Summary for Quick Recall

Gillick competence allows under-16s to consent to treatment if they fully understand it, but unlike competent adults, their refusal can be overridden when serious harm would result. Fraser guidelines are the specific criteria for contraceptive provision. Always assess competence for the particular decision, encourage family involvement without mandating it, maintain confidentiality, and keep the child's welfare central.

Questions and Answers

Here are high-yield interview questions with strong model answers on Gillick competence—the kind used in paediatrics, EM, psychiatry, and surgical interviews.

1. What is Gillick competence?

Answer:

Gillick competence refers to the legal principle from Gillick v West Norfolk and Wisbech Area Health Authority which states that a child under 16 can consent to medical treatment if they have sufficient understanding and intelligence to fully understand the proposed intervention.

It is decision-specific and not age-based.

2. How do you assess Gillick competence?

Answer:

I assess whether the young person can:

Understand the information relevant to the decision
Retain that information
Weigh risks, benefits, and alternatives
Appreciate consequences of accepting or refusing treatment
Communicate a consistent choice

I tailor the explanation to their level of maturity and document the discussion clearly.

3. Is there a specific age for Gillick competence?

Answer:

No. There is no fixed age threshold. Competence depends on the individual’s ability to understand the specific decision in question.

4. Does Gillick competence apply to all medical decisions?

Answer:

Yes. It applies broadly to any medical treatment or intervention, but the level of understanding required increases with the complexity and risk of the decision.

5. Can a Gillick-competent child refuse treatment?

Answer:

Yes, a Gillick-competent child can refuse treatment. However, if refusal places them at significant risk of serious harm, escalation to senior clinicians and potentially legal advice or court involvement may be required in their best interests.

6. How does Gillick competence relate to parental responsibility?

Answer:

If a child is Gillick competent, they can consent independently, even if parents disagree. However, clinicians should still consider parental involvement where appropriate and act in the child’s best interests.

7. How would you explain Gillick competence in simple terms to a patient?

Answer:

“It means that if you understand enough about your treatment, including the risks and benefits, you can make decisions about your own healthcare even if you’re under 16.”

8. What is the difference between Gillick competence and Fraser guidelines?

Answer:

Gillick competence = general principle for any medical decision
Fraser guidelines = specific criteria for providing contraception without parental involvement

Fraser is essentially a subset application of Gillick in sexual health.