Gillick Competence

 

Earlier this year I was invited to speak on a panel at a forum on the topic of Gillick Competence. For those unaware, Gillick competence is a legal framework used to decide if a young person (usually under the age of 16) has the capacity to consent to medical treatment or not. Interestingly, this concept originated in England following the case of Gillick v West Norfolk and Wisbech AHAin theHouse of Lords in 1986. This case was brought to the courts as a mother (Mrs Gillick) disagreed with the fact that a doctor could prescribe contraception to one of her children below the legal age to consent to sexual intercourse. Her notion was dismissed, and it was held by the court that children under the age of 16, which was considered to be the legal age of consent, were able to consent to medical treatment if they were able to demonstrate “sufficient understanding and intelligence to understand fully what is proposed” ([1986] AC 112, 187[D]).

This ruling by the courts is used to this day as a benchmark for teenagers and young people in making decisions about their healthcare in Australia.

As a GP, Gillick competence is always there to be taken into consideration when seeing young people. I think it is a great thing as first of all it asks us to have a conversation with a young person, as if they were an adult, about their medical treatment – the risks, benefits, possible side effects and what they think about all these things. Depending on age and level of understanding, a decision can then be made with or without their parents present and having input into the decision. Even if the young person prefers to have their parents involved, starting the conversation and having them think about their health and preferences from a young age is great to kick start responsibility and awareness for their health in general, as well as warming them to discussing things about their bodies and health with their doctor – we always want people to feel able to come and talk to us easily!! Also so we’re not just some scary people that give needles all time…

Interestingly, Gillick competence does not always hold if a young person decides to decline recommended or required medical treatment. In this instance, it is easier for a young person to be deemed able to consent to accept medical treatment, but not to refuse medical treatment – which can make things a bit tricky if it comes to this.

At the end of the day, as a doctor – I always want to make sure my patients, of any age, are as informed and comfortable as they can be about any medical treatment I or another health professional recommends to them. These discussions can take time, and a standard ’15 minute’ appointment with a GP won’t always allow for this thoroughness and completeness of discussion. My recommendation is always, if in doubt – book a long appointment! Then if you don’t need it there is no harm done, but gives everyone the space to talk about their feelings, thoughts and any concerns in detail.

As a ‘young person’ (ie if you’re under the age of 18) and want to see a doctor by yourself, you can. The doctor can decide if they want or need to talk to your parents, but it is important first and foremost that you have access and feel like you can talk to one if you need to about private things. From a practical point of view, you will need your Medicare card details to see a GP most of the time, but this can be searched on line sometimes in case of an emergency so if you don’t have it and need to see a doctor, it’s always better to just go!

 

Here are some further resources and reading about Gillick Competence and decision making for young people. Enjoy!

Involving young people in decision making https://www.preparingforadulthood.org.uk/downloads/young-people-and-family-participation/involving-young-people-in-decision-making.htm

Decision Making Skills
https://beyou.edu.au/fact-sheets/wellbeing/decision-making-skills

What is Gillick Competence? https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4962726/#cit0005

Youth Participation in Decision Making
https://www.un.org/esa/socdev/unyin/documents/ch10.pdf

 

PS Main photo credits – me as a ‘younger person’ (I’m still young 😉 ) in high school looking particularly fashionable at a ‘Night of the Notables’ presentation. I was horse mad at the time – hence the attire!

 

 

 

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