Medicine Interview: Hot Topics - Gillick Competence and Fraser Guidelines

Medicine interviews are an essential part of the medical profession, and aspiring medical professionals must prepare for them diligently. One of the topics that frequently comes up in these interviews is the Gillick competence and Fraser guidelines. In this article, we will explore the Gillick competence and Fraser guidelines, their significance, and how they impact the practice of medicine.

What is the Gillick Competence?

The Gillick competence is a term used to describe the legal concept of a child’s right to make decisions regarding their medical care without the consent of their parents or guardians. 

This concept was established in a 1985 legal case in the United Kingdom, where a mother challenged the right of doctors to prescribe contraception to her underage daughter without her knowledge or consent.

The House of Lords ultimately ruled that the doctor could provide contraception to the underage girl without her mother’s consent if the doctor believed that the girl had sufficient understanding and intelligence to make her own decisions regarding her medical care. 

This ruling led to the development of the concept of Gillick competence, which established that children who are deemed mature enough to make informed decisions regarding their medical care could do so without their parents’ consent.

Medicine MMI Circuits

Experience real-life medicine MMIs, with individual feedback on each station to prefect your answers

Buy Now

Why is it important in the medical field?

When responding to this question, it’s essential to provide a concise definition of Gillick competence, emphasising its significance in allowing underage patients to make decisions about their medical care without the interference of their parents or guardians. You could also mention the legal precedent set by the Gillick case in the UK and how it has influenced medical practice worldwide.

How do healthcare professionals determine whether a minor is Gillick competent?

When assessing a child’s capacity to give consent, there is no standardised set of questions used to evaluate their Gillick competency. However, healthcare professionals should take into account the following factors:

• The child’s age and level of maturity
• The child’s mental capacity
• Whether the child understands the nature of the treatment, including its benefits, risks, and long-term effects
• Whether the child comprehends the potential consequences of their decision
• Whether the child has fully understood the information and advice provided
• Whether the child is aware of alternative options, if available
• Whether the child is able to articulate the reasoning behind their decision-making process

It is important to note that a child’s understanding of various treatments can differ, and their capacity may fluctuate over time. As a result, decisions regarding Gillick competency must be evaluated on a case-by-case basis.

What are the Fraser Guidelines?

The Fraser guidelines are a set of guidelines developed in 1985 by the Royal College of Obstetricians and Gynaecologists in the United Kingdom. These guidelines were developed in response to the Gillick competence ruling and were intended to provide guidance for healthcare professionals who are working with underage patients who are seeking contraception or other forms of sexual health care.

These guidelines are meant to determine whether it is appropriate to provide contraceptive advice or treatment without parental consent. 

The Fraser Guidelines are based on several criteria:

1. The minor must have sufficient maturity and intelligence to comprehend the nature and consequences of the proposed treatment.
2. The minor cannot be convinced to disclose the treatment to their parents or permit the physician to do so.
3. The minor is highly likely to initiate or continue sexual activity, regardless of whether or not they receive contraceptive treatment.
4. The minor’s physical or mental health is at risk if they do not receive the advice or treatment.
5. The advice or treatment provided is in the best interests of the minor.

The Fraser guidelines state that healthcare professionals should provide contraception and other forms of sexual health care to underage patients without their parents’ consent if the healthcare professional believes that the patient is likely to continue having sex and that their physical or mental health could be adversely affected by not receiving the care they need.

The guidelines also state that healthcare professionals should encourage underage patients to involve their parents or guardians in their healthcare decisions wherever possible. Still, ultimately, the patient’s right to confidentiality and privacy should be respected, and the healthcare professional should make a judgment based on the patient’s best interests.

Applications of Fraser Guidelines & Gillick Competency

The application of Fraser guidelines and Gillick competency varies depending on a child’s age. Here’s what you need to know:

Under 13

There is no minimum age for Gillick competency or Fraser guidelines to be relevant. Typically, parents are involved in decisions regarding treatment for children under the age of 13 as it is deemed unsafe and inappropriate for children to make such decisions on their own.

When it comes to contraception and sexual health, any information regarding sexual activity is taken seriously regardless of the child’s competence, as children under the age of 13 are unable to legally consent to sexual activity.

Under 16

If someone under the age of 16 shares information that raises concerns about their safety, the following should be considered:

• If the child is Gillick competent and disclosing the information is deemed essential for their protection, healthcare professionals should report their concerns through safeguarding measures.
• If the child is not Gillick competent, healthcare professionals are required to escalate their concerns through safeguarding measures.
• If both cases apply, the child must be informed unless doing so poses a significant risk to their safety.
• If the concerns are escalated, the police or local authority may be consulted to decide whether it is in the child’s best interests to inform their parents. However, there may be instances where informing the parents is not in the child’s best interests.

Between 16 and 17

Individuals aged 16 to 17 have the legal capacity to give consent to medical treatment. However, unlike adults, their refusal of treatment can be overridden by a court or someone with parental responsibility. 

This is because of the obligation to act in the best interests of the young person, which includes situations where their refusal of treatment could result in death or irreversible harm, whether mental or physical.

Examples of the Gillick competence and Fraser guidelines in practice:

The Gillick competence and Fraser guidelines are essential in ensuring that underage patients have access to the medical care they need without the interference of their parents or guardians. 

Here are some examples of how these concepts are applied in practice:

Example 1: A 16-year-old girl seeks contraception from her doctor. She tells the doctor that she does not want her parents to know about contraception and that she is mature enough to make her own decisions regarding her sexual health. 

The doctor assesses the girl’s understanding and intelligence and determines that she is competent to make decisions regarding her medical care. The doctor then provides the contraception to the girl without her parent’s knowledge or consent, in accordance with the Gillick competence.

Example 2: A 14-year-old boy seeks treatment for a sexually transmitted infection (STI). The boy tells the healthcare professional that he does not want his parents to know about the STI and that he is afraid of their reaction. 

The healthcare professional assesses the boy’s understanding and intelligence and determines that he is competent to make decisions regarding his medical care. The healthcare professional then provides the treatment to the boy without his parent’s knowledge or consent, in accordance with the Fraser guidelines.

In summary, when responding to questions about Gillick competence in medical school interviews, it’s essential to demonstrate an understanding of its definition, significance, and limitations, as well as the ethical considerations involved in its application. By doing so, you can show that you have a well-rounded understanding of this important topic and are equipped to handle complex ethical issues in your future medical practice.

Conclusion:

In conclusion, the Gillick competence and Fraser guidelines are essential concepts in the practice of medicine, particularly in the area of sexual health care for underage patients. 

These concepts ensure that underage patients can make informed decisions regarding their medical care without the interference of their parents or guardians. Healthcare professionals must be aware of these guidelines and apply them appropriately in their practice to ensure that patients receive the care they need while also respecting their rights to confidentiality and privacy.

FAQs

→ What are the limitations of Gillick competence?

It’s important to acknowledge that there are limitations to Gillick competence. For example, it only applies to medical decisions, and minors may not have the same level of legal rights as adults. In addition, there may be cases where it’s not clear whether a minor is competent to make a particular medical decision, and healthcare professionals may need to seek further guidance from legal or ethical experts.

→ What ethical considerations are involved in applying Gillick competence in practice?

When responding to this question, you could mention some of the ethical issues that may arise in the context of Gillick competence, such as the potential for conflict between the minor’s rights and their parents’ wishes, the risk of harm to the minor if they make an uninformed decision, and the need to balance the minor’s autonomy with their best interests. 

You could also discuss how healthcare professionals can navigate these issues while upholding their professional and ethical obligations.

→ How do the Fraser guidelines relate to Gillick competence?

In response to this question, you could explain how the Fraser guidelines were developed in response to the Gillick competence ruling and provide an overview of their key principles, such as the importance of respecting minors’ rights to confidentiality and privacy while also encouraging them to involve their parents or guardians in decision-making wherever possible.