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When deciding whether a child is mature enough to make decisions, people often talk about whether a child is 'Gillick competent' or whether they meet the 'Fraser guidelines'. This factsheet briefly explains the meaning of these terms.
Gillick competency and Fraser guidelines refer to a legal case which looked specifically at whether doctors should be able to give contraceptive advice or treatment to under 16-year-olds without parental consent. But since then, they have been more widely used to help assess whether a child has the maturity to make their own decisions and to understand the implications of those decisions.
In 1982 Mrs Victoria Gillick took her local health authority (West Norfolk and Wisbech Area Health Authority) and the Department of Health and Social Security to court in an attempt to stop doctors from giving contraceptive advice or treatment to under 16-year-olds without parental consent.
The case went to the High Court where Mr Justice Woolf dismissed Mrs Gillick’s claims. The Court of Appeal reversed this decision, but in 1985 it went to the House of Lords and the Law Lords (Lord Scarman, Lord Fraser and Lord Bridge) ruled in favour of the original judgement 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."
The Fraser guidelines refer to the guidelines set out by Lord Fraser in his judgement of the Gillick case in the House of Lords (1985), which apply specifically to contraceptive advice:
"...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."
Lord Scarman’s comments in his judgement of the Gillick case in the House of Lords (1985) are often referred to as the test of "Gillick competency":
"...it is not enough that she should understand the nature of the advice which is being given: she must also have a sufficient maturity to understand what is involved."
He also commented more generally on parents’ versus children’s rights:
"Parental right yields to the child’s right to make his own decisions when he reaches a sufficient understanding and intelligence to be capable of making up his own mind on the matter requiring decision."
Since the Gillick case, legal, health and social work professionals continue to debate the issues of a child’s rights to consent or refuse treatment, and how to balance children’s rights with the duty of child protection professionals to act in the best interests of the child. Further court rulings, new legislation and revised guidance continue to amend the legal position.
Taylor, R. (2007) Reversing the retreat from Gillick? R (Axon) v Secretary of State for Health. Child and Family Law Quarterly, 19(1): 81-97.
Wheeler, R. (2006) Gillick or Fraser? A plea for consistency over competence in children: Gillick and Fraser are not interchangeable. British Medical Journal, 332(7545): 807.
Freely view abstract or access full text by subscription: British Medical Journal, 332(7545): 807.
DeCruz, S. P. (1987) Parents, doctors and children: the Gillick case and beyond. Journal of Social Welfare Law (March): 93-108.
Freely view abstract or access full text by subscription: Journal of Social Welfare Law (March): 93-108.
Children's Legal Centre (1985) Landmark decision for children's rights. Childright, 22: 11-18.
Gillick v West Norfolk & Wisbech Area Health Authority  UKHL 7 (17 October 1985) from the British and Irish Legal Information Institute (BAILII) website.
Gilmore, S. and Herring, J. (2011) 'No' is the hardest word: consent and children's autonomy. Child and Family Law Quarterly, 23(1): 3-25.
British Medical Association (2001) Consent, rights and choices in health care for children and young people. London: BMJ Publishing Group.