Gillick Competence and the Fraser Guidelines
Gillick v West Norfolk and Wisbech AHA [1985], House of Lords
Summary
In 1985 the House of Lords considered whether doctors could give contraceptive advice to girls under 16 without parental consent. It ruled that a child under 16 can consent to their own treatment if they have enough understanding and intelligence to fully understand what is proposed — now called 'Gillick competence'. Competence depends on the individual and the decision: a young person may be competent to consent to a simple treatment but not a complex one. Lord Fraser set out specific guidelines for contraception: the young person understands the advice; cannot be persuaded to tell their parents or allow the doctor to; is likely to have sex with or without contraception; their health is likely to suffer without it; and it is in their best interests. Young people aged 16–17 are presumed able to consent to treatment. Safeguarding always applies: sexual activity involving a child under 13 must be treated as a child protection concern.
Why it matters at interview
Confidentiality and consent involving teenagers is a very common MMI station. Knowing Gillick and Fraser lets you balance autonomy, safeguarding and best interests accurately.
Key takeaways
- Under-16s can consent if Gillick competent for that decision.
- Fraser guidelines apply specifically to contraception and sexual health advice.
- Encourage involving parents, but a competent young person's confidentiality should be respected.
- Safeguarding concerns (e.g. under-13s, exploitation) override confidentiality.
How to use it
State the default (respect competent young person's confidentiality), the test (Gillick/Fraser), and the limits (safeguarding).