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Clarifying guidelines on Gillick competence

The recent study reported in Pulse (April 7), that a small minority of practices still refuse to give under-16s contraceptive advice without a parent being present, nearly 20 years after the Gillick ruling, makes sobering reading.

This may be partly because there is still a degree of uncertainty among GPs about assessing Gillick competence. It is certainly one of the commonest queries raised by doctors calling our medicolegal advice line.

We thought readers might find it useful to recap the advice given in the 1985 Gillick case which states that doctors are justified in giving contraceptive treatment to under-16s without parental consent if:

 · The child understands the doctor's advice

 · The doctor cannot persuade her to inform her parents or to allow the doctor to tell her parents she is seeking contraceptive advice

 · She is likely to begin or continue having sexual intercourse with or without contraception

 · Her physical and mental health are likely to suffer without contraceptive advice or treatment

 · Her best interests require the doctor to give her contraceptive advice or treatment without parental consent.

Of course Gillick confirmed the right of children under 16 to consent to treatment in their own right and does not just relate to provision of contraceptive treatment.

In assessing if a child is able to understand advice, GPs should bear in mind that children under 16 can truly consent to treatment only if they have sufficient maturity to understand its nature, purpose and hazards, including the consequences of not having the treatment. This ability will vary with age, the child and the nature of the treatment.

Dr John Gilberthorpe

Medicolegal adviser

MDU, London

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