This is a UKMLA-centred article about the Fraser guidelines.

Introduction

As future healthcare providers, medical students bear a responsibility to respect and safeguard the rights of their patients, especially when it comes to sensitive matters such as consent for medical treatment. Fraser guidelines, established in 1985, serves as a crucial ethical framework that outlines the principles guiding the assessment of a young person’s capacity to provide consent for medical treatment, including contraception and abortion.

In the UK, adults, defined as patients over the age of 18 are legally regarded as competent therefore able to make decisions regarding their health. For a patient between 16 and 18 years old, consent can be obtained from themselves or a legal guardian. It is important to note that these rules only apply to acceptance of a medical treatment, and generally only individuals over the age of 18 can deny treatment.

How to assessing capacity

Children under the age of 16 can consent to medical treatment if they are deemed to have sufficient judgement to thoroughly understand the terms to what is proposed. In making this judgement, there are a set of criteria which must be fulfilled:

1. Sufficient Age and Maturity: The individual must be of an age and maturity level where they can fully understand the information and implications related to the proposed medical treatment or intervention.

2. Understanding of the Information: They must have a clear understanding of the nature, purpose, and potential risks and benefits of the treatment, as well as the likely consequences of not undergoing the treatment.

3. Ability to Retain Information: The person must be able to retain the information provided to them and use it to make a rational decision. This implies that they can remember and consider the relevant details over a reasonable period of time.

4. Ability to Weigh Options: The individual should demonstrate an ability to weigh the potential benefits against the potential risks and make a reasoned decision based on this assessment.

5. Freedom from External Pressure or Coercion: It must be evident that the person’s decision is made freely, without any undue pressure or influence from external parties, including parents, guardians, or healthcare providers.

6. Capacity to Communicate Decision: The person should be able to effectively communicate their decision, whether it be consent or refusal, to the healthcare provider.

Conclusion

It is important to note that Gillick competence is specific to each individual and the context of the proposed medical treatment. A person may be deemed Gillick

competent for one type of treatment but not for another, depending on their level of understanding and maturity regarding each specific situation.

As healthcare professionals, it is important to keep accurate records of the discussions with patients, including documentation of capacity at given points in time. As the capacity for informed consent may evolve over time, healthcare professionals should re-assess the young person’s ability to make decisions about their health, which underlies the core principles of medical practice.

References

1. https://learning.nspcc.org.uk/child-protection-system/gillick-competence-fraser-guidelines

2. https://www.nhs.uk/conditions/consent-to-treatment/children/

3. https://www.bing.com/search?q=gillick+competence&cvid

Author – Mohona Sengupta  

Editor – James Mackintosh

Last updated 10/10/23