Gillick, Fraser and capacity

Question 1

What is Gillick competence?

Answer 1

Gillick competence applies in someone under the age of 16, who has capacity to consent to treatment or non-treatment

Question 2

How do you determine if someone’s Gillick competent?

Answer 2

To be “Gillick competent” the child or young person must have sufficientintellectual and emotional maturityto fully understand thenature of what is proposed, including therisksandbenefits, as well as thereasonable alternativesandconsequences of no treatmentat all.

Question 3

What questions would you consider to determine Gillick competence?

Answer 3

• Age of the child or young person
• Maturity and mental capacity
• Understanding of the issue and what it involves
• Advantages of treatment
• Disadvantages of treatment
• Understanding of risks and consequences of treatment and non-treatment
• Their ability to communicate their decision and the rationale behind it

Question 4

What are the Fraser guidelines?

Answer 4

Of note, the Fraser guidelines applyspecificallyto the provision ofcontraceptionandsexual healthadvice to a person under the age of 16 without parental knowledge or permission.

Question 5

What are the requirements to give someone under the age of 16 contraception?

Answer 5

1. They cannot be persuaded to inform their parents about the consultation, or allow the doctor to inform their parents/carers
2. They understand the content of the consultation
3. Their physical and/or mental health are likely to suffer unless they receive advice or treatment
4. It is in their best interests to receive advice without their parents/carers knowledge
5. They are likely to continue to have sex despite the outcome of the consultation

Question 6

What does thee mental capacity act state?

Answer 6

The Mental Capacity Act (MCA) is designed to protect and empower people who may lack the mental capacity to make their own decisions about their care and treatment. It applies to people aged 16 and over.

A patient is assumed to have capacity unless proven otherwise. Capacity is decision and time-specific.

If a patient lacks capacity, you must act in their best interests in the least invasive manner. An unwise decision does not mean the patient is lacking capacity.

Question 7

What are the four key parts of having capacity?

Answer 7

1. Patient understands the information
2. Patient can retain the information
3. Patient can weigh up the risks and benefits
4. Patient can communicate decision

Question 8

What is part of the information you give?

Answer 8

What a specific procedure entails
Why the patient should be getting the procedure

Risks
Benefits
Explains risks and consequences of NOT receiving a blood transfusion
Explains alternative management plans