0 MA CHILD CARE LAW AND PRACTICE MODULE

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MA CHILD CARE LAW AND PRACTICE
MODULE: LAW-40004 CHILDREN AND MEDICINE

Question 2. “A Gillick-competent child can consent to medical intervention but
does not have a valid right to refuse treatment.” Do you agree with this
statement? Critically defend your position.

Student ID: 17203559

WORD COUNT: 5,000 (excluding bibliography and front-page)

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2.1 INTRODUCTION
The essay will attempt to discuss whether a Gillick-competent child can consent to
medical intervention but does not have a valid right to refuse treatment. Unlike adults,
a minor is deemed to lack capacity to give consent to treatment, and that should only
be given by authorised person or court. For any consent to be valid, it must be granted
by a competent person who has the ability to make the decision. It is very unlikely that
a child in the first stage of development can consent to any important medical or
surgical treatment, in which case the father or mother must give their consent. The
legal position is that no medical treatment should be given without consent of any
patient whether minor or adult.

2.2 DEFINITION/CONCEPTS
Consent is the legal expression of the moral principle of autonomy.1 The law on
consent to medical treatment is based on the rights of self-determination (rights of an
individual to decides what is done with his/her body). The concept of consent has
three separate but related elements: autonomy, capacity, and voluntary. Richard
Harper (2014) argues that ‘Consent is the voluntary and continuing permission of a
patient to receive any medical treatment, based on an adequate knowledge of the
purpose, nature, likely effects and risks of that treatment including the likelihood of its
success and any alternatives to it’.2

1 Richard Griffith, What is Gillick competence? Human Vaccines & Immunotherapeutics. 2016 Jan; 12(1): 244-
247. 2 Richard Harper (2014: 3) Medical Treatment and the Law: Issues of Consent. Jordan Publishing: Bristol.

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In England NHS Trust v JB 2014, Justice Peter Jackson stated that:3

‘anyone capable of making decisions has an absolute right to accept or refuse
medical treatment, regardless of the wisdom or consequences of the decision.
The decision does not have to be justified by anyone. In the absence of consent
any invasion of the body will be a criminal assault. The fact that intervention is
well-meaning or therapeutic makes no difference’.

2.3 STATEMENT OF THE LAW
The English law recognises that children do not possess the same capacity to make
decisions as adults. With regard to children, consent of medical treatment should be
obtained from a number of sources and any treatment should not be undertaken
without such consent or authority. The person from whom consent may be obtained
are:
• Those with parental responsibility: usually one or both of the parents, unless
the responsibility has been allowed by the court in some different way or to a
third party;
• The child in question if he or she is over the age of 16 or is otherwise of sufficient
maturity or comprehension to take a decision if the relevant gravity;
• The court exercising inherent or statutory jurisdiction.

3 England NHS Trust v JB 2014, EWHC 342 (COP).

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• The Family Law Reform Act 1969
The Family Law Reform Act of 1969, provides that children over the age of 16 have
the power to consent to their own treatment. Section 8 of the 1969 Act states as
follows:4

“1) The consent of a minor who has attained the age of 16 years to any surgical,
medical or dental treatment which, in the absence of consent, would constitute a
trespass to his person, shall be as effective as it would be if he were of full age;
and where a minor has by virtue of this section given an effective consent to any
treatment it shall not be necessary to obtain any consent for it from his parent or
guardian.
2) In this section “surgical, medical or dental treatment” includes any procedure
undertaken for the purposes of diagnosis, and this applies to any procedure
(including, in particular, the administration of an anaesthetic) which is ancillary to
any treatment as it applies to that treatment.
3) Nothing in this section shall be construed as making ineffective any consent
which would have been effective if had not been enacted5.

Therefore, the consent of any child over the age of 16 is as valid as if given by an adult
patient. Parliament thus created the presumption that such children have the relevant
capacity. But clearly a child of that age has limited capacity as an adult.

4 Article 8, Family Law Reform Act of 1969. 5 Cited in Robert Francis QC and Christopher Johnstone (2001: 33) Medical Treatment: Decisions and the Law,
Butterworths, London, Dublin and Edinburg.

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• Section 48 of the Education Act 1944
Section 48 of the Education Act 1944,6 subsections 1 – 4 states that:
1) It shall be the duty of every local education authority to provide for the medical
inspection, at appropriate intervals, of pupils in attendance at any school or
county college maintained by them, and every local education authority shall
have power to provide for such inspection of senior pupils in attendance at any
other educational establishment maintained by them.
2) For the purpose of securing the proper medical inspection of the pupils in
attendance at any such school, college or other educational establishment, any
officer of a local education authority authorised in that behalf by the authority
may require the parent of any , pupil in attendance at any such school to submit
the pupil for medical inspection in accordance with arrangements made by the
authority, and may require any pupil in attendance at a county college or other
educational establishment maintained by the authority to submit to such
medical inspection; and any person who fails without reasonable excuse to
comply with any such requirement shall be liable on summary conviction to a
fine not exceeding five pounds.
3) It shall be the duty of every local education authority to make such
arrangements for securing the provision of free medical treatment for pupils in
attendance at any school or county college maintained by them as are
necessary for securing that comprehensive facilities for free medical treatment
are available to them either under this Act or otherwise, and every local
education authority shall have power to make such arrangements as aforesaid
6 Section 48, Education Act 1944

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with respect to senior pupils in attendance at any other educational
establishment maintained by them.
4) It shall be the duty of every local education authority to make arrangements for
encouraging and assisting pupils to take advantage of such facilities as
aforesaid:
Provided that if the parent of any pupil gives to the authority notice that he
objects to the pupil availing himself of any medical treatment provided under
this section, the pupil shall not be encouraged or assisted so to do.

• The Children Act 1989
The Children Act 1989, section 2(7),7 states that one parent with parental responsibility
can act alone and consent to treatment, without consulting or having to reach an
agreement with the other parent. However, the courts have stated that, in relation to
important issues, parents must consult. It is not clear precisely what issues might be
regarded as ‘important’. In Re J 2000 1 FLR 571,8 the court held that circumcision
was one of such issue. Where both parents with parental responsibility are unable to
reach an agreement, an application should be made to the court to determine the
issue.9

The Children Act 1989, section 3(5), states that a person with care of a child may do
‘what is reasonable in all circumstances of a case for the purpose of safeguarding on
promoting the child’s welfare’.10 The children’s welfare is the most paramount concern
7 Children Act 1989, section 2(7). 8 Re J 2000 1 FLR 571. 9 Children Act 1989, s.8. 10 Children Act 1989, section 3(5).

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of the courts. It also specifies that any delays in the system processes will have a
detrimental impact on a child’s welfare.

The law protects the health professionals from litigation of claims whether from their
patients, who may be a minor over the age of 16 or a ‘Gillick competent’ child under
that age, or from another person having parental responsibilities which include a right
to consent to treatment of the minor. Anyone who gives him consent may take it back,
but the health professional only needs one and so long as they continue to have one
they have the legal right to proceed.11

However, where a child is fluctuating between competence and incompetence, he/she
should be treated as incompetence.12 The primary concern here is that to ensure that
the law is workable. A hospital caring for a teenager who is competent to consent one
moment, and then incompetent the next, would be in a difficult position if it had to
assess the child continuity every time there were need to treat her/him.

2.4 CASE STUDY/CASE LAW: THE GILLICK COMPETENT CHILD
Mrs. Victoria Gillick wanted to raise her teenage daughters in accordance with her
deeply personal values. But her local authority issued guidance, which had been
drafted by the Department of Health and Social Security (DHSS) to GPs on
contraceptive advice for under 16’s. She challenged this guidance, and objected that

11 Re W (A minor) (1992) WLR 758.
12 Re R 1999 4 AII ER 177

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the advice infringed her rights as a parent, and would lead to what would be an
unlawful assault (Gillick v West Norfolk and Wisbech AHA 1985).13

The court held that: ‘It is abundantly plain that the law recognises that there is a right
and duty of parents to determine whether or not to seek medical advice in respect of
their child, and, having received advice, to give or withhold consent to medical
treatment.’ Nevertheless, the policy was capable of being lawful. A court could correct
unlawful advice given by a government department. A doctor could give such advice
to a girl under 16 where she would understand it, where she could not be persuaded
to involve her parents, she was likely to have sex irrespective of advice, her health
was at risk, and it was in her nest interests. A parent’s rights of control over a child
diminished as that child’s understanding grew approaching adulthood.

To be Gillick competent, the child must be:
a) Understand the nature and implications of the treatment, which would
include the likely effects and potential side effects;
b) Understands the implications of not pursuing the treatment, including the
nature, likely progress and consequences of any illness that would result
from not receiving the treatment;
c) Retain the above information long enough for the decision-making process
to take place; and
d) Be of sufficient intelligence and maturity to weigh up the information and
arrive at a decision.
13 Gillick v West Norfolk and Wisbech AHA 1985 UKHL.

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Following the court case in Gillick v West Norfolk and Wisbech AHA 1985,14 children
over the age 16 years were deemed to have the legal capacity to consent to medical
treatment, provided they can demonstrate sufficient maturity and intelligence to
understand and appraise the nature and implications of the proposed treatment,
including the risks and alternative courses of actions.

• FRASER GUIDELINES
Fraser guidelines was a reference to Lord Fraser’s involvement with the Gillick case.
He commented on the responsibility of doctors to ensure adequate capacity of children
specifically on receiving contraceptive prescription and advice. It makes no comment
on the capacity of children for any other treatments or procedure.

The Fraser Guidelines requires:
• The young person understands the advice being given.
• The young person cannot be convinced to involve parents/carers or allow the
medical practitioner to do so on their behalf.
• It is likely that the young person will begin or continue having intercourse with
or without treatment/contraception.
• Unless he or she receives treatment/contraception their physical or mental
health (or both) is likely to suffer.
• The young person’s best interests require contraceptive advice, treatment or
supplies to be given without parental consent.
14 Gillick v West Norfolk and Wisbech AHA 1985 UKHL.

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The Lord Fraser’s guidance is narrower and relates only to contraception. The
guidance includes the necessity to ensure that the girl understands the advice given
with respect to contraception, but otherwise concentrates on the desirability of parental
involvement and the enhanced risks of unprotected sex.

2.5 NECESSITY AND CHILD’S BEST INTEREST
There is only one test. The court’s prime and paramount consideration is the best
interests of the minor. The term ‘best interests’ is often used when treating children
and incompetent adult patients. In Re J (A Minor) (Wardship: Medical Treatment)
1990. 15 Lord Taylor stated that that the prime and paramount concern of the court
when dealing with children must be the best interests of the child in question. The
guiding principle of best interest seeks to ensure that treatment is only administered if
it benefits the child in question in some way. If this is not the case, then it may not be
the best interest to administer medical treatment.

In the decision in Portsmouth NHS Trust v Wyatt 2006 1 FLR,16 the Court of Appeal
set out the ‘intellectual milestone’ for the court consider what is best interests. They
are:
1) The judge must decide what is in the best interests of the child;
2) In doing so, the child’s welfare is a paramount consideration;
15 Re J (A Minor) (Wardship: Medical Treatment) 1990 3 All ER 930. 16 Portsmouth NHS Trust v Wyatt 2006 1 FLR.

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3) The judge must look at it from the assumed point of view of the patient;
4) There is a strong presumption in favour of the course of action that would
prolong life but that presumption is not rebuttable;
5) The term ‘best interest’ encompasses medical, emotional and other welfare
issues; and
6) The court must conduct a balancing exercise in which all relevant factors are
weighed.

In Re J (a minor): (Medical Treatment), (1992)17 an application was made for a
declaration allowing a hospital to treat a girl aged 16 years suffering from anorexia
nervosa against her wishes. During the appeal hearing, J’s condition deteriorated and
there was a serious risk of irreversible harm to her brain and reproductive organs. Mr
Justice Thorpe, decided that, although J was able to make an informed decision, the
court had jurisdiction to make orders concerning J’s medical treatment against J’s
wishes and authorised her treatment. Lord Justice Balcombe, said: ‘that the court
would approach its decision with a strong predilection to give effect to the child’s
wishes. Nevertheless, there must come a point at which the court could override the
child’s wishes in the child’s own best interests, objectively considered. Such a point
would have come if the child was refusing treatment in circumstances which would
probably lead to the child's death or to severe permanent injury’.18

17 Re J (a minor): (Medical Treatment) (1992) CA 1. 18 Ibid.

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2.6 PARENTAL RESPONSIBILITY
Minors are deemed to lack the capacity to consent, and therefore the consent for
treatment can be provided by anyone with parental responsibility for the child.
Parental responsibility is defined in the 1989 Children Act as “all the rights, duties,
powers, responsibilities and authority which by law a parent of a child has in relation
to the child and his property”.19 The 1989 Act specifies that more than one person can
have parental responsibility, although they can act alone in decision making for the
child.20 If a child does not have anyone to care for them with parental responsibility a
guardian can be appointed by the court.21 That appointment can be overturned on
application of the parent with parental responsibility, by the child or in family
proceedings.

The concepts of ‘parental rights’ (that a parent have a right to make decisions for their
children) has been replaced by the concepts of ‘parental responsibility’ introduced by
the s.3 Children Act 1989. In this section, parental responsibility includes all the rights,
duties, powers, responsibilities, and authority which by the law a parent of a child has
in relation to the child and his property22. In Re J 2000,23 it was held that circumcision
was one of such issue, as was the decision not the give a child the MMR vaccine.24

19 Children Act 1989, Part I, Section 3. 20 Children Act 1989, Part I, Section 2. 21 Children Act 1989, Part I, Section 5. 22 Wai-Ching Leung, Liam J. Donaldson (1997) Consent to Medical Treatment and Children. Clinical Risk 1997.
Volume: 3 Issue: 4, page(s): 114-118. 23 Re J 2000 1 FLR 517. 24 Re B 2003 EWCA Civ 1148.

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All mothers have parental responsibility for their children but not all fathers. Fathers
who are married to the mother or are registered on the child’s birth certificate do, but
otherwise a father will need to enter into a parental responsibility agreement with the
child’s mother, or apply to the court for parental responsibility order or residence
order.25 If those with parental responsibility do not consent to medical treatment, a
doctor may still be authorised to treat the child by order of the court, in an emergency,
under the doctrine of necessity.26

If the child’s parents are married both have parental responsibility; if they are
unmarried, the father does not automatically have parental responsibility however.27 A
father of a child, who was not married to the mother at the time of birth may apply to
the courts for parental responsibility, or this may be done through mutual agreement
between the mother (or child) and father.28

2.7 THE COURTS
The court conducts a balancing act with all pertinent expert evidence and other
evidence before it, so that the courts can decide whether or not the proposed treatment
is in the best interest of the child. Although, the opinion of the parents must also be
considered, however, they cannot prevail over the opinion of the court on the best
25 Children Act 1989, s.4. 26 Glass v UK 2004 I FCR 553. 27 Children Act 1989, Part I, Section 2. 28 Children Act 1989, Part I, Section 4.

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interests of the child.29 In assessing whether a child is competent or not, the court
should not reason that, because the decision is ‘wrong’, the child must lack capacity.

In Re E (Minor) 1993,30 the nature of the decision precluded an otherwise apparently
Gillick competent child. A teenager (E) was 15 years old Jehovah’s witness with
Leukaemia, who required blood transfusion as part of medical treatment. He refused
to consent blood transfusion and his parents refused also to consent. The matter was
referred to court, and the judge, Ward J concluded that E was a ‘boy of sufficient
intelligence to be able to take decisions about his own well-being, but also stated that
there are a range of decisions of which some are outside his ability fully to grasp their
implications’. The court then made a ruling the E was not of sufficient understanding
and intelligence and maturity to give a full and informed consent.31

In South Glamorgan CC v B 1993,32 the court held that a minor can be admitted to
a psychiatric care facility against her wishes if it is in the best interest of the minor. The
affected minor had been previously assessed by various psychiatrists and social
workers after she had refused to attend school and begun to lead a reclusive life. Their
recommendation had been that she be removed from her present home with her father
and be admitted into an adolescent unit where she could receive psychological
therapy. Following the divorce of her parents, the minor’s temperament and mental
health had seriously deteriorated. Although her father opposed these proceedings, her
29 Richard Harper (2014: 16). Medical Treatment and the Law: Issues of Consent. Family Law: Bristol. 30 Re E (Minor) 1993 1 FLR 386. 31 Robert Francis QC and Christopher Johnstone (2001: 34-25), Medical Treatment: Decisions and the Law.
Butterworths: London Dublin and Edinburgh. 32 South Glamorgan CC v B 1993 1 FLR 574.

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mother and the court appointed guardian both thought that psychiatric care was most
appropriate for the minor. The court agreed, stating that the best interests of the child
override any other considerations.

In Re R 1991 and R W 1992, the court held that a doctor need only one ‘flak jacket’
as a protection from potential protection. This means that a doctor can provide
treatment in any of the following situations:
• The Gillick competence child consents, but the parent objects;
• A parent with parental responsibility consents, but the Gillick competence child
objects; or
• The court authorises the treatment, despite the objections that the parent and
child.

If necessary, a reasonable level of force may be used to ensure that the treatment is
given to the child who is objecting.33

2.8 UNITED NATIONS CONVENTION ON THE RIGHTS OF THE CHILD 1990
The United Nations adopted the Convention on the Rights of the Child on 20th
November 1989. The United Nations Convention on the Rights of the Child 1990
(UNCRC) was ratified by the UK in 1991. The United Nations Convention on the Rights
of the Child (UNCRC, 1989) defines a child as anyone under the age of 18.34 UNCRC
33 Re C (Detention: Medical Treatment 1997 2 FLR 180. 34 United Nations Convention on the rights of the child adopted under general assembly resolution
44/25.1989.

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requires that childhood be recognized as a period of development and that our
domestic laws must be developed ‘in a manner consistent with the evolving capacities
of the child.

In the preamble the UN Convention states that any child, by reason of his physical and
mental immaturity, needs special safeguards and care, including appropriate legal
protection, before and after birth. Article 12 states that: ‘Parties shall assure to the
child who is capable of forming his or her own views the right to express those views
freely in all matters affecting the child, the views of the child being given due weight in
accordance with the age and maturity of the child’.35

2.9 ETHICAL CONSIDERATION
It is a fundamental principle of medical ethics that before treating a patient, a medical
professional should get the patient’s consent.36 Much as obtaining consent is now
viewed as an important mechanism for ensuring that individual autonomy is respected,
there are problems when dealing with children.

Consent is often regarded as the legal expression of the ethical principle of autonomy.
It is important that the consent obtained is truly informed; however, obtaining consent
can at times can be challenging. It is even more complex when engaging in consent
with children. For consent to be considered informed, Tymchuk (1997)37 indicates four
35 United Nations Convention on the rights of the child adopted under general assembly resolution 44/25.1989 36 Re B (Consent to Treatment: Capacity) 2002 EWHC 429, 2002 1 FLR 1090. 37 Tymchuk, A. J. (1997). Informing for consent: Concepts and methods. Canadian Psychology, 38(2), 55-75.

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additional criteria: an indication of choice, the reasonableness of the choice made
within the circumstances, adequate understanding, and adherence to a decision-
making process that minimally includes evaluation of risks and benefits of the
treatment process. Similarly, Croxton et al. (1988: 5)38 argues that “full explanation of
the potential risks and benefits of the proposed procedures along with the exploration
of alternative means of intervention”.

Where there is dispute between parents and doctors over medical treatment for
children, the parties should attempt to reach a compromise. If necessary, the court will
be required to resolve the dispute using the welfare principle as the guiding rule. When
making such decisions, the courts have emphasized that they will place weight on the
views of parents, but the guiding principle will be what is the best for the welfare of the
child.39

2.10 DISCUSSION
The concept of competence is fundamental to the consent in medical treatment. Under
the UK law, a Gillick competence child should have the ability to understand
information about the proposed treatment. This includes the purpose of the treatment,
the nature, the possible effects and risks, the possibilities of success and the
availability of any alternative. But then different patients can weigh the information
differently from their doctors. In addition, understanding does not imply that a decision
38 Croxton, T A., Churchill, S. R., ; Fellin, P. (1988). Counseling minors without parental con-sent. Child Welfare,
67(1), 3-14. 39 Re A (Conjoined Twins: Medical Treatment) 2001 1 FLR 1, 49E.

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is made on a rational basis. In fact, there are cases of critical decisions, and at times
is a matter of life and death or long-term effects if the child refused treatment.

Pearce, J (1994, p.713)40 argued about the consequences of withholding consent to
treatment that are usually much more significant and potentially dangerous than simply
giving consent. To him a more stringent test should therefore be applied when
assessing a child’s ability to refuse consent than when assessing competence to
consent. Pearce (1994, p.715) also said: ‘There is a danger of using ‘the best interests
of the child’ as an excuse for poor communication and for failing to take the necessary
time to explain the proposed treatment properly. At the same time there is also a risk
of placing an unacceptably high level of responsibility on the child which can release
parents from their own duty of care’.41

That brings the us to question whether a Gillick competent child has self-autonomy to
refuse treatment. It can be argued that the UK laws have tried to create a false notion
of autonomy and respect for rights of children allowing them to give their consent, but
would not allow them to refuse treatment. The law has been designed in a such way
that a Gillick competent child minor must exhibit an understanding of his/her illness
and the procedures to be undertaken. These allowances have been designed to permit
appropriate treatment or medical advice for minors who seek advice on contraceptive,
and where parental permission would violate the minors’ privacy and prevent them
from seeking crucial medical treatment or advice.
40 Pearce, J. (1994, p.713) Consent to treatment during childhood. The assessment of competence and
avoidance of conflict. British Journal of Psychiatry, 165, 713-716. 41 Ibid Pearce, J (1994, p.715).

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There are also other situations in which a Gillick competent child can be overruled by
the court. When he or she is in care, the local authority has parental responsibility and
can give their consent (parents also retain responsibility). In that case a Gillick
competent child will only receive treatment with the permission of the court (Re G-U
(A Minor) (Wardship)),42 and the court can use its inherent jurisdiction to overrule a
competent child who refuse treatment.

A doctor cannot be compelled to provide treatment to a competent child who is refusing
treatment, if this is not in the child’s best interest. However, doctors will be compelled
to administer treatment in case of emergency, either under the authority of the person
with parental responsibility or the court will exercise its inherent jurisdiction to authorise
medical treatment. In order to ensure consent is valid, the doctors need to be certain
of two important factors: the proposed treatment has been consented by the person
with parental responsibility and/or authorised by the courts.

Although an adult may refuse treatment even for no reason, that is not the case with
a Gillick competent child. There appears to be an irony or contradiction of whether a
Gillick competent child may refuse consent to treatment. If mature child consented to
treatment, the doctors will respect that decision. However, if the child refuse to
consent, then the doctors will reject it. It is almost if the law is saying ‘we will respect
children rights to autonomy, but only if they consent to treatment’. Rather than seeing
42 Re G-U (A Minor) (Wardship) 1984 FLR 811.

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children as competent to decides for themselves, it seems the law does is not very
clear.

The law also improperly sets far higher standards of competence for children than for
adults.43 If the child makes a decision which the court disagrees, then the child is
declared as lacking capacity. Whereas if the child agrees with the court, then the child
is declared competent. For example, where a child is expressing religious views as
the basis of refusal to consent to treatment, the courts are likely to regard the child as
lacking capacity44. The court will always base its decision on its view of the child’s
best interests.

Whereas the Family Law Reform Act 1969 s.845 allows 16 and 17-year-olds can
consent medical decisions independently of their parents, this is not always the case.
Depending on the nature of the proposed treatment, it must be ensured that the child
understands all the consequences of the decision from an ethical, philosophical,
moral, social and global perspective. If the child does not understand in such
perspectives, an interactive discussion on such repercussions should be made at the
child’s level so that the child becomes aware of such consequences as well.

The law establishes an arbitrary age to determine who is a competent child of Gillick.
While the age of maturity differs among children, there should not be an age limit after
which all children suddenly acquire competence. However, a child’s competence
43 Bridgman, J (2015) ‘Misunderstanding, threats, and fear, of the law in conflicts over children’s health care’,
Medical Law Review 23: 477. 44 Jonathan Herring (2016: 227) Medical Law and Ethics, Oxford University Press: Oxford. 45 Family Law Reform Act 1969 s8

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depends not only on age, but also on the severity of medical or emergency conditions.
What the doctors normally takes into account is nature the disease or treatment , which
is more important than age in acquiring competence for consent to the treatment. In
the end, it is really for health professionals who decide if the child is competent enough
to consent to treatment.

2.11 CONCLUSION
In concluding remarks, whereas the UK law recognizes that a Gillick
competent child may refuse consent to medical treatment but this may be
overruled by the courts. That means unlike the position of competent adults,
a refusal by the Gillick competent child, it is not binding, if the child is lacking
capacity to consent. In the absence of any such authority, it is unlawful to
treat a child unless the circumstances are such that is not possible to obtain
such consent and it is in the child’s best interests to have the treatment. Even
if both the child and their parents refuse treatment, the courts are reluctant
to accept it, especially if it is in the child’s best interest.

BIBLIOGRAPHY:
• Children Act 1989, Part I, Section 2.
• Children Act 1989, Part I, Section 3.
• Children Act 1989, Part I, Section 4.
• Children Act 1989, Part I, Section 5.

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• Children Act 1989, s.8.
• Children Act 1989, section 2(7).
• Children Act 1989, section 3(5).
• Croxton, T A., Churchill, S. R., & Fellin, P. (1988). Counseling minors without
parental consent. Child Welfare, 67(1), 3-14.
• England NHS Trust v JB 2014, EWHC 342 (COP).
• Family Law Reform Act 1969 s8.
• Gillick v West Norfolk & Wisbech AHA & DHSS 1983 3 WLR (QBD).
• Gillick v West Norfolk and Wisbech AHA 1985 UKHL.
• Glass v UK 2004 I FCR 553.
• Gustafson, K. E. & McNamara, J. R. (1987). Confidentiality with minor clients:
Issues and Guidelines for therapists. Professional Psychology: Research and
Practice, 18(5). 503-508.
• John Eekelaar, ‘The Emergence of Children’s Rights’ (1986) Oxford Journal of
Legal Studies 161.
• Jonathan Herring (2016: 227) Medical Law and Ethics, Oxford University Press:
Oxford.
• Kieran Cronin, The Furrow, Vol. 62, No. 7/8 (July/August 2011).
• NHS Trust v A, B, and C 2014 EWHC 1445.
• Pearce, J. (1994: 713) Consent to treatment during childhood. The assessment of
competence and avoidance of conflict. British Journal of Psychiatry, 165, 713-716
• Portsmouth NHS Trust v Wyatt 2006 1 FLR.
• Re A (Conjoined Twins: Medical Treatment) 2001 1 FLR 1, 49E.
• Re B (Consent to Treatment: Capacity) 2002 EWHC 429, 2002 1 FLR 1090.

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• Re B 2003 EWCA Civ 1148.
• Re C (Detention: Medical Treatment 1997 2 FLR 180.
• Re E (Minor) 1993 1 FLR 386.
• Re J (A Minor) (Wardship: Medical Treatment) 1990 3 All ER 930
• Re G-U (A Minor) (Wardship) 1984 FLR 811.
• Re J (A Minor): (Medical Treatment) (1992) CA 1.
• Re J 2000 1 FLR 517.
• Re J 2000 1 FLR 571.
• Re R 1999 4 AII ER 177.
• Richard Griffith, What is Gillick competence? Human Vaccines ;
Immunotherapeutics. 2016 Jan; 12(1): 244-247.
• Richard Harper (2014). Medical Treatment and the Law: Issues of Consent. Family
Law: Bristol.
• Robert Francis QC and Christopher Johnstone (2001) Medical Treatment:
Decisions and the Law. Butterworth: London, Dublin and Edinburgh.
• Section 48, Education Act 1944.
• South Glamorgan CC v B 1993 1 FLR 574.
• Tymchuk, A. J. (1997). Informing for consent: Concepts and methods. Canadian
Psychology, 38(2), 55-75.
• Wai-Ching Leung, Liam J. Donaldson (1997) Consent to Medical Treatment and
Children. Clinical Risk 1997. Volume: 3 Issue: 4.