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How should paediatricians assess Gillick competence?

Vic Larcher1, Anna Hutchinson

  • 1Consultant in Paediatrics and Clinical Ethics, Great Ormond Street Hospital NHS Trust, Great Ormond Street, London WC1N 3JH, UK. larchv@gosh.nhs.uk

Archives of Disease in Childhood
|December 2, 2009
PubMed
Summary

Assessing a child's capacity to consent to medical treatment requires understanding their cognitive ability and experience. Professionals have a duty to support and evaluate a child's competence, especially for complex decisions.

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Area of Science:

  • Medical Law
  • Pediatric Healthcare
  • Bioethics

Background:

  • Valid medical consent is a legal necessity.
  • Children under 16 may possess decision-making capacity, known as 'Gillick competence', requiring assessment.
  • Assessing competence is context-dependent and linked to cognitive abilities.

Purpose of the Study:

  • To outline the principles and practices for assessing a child's competence to consent to medical treatment.
  • To highlight the professional duty to enhance children's decision-making capacity.
  • To guide professionals on when and how to assess competence, particularly in complex or disputed cases.

Main Methods:

  • Review of legal and ethical frameworks for medical consent in minors.
  • Exploration of factors influencing competence, including cognitive development and experience.
  • Consideration of assessment strategies and the role of third parties.

Main Results:

  • Competence assessment is multifaceted, requiring consideration of the child's social, medical, emotional, and cognitive context.
  • Professionals are obligated to foster competence through education and support.
  • Developmentally appropriate assessments are crucial, exploring systemic influences and risk-benefit analysis.

Conclusions:

  • Assessing a child's competence for medical consent demands a holistic, context-specific approach.
  • Involving independent third parties, such as psychologists, may be necessary for complex cases or disputes.
  • The ultimate goal is to ensure legally valid consent while protecting the child's best interests.