When deciding whether a child is mature enough to make decisions, people often talk about whether a child is ‘Gillick competent’ or whether they meet the ‘Fraser guidelines’.
Gillick competency and Fraser guidelines refer to a legal case which looked specifically at whether doctors should be able to give contraceptive advice or treatment to under 16-year olds without parental consent. But since then, they have been more widely used to help assess whether a child has the maturity to make their own decisions and to understand the implications of those decisions.
Any Pharmacy Staff having a discussion with a young person under16 years old should gently explore the following details at each consultation. These should be fully documented and should include an assessment of the young person’s maturity, and whether they are acting voluntarily.
This Fraser Competency Form can be used as a check list for all services accessed by young people under 16, for example, EHC provision under PGD or Chlamydia treatment under PGD; Stop Smoking Adviser Service.
In terms of Safeguarding for commissioned Sexual Health services, pharmacists are expected to explore the nature of the relationship of the young person and the age of the partner. Refer to the EHC service Proforma.
Fraser Guidelines – Background
In 1982 Mrs Gillick challenged the lawfulness of Department of Health guidance that doctors could provide contraceptive advice and treatment to girls under the age of 16 without parental consent or knowledge in some circumstances.
The House of Lords (Lord Fraser) in 1985 upheld that a doctor could give contraceptive advice and treatment to a young person under the age of 16 if:
- she had sufficient maturity and intelligence to understand the nature and implications of the proposed treatment
- she could not be persuaded to tell her parents or to allow her doctor to tell them
- she was very likely to begin or continue having sexual intercourse with or without contraceptive treatment
- her physical or mental health were likely to suffer unless she received the advice or treatment
- the advice or treatment was in the young person’s best interests.