Thread by @TessaRDavis

In 1985 the Gillick judgment laid out how young people in the UK can consent to treatment without parental agreement.

12-15 year olds can now have the COVID vaccine.

They can consent even if the parents refuse.

These 5 points will help you understand Gillick competence: 🧵👇

But first, some definitions are key.

Most people know that when you become 18 you're considered an adult.

And when you're 16/17 you can consent to treatment just like an adult can.

But, unlike adults, at 16/17 if you refuse treatment it could, in some cases, be overridden.

What about under 16s?

Most people think that those under 16 can't make decisions without their parent's agreement, But they can.

Experts agree that this isn't about AGE. It's about CAPACITY

That's where Gillick competence comes in.

It changes how we can listen to young people

Point #1: Competence can be assessed.

Gillick competence assessment is based on:

• Maturity
• Understanding: the issues, risks, consequences, alternatives
• Ability to explain their reasons in their own words

Gillick unlocks the ability to consent without parental agreement

Point #2: Competence doesn't equal consent

Just as with adult consent, they need to be making the decision themselves.

Each issue needs to be considered on its own.

Importantly, if a young person is under pressure, then their consent won't be valid. Even if they have capacity.

Point #3: Competence is situational.

It's easy to assume that being competent for one decision means they are for all.

Competence can change if:

• the decision is more complex
• they are under lots of stress

Having capacity in ONE scenario doesn't mean they have it for all.

Point #4: The parents don't have to agree.

It's better to get parental agreement, but it's not necessary.

This guidance is in place explicitly so that parent decisions CAN be overruled if their child disagrees.

With so much bias out there, this gives young people more freedom.

Point #5: We must respect our young people

Finally the most important idea of all

We should be pleased our young people can have capacity to decide themselves

This means we

• Recognise their intellect
• Respect them as independent thinkers
• Recognise their societal value

TL;DR - 5 ideas to help you understand Gillick competence

• #1: Competence can be assessed
• #2: Capacity doesn't equal consent
• #3: Competence is situational
• #4: The parents don't have to agree
• #5: We should respect our young people

My 14yo will make her own decision

If you found this thread valuable:

1. Follow me for more threads on paediatrics + learning → @tessardavis

2. Here’s another similar thread you might enjoy:

https://twitter.com/TessaRDavis/status/1434825128681091074?s=20

29/30 of #ship30for30

And thanks to the RCPCH for their statement: rcpch.ac.uk/news-events/ne…

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Thanks to those who flagged that Scotland is slightly different (@dan_wilkes + @robmcd85).

Although the Gillick judgment did apply to Scotland as it was a House of Lords ruling, Scotland has its own statute that supercedes it.

Here's a great explainer:
bmj.com/rapid-response…