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How should Paediatricians assess Gillick competence?
  1. Victor F Larcher1,*,
  2. Anna Hutchinson2
  1. 1 Great Ormond Street Hospital, United Kingdom;
  2. 2 GOSH NHS Trust, United Kingdom
  1. Correspondence to: Victor F Larcher, c/o Symptom Care Team, Great Ormond Street hospital, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, United Kingdom; larchv{at}gosh.nhs.uk

Abstract

Children are Gillick competent if they are able understand information about medical treatment and to use it to make a free choice i.e give valid consent. The level of ability required is task dependent. Low impact decisions (on the child’s and family’s future welfare) require less ability but are important in developing competence. Formal tests of competence include a simple ability to choose, the exhibition of a reasonable or a rational choice, the ability to understand or actual understanding. The Gillick standard may require children have higher levels of competency than adults

Development of competence is linked both to a child’s neurodevelopmental and their experience and may be enhanced by information sharing and encouraging participation.

Formal testing of competence is likely to be requested when the child wishes to make a decision that others regard as not being in his/her best interests. Assessors should have skills in talking with children, understand the relevant test to be applied and avoid conflicts of interests. Assessments require understanding of the child in the context of their illness and their family and should facilitate enhancement of competence. They should be developmentally appropriate, explore systemic influences, and consider the child’s emotional state, cognitive development and ability to balance risks and benefits.

Responsibility for the overall assessment of Gillick competence lies with doctors but involvement of a psychologist or other independent third party should be considered when a child’s competence is the subject of serious concern or the decisions involved are complex or where there is conflict between the various parties involved.

All members of the multidisciplinary team have a duty to enhance the competence of children in their care.

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