• adolescent Health
• child psychiatry
• ethics

Gillick1 competence emerged from a dispute as to whether a teenage girl under 16 years of age could be entitled to give consent in relation to contraception. In 1986, the House of Lords found that if a child of this age had sufficient maturity and intelligence to understand the nature and implications of the proposed treatment, then she was competent to make that decision independently of her parents. Many potentially Gillick-competent children honour this legal right by ignoring it, preferring to acquiesce to the parental tendency to ‘lead’ the provision of consent.

By contrast, during conflict, Gillick is often discussed, and in almost every case, the dispute arises when the competent child rejects treatment, founded on her notional right to consent or refuse. The child does not agree with her doctor’s assessment of where her best interests lie. Such a refusal happens countless times each day in the NHS, in circumstances where no serious harm will turn on the decision. These will either (usually) end in the child acquiescing or occasionally a tactical withdrawal for both sides and a fresh attempt another day. But occasionally, when life or limb turns on this decision, a court will be approached, and will almost inevitably agree with the doctor that the blood transfusion or the feeding or organ transplant or the termination should proceed. In the sphere of mental illness, if the competent child refuses voluntary assessment or treatment, rapprochement will be more …