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Fraser GuidelinesGillick Competence

Safeguarding

Sean Botham

Fraser Guidelines

What are they for? [3]

To ascertain if a Doctor is justified in proceeding with a consultation / treatment regarding contraception, without the parent’s consent or even knowledge.

Fraser Guidelines apply specifically to contraceptive advice / treatment.

Criteria

For a doctor to be justified in doing this, certain criteria must be met. List them. [5]

1. The girl (despite being < 16 years of age) understands the advice being given.

2. He / she cannot persuade her to inform her parents or to allow him to inform them that she is seeking contraceptive advice.

3. That she is likely to begin / continue sexual intercourse with or without contraception.

4. That unless she receives contraceptive advice / treatment, her physical or mental health (or both) will suffer.

5. That her best interests require him to give the contraceptive advice, treatment or both without parental consent.

If these Guidelines are met…

Patient = GILLICK COMPETENT.

Treatment can continue without parent’s consent / knowledge.

Gillick competency + Fraser Guidelines help us to balance children’s rights and wishes with our responsibility to keep

children safe from harm.

How is Gillick Competency Assessed? [3]

Gillick-competent under-16s should have:

Sufficient understanding + intelligence to be capable in making up his/her mind on the matter requiring decision.

Sufficient maturity to understand what is involved.

Parental rights yield to the child’s rights to make their own decisions when they reach a sufficient understanding and intelligence capable of making up his / her own mind

on the matter requiring decision.

Who can Consent for Minors? [4]

1. 16 – 17 year olds.

(Unless they lack capacity…presumption of capacity from age 16)

2. Gillick-competent under 16 year olds.

3. Person / local authority with parental responsibility.

4. Courts.

What makes this consent valid? [3]

• Must be given voluntarily.

• Person giving consent must be appropriately informed.

• Person must have the capacity to consent to the intervention in question.

What are the 4 categories of abuse? [2]

1. Physical

2. Neglect

3. Emotional

4. Sexual

More of a spectrum, with considerable overlap.

What is Neglect? [1]

Failure to meet the physical, emotional, educational or social needs of an individual.

How can Neglect Present? [5]

1. Poor health (hygiene, diseases, no access to healthcare).

2. Poor nutrition (faltering growth).

3. Lack of supervision (accidents / injuries).

4. Lack of stimulation (developmental delay, poor school attendance).

5. Lack of affection (withdrawn / craving attention).

Give 5 markers of emotional abuse. [5]

1. Developmental delay.

2. Social immaturity.

3. Aggression.

4. Attention difficulties.

5. Educational failure.

Give 5 ways that sexual abuse can present. [5]

1. Pregnancy.

2. STI.

3. Trauma.

4. Odd behaviours (withdrawal / self-harm / enuresis / encopresis).

5. Unusual sexual behaviour / knowledge.

Enuresis = involuntary urination, especially at night

Encopresis = involuntary defecation especially associated with emotional disturbance /

psychiatric disorder.

What is triad of safeguarding + promoting welfare in children? [3]

ChildSafeguarding

and promoting welfare

Child

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velo

pmen

tal n

eeds Parenting capacity

Family and environmental factors