Medicine Interview Hot Topics: Gillick Competence
Gillick competence originated in the UK, and is used to decide whether a child under the age of sixteen is able to make informed decisions and consent to their medical treatment without the need for approval or consent from parents. In fact, if a child is Gillick competent, their parents do not even need to be informed about the treatment which will take place. By UK law, over eighteens are considered adults able to make informed decisions; sixteen and seventeen year olds are still considered minors, but it is assumed that they are able to make decisions about their own health. Gillick competence is therefore only applicable in the under sixteens, where there is a question mark as to whether a child is able to make informed decisions.
The Fraser Guidelines are a set of rules which specifically are only applicable to contraception and sexual health in the under sixteens. They are used to tackle whether to give contraception/ sexual health advice without parental consent. The guidelines are:
- He/she has sufficient maturity and intelligence to understand the nature and implications of the proposed treatment
- He/she cannot be persuaded to tell her parents or to allow the doctor to tell them
- He/she is very likely to begin or continue having sexual intercourse with or without contraceptive treatment
- His/her physical or mental health is likely to suffer unless he/she received the advice or treatment
- The advice or treatment is in the young person’s best interests.
Potential Questions that could be asked about Gillick Competence in Medical School Interviews:
- What does the law say about children under the age of 16 giving consent for treatment?
- What are the issues surrounding Gillick competence?
- Why might people argue against Gillick competence?
- You are a doctor with a 13-year-old patient who is pregnant and wants an abortion. She does not want her parents to find out. What would you do in this scenario?
- Outline arguments for and against Gillick competence
How to answer questions involving Gillick Competence
In general, questions directly addressing Gillick Competence are rare. The concept of Gillick Competence is, however, a useful tool to demonstrate to interviewers that you are aware of issues surrounding consent. Therefore, to answer questions involving consent, the principles of medical ethics must once again be used to build a strong and balanced argument. Taking the example above about the pregnant 13-year-old, it would be important to show a clear understanding that there are arguments for and against using the Gillick test, but in this situation, this is the best course of action in order to maintain confidentiality. This ties in with patient autonomy, as, if the she passes the Gillick test, then she is considered competent enough to have autonomy over her treatment. The factors of beneficence and non-maleficence must also be considered, however, as if the girl comes from a highly orthodox family, then this may not be tolerated and the outcomes may be worse by informing the parents. In this way, different principles must be considered and then used to structure a coherent answer.
How to Include Gillick Competence in your Interview
Gillick competence is something that can only be applied when directly asked a question about consent and confidentiality in a child under the age of sixteen. It is therefore very important to identify the opportunity to talk about Gillick Competence and use it to demonstrate your knowledge of consent. In this way, it is possible to direct the conversation to the topics that you are most comfortable talking about, and Gillick competence is an easy tool to use to show off your awareness of modern issues. Questions surrounding Gillick Competence and consent are often relevant to the principles of medical ethics, so be sure to include these in your answers!
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