top of page

Understanding Gillick Competence & Fraser Guidelines in Adolescent Care

Updated: Jul 26


What Are They?

  • Gillick competence: A broader legal and clinical standard determining whether a child (under 16) has the maturity and understanding to make informed medical decisions.

  • Fraser guidelines: A focused application of Gillick competence for sexual and reproductive health, guiding whether contraceptive or related advice can be provided without parental consent.


📌 When Are They Needed?

  • Gillick applies when a minor under 16 is making significant medical decisions—e.g., consenting to tests, procedures, abortion.

  • Fraser is specific to sexual/reproductive services (e.g., contraception, STI testing, emergency contraception).


Scenario 1: Contraception With a Classmate (Peer Relationship)


Context:

A 14-year-old girl, in a mutually consensual relationship with her classmate, requests hormonal contraception.


✔️ Apply Both Gillick & Fraser

  1. Gillick competence check Questions to ask:

    • “Can you tell me how this method works?”

    • “What are the possible side effects?”

    • “What might happen if you don’t use any contraception?”

    • “Can you explain why you’ve chosen this method?”

    Purpose: Assess her capacity to process information, weigh risks and benefits, and comply with instructions.

  2. Fraser criteria application Ensure all are met:

    • She demonstrates understanding.

    • She cannot be persuaded to tell her parents (and prefers confidentiality).

    • She is or likely to be sexually active.

    • Her health (physical/emotional) may suffer without contraception.

    • It’s in her best interests.

    Framing example: “If you're at risk of pregnancy and it might affect your health or life, can you tell me more about your understanding of this choice?”


Scenario 2: Contraception With a Teacher (Coercive Context)


Context:

A 15-year-old indicates sexual involvement with a teacher—an adult and non-consensual/illegal scenario.


🚨 Apply Safeguarding Priority Before Fraser

  • Regardless of competence or Fraser criteria, immediately initiate safeguarding procedures.

  • Do not focus on contraception or confidentiality until you have:

    1. Reassured her that she’s not at fault.

    2. Undressed your duty of confidentiality (unless risk of harm).

    3. Triggered child protection protocols.

🛑 Contraception is secondary—focus first on protection, safety, and legal duties.



Scenario 3: Teenage Pregnancy – Breaking the News

Context:

A 15-year-old presents with vomiting; a UPT confirms she’s pregnant, and no parent is present.


✔️ Use Gillick Competence

  • Not Fraser, since offering treatment or discussing options—not contraception.

  • Routine check for capacity to decide on pregnancy continuation or abortion:

    • “What do you understand pregnancy means at your age?”

    • “What are your thoughts or feelings about the results?”

    • “What are your options now, and how do you feel about each?”

    • “Do you feel pressured by anyone to make one decision over another?”


Communication approach:

  • Use a gentle structure: introduce, give news, pause, explore feelings, discuss options, check understanding.

  • Confirm Gillick competence through her coherent understanding of choices, consequences, and voluntary expressed decision-making.

  • Document the discussion, capacity assessment, decision, and reasoning.


🔁 Comparison Summary

Scenario

Gillick Competence Needed?

Fraser Guidelines Applicable?

Additional Actions

14y with classmate requesting contraception

✅ Yes

✅ Yes

Confidential counseling

15y coerced by teacher for contraception

❗ Not yet

❗ Not applicable

Safeguarding protocols

15y pregnant, deciding on abortion/options

✅ Yes

❌ No

Informed consent documentation


🛠️ Handy Question Prompts for Clinical Use


Gillick Competence:

  • “Can you tell me in your own words…?”

  • “What do you understand about the risks and benefits?”

  • “Who is helping you with this decision, and do you feel pressured?”

  • “Are you comfortable with this decision?”


Fraser Guidelines (if allowed from safeguarding assessment):

  • “Could you tell me why you're seeking contraception now?”

  • “What do you know about how it works and possible side effects?”

  • “Do you feel able but unwilling to involve your parents right now?”

  • “How might your life be affected if we couldn’t proceed?”


✅ Key Takeaways for PLAB 2

  1. Safeguarding always comes first when coercion or abuse is suspected.

  2. Gillick competence is essential in:

    • Contraceptive decisions (with Fraser)

    • Pregnancy options (without Fraser)

  3. Fraser only adds relevance when contraception/sexual health is involved and no abuse risk.

  4. Documentation matters:

    • Summarize rationale, patient’s understanding, decision capacity, and next steps.

  5. Pauses and empathy enhance clarity and patient trust.




📚 References

Comments

bottom of page