A person aged 18 or over is recognised as an adult with full autonomy to make decisions about their health.
Those aged 16 and 17 years can also make independent decisions about their health. If they refuse treatment, the court can override this in certain situations (although this is rare).
Children under 16 can make treatment decisions, but only if they are deemed to have Gillick competence. There is no lower age limit for when children can make decisions about their health, although it is unusual to obtain consent from someone under 13. Refusal of treatment can be overridden to prevent significant harm.
The way this is often tested in exams relates to girls under 16 years seeking contraception from their GP. This is the scenario that originally established “Gillick competence” and the “Fraser guidelines”.
Gillick Competence
Gillick competence refers to a judgment about whether a child’s understanding and intelligence are sufficient to consent to treatment. Gillick competence needs to be assessed on a decision-by-decision basis, checking whether the child understands the implications of the treatment. Consent needs to be given voluntarily. When prescribing contraception to children under 16, it is important to assess for coercion or pressure, for example, coercion by an older partner. This might raise safeguarding concerns.
Fraser Guidelines
The Fraser guidelines are specific guidelines for providing contraception to patients under 16 years without having parental input and consent. They do not apply to other healthcare decisions. The guidelines were established by the House of Lords in 1985. To follow the guidelines, they need to meet the following criteria:
- They are mature and intelligent enough to understand the treatment.
- They can’t be persuaded to discuss it with their parents, or let the health professional discuss it.
- They are likely to have intercourse regardless of treatment.
- Their physical or mental health is likely to suffer without treatment.
- Treatment is in their best interest.
Children should be encouraged to inform their parents, but if they decline and meet the criteria for Gillick competence and the Fraser guidelines, confidentiality can be maintained.
Safeguarding When Providing Contraception
It is important to explore whether there is any possibility of coercion, abuse or exploitation. When this is suspected, confidentiality may need to be broken and a safeguarding referral made. Where safe, the child should be informed and supported in this process.
All sexual activity in children under 13 years is legally classified as non-consensual, requiring an immediate safeguarding referral, which will also lead to police involvement.
Last updated November 2025
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