The Use and Abuse of “Gillick competence” in clinical practice.
Sarah Martin1, Queensland Children’s Hospital South Brisbane, Brisbane 1Queensland Children’s Hospital, South Brisbane, Brisbane, QLD, Australia
Abstract
The concept of “Gillick competence” is inconsistently applied in clinical practice.
My observations are that:
1. Young people are included inconsistently in decisions pertaining to their own health.
2. Clinicians’ understanding of the term “Gillick competence” is variable.
3. Often, young people are deemed “competent” when they agree with their treating clinician but “not competent” when they express an alternative opinion.
4. “Gillick competence” is sometimes approached as a yes/no question in health care but the reality of adolescent decision making is more nuanced. The current approach can lead to adolescents becoming disengaged from decisions pertaining to their health care and does not serve to support adolescents’ evolving autonomy.
5. The nexus between mental health and “Gillick competence” is a source of confusion.
6. In some cases, this leads to moral distress in clinicians who are not sure they are making the best decision for the adolescent.
Today, nearly 40 years since the original court case, the term “Gillick competence” still appears in clinical guidelines, textbooks and journal articles as “the answer” to adolescent decision making in health care. But it is not fit for purpose.
In this brief presentation, I plan to use examples from everyday clinical practice to demonstrate the limitations of “Gillick competence”.
Biography
Emergency physician and clinical ethics fellow at Queensland Children’s Hospital.
PhD candidate with the Australian Centre for Health law Research at the Queensland University of Technology.