Gillick Competency and Implied Consent

(A new page from my health resource, Informed Consent Matters, including a template letter to send to schools.)

If you are a parent or carer of a child under 16, then Gillick competency and implied consent are very important concepts to be aware of, especially once your child becomes secondary school-aged.

The Gillick competency ruling, a landmark legal case from the 1980s, effectively allows children as young as 12 (and sometimes younger) to consent to their own medical treatment, without the consent (or even knowledge) of a parent or guardian. Please note that there is no official lower age limit to Gillick competency, so theoretically, it could be applied to a child of any age.

The Gillick competency ruling was initially instated in a bid to protect vulnerable children from risking an underage pregnancy, by allowing them to acquire contraceptives without their parents' permission. 

Although this ruling initially only pertained to contraceptives, since the Gillick competency ruling was passed in 1985, the definition has been expanded to include other forms of medicine, too.

That means that, legally, a child under 16 may now consent to their own medical treatment, without parental knowledge or agreement, "if they're deemed to have the maturity and understanding to be capable of making decisions about their own health and medical treatment."

What this means in practice is that providers of medical interventions such as vaccination can (and do) administer vaccinations to children without informing their parents - and that there are not typically legal consequences to them for doing so, because they will claim they judged the child to be "Gillick competent" to make their own decisions.

Of course, children are highly susceptible to pressure and manipulation from older, more experienced adults - which is precisely why we have age-based consent laws to protect them - so it is not at all uncommon for school immunisation teams to pressurise a child into receiving a vaccination they do not want, and which their parents have expressly declined.

Informed Consent Matters is aware of many instances where underage children have been coerced into receiving vaccinations at school in this way, and we know that there is often also immense pressure on children from teachers and classmates to receive injections. One teacher that we are aware of asked a 12-year-old girl, in front of all her classmates, if she "wanted to get cancer" when she declined the HPV vaccination.

Clearly, the manipulation and coercion of children in this way is completely unethical, but unfortunately, it is hard to prove it is illegal (as challenged authorities will simply claim the child was Gillick competent and consented, whether this is true or not), so parents must be fully informed of the fact that it is possible for their underage children to receive vaccinations and other medical processes without their permission or even knowledge.

Therefore, it is crucial to talk to your child about how to deal with a situation where they may find themselves being pressured into medical interventions they do not want, and to take measures to prevent them from being in this position - which is especially important in the context of a concept known as "implied consent".

In a document entitled. 'Considerations regarding consent in vaccinating children and adolescents between 6 and 17 years old', the World Health Organisation (WHO), states:

"Implied consent [is a] process by which parents are informed of imminent vaccination through social mobilization and communication, sometimes including letters directly addressed to the parents. Subsequently, the physical presence of the child or adolescent, with or without an accompanying parent at the vaccination session, is considered to imply consent. This practice is based on the opt-out principle and parents who do not consent to vaccination are expected implicitly to take steps to ensure that their child or adolescent does not participate in the vaccination session. This may include not letting the child or adolescent attend school on a vaccination day, if vaccine delivery occurs through schools."

This means that, according to the WHO, parents are consenting to vaccination simply by sending their children to school on the day the vaccination is taking place, even if the parents have not signed, or even read, a consent form.

This makes it clear that, for parents who do not wish their children to receive certain vaccines, keeping your child off school on the day of the vaccination is essential: but it also means being vigilant about so-called "catch-up clinics", where immunisation teams re-visit schools to "catch up" children who did not receive the vaccination on the initial visit. 

Schools do not always explicitly inform parents when these catch-up clinics are taking place, so it's important to discuss this possibility with your child and arrange a plan of action should a "catch-up clinic" occur at their school.

Informed Consent Matters recommends that, if you do not want your child vaccinated without your permission, that you contact your child's school at the beginning of the school year with a letter stating you do not consent to your child receiving vaccinations at school. 

In this letter, include a signed statement from your child, stating that they do not consent to vaccinations and therefore, if any are administered at school without parental knowledge and consent, these will have been administered under coercion and duress, and as such, the school should expect the appropriate legal action to follow. 

Most schools will honour a parental request of this nature once they are aware there could be severe repercussions for them if they do not. 

Please see here for template letter to send to schools.

We hope this information has been useful in further clarifying the concepts of Gillick competency and implied consent, and will help empower you to make the right choices for your family.

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