Gillick Competence - Fraser Guidelines

Fraser Guidelines

It is lawful for doctors to provide contraceptive advice and treatment without parental consent providing certain criteria are met. These criteria, known as the Fraser Guidelines, were laid down by Lord Fraser in the House of Lords' case and require the professional to be satisfied that:

• the young person will understand the professional's advice;
• the young person cannot be persuaded to inform their parents;
• the young person is likely to begin, or to continue having, sexual intercourse with or without contraceptive treatment;
• unless the young person receives contraceptive treatment, their physical or mental health, or both, are likely to suffer;
• the young person's best interests require them to receive contraceptive advice or treatment with or without parental consent.

Although these criteria specifically refer to contraception, the principles are deemed to apply to other treatments, including abortion. Although the judgement in the House of Lords referred specifically to doctors, it is considered to apply to other health professionals, including nurses. It may also be interpreted as covering youth workers and health promotion workers who may be giving contraceptive advice and condoms to young people under 16, but this has not been tested in court.

If a person under the age of 18 refuses to consent to treatment, it is possible in some cases for their parents or the courts to overrule their decision. However, this right can be exercised only on the basis that the welfare of the young person is paramount. In this context, welfare does not simply mean their physical health. The psychological effect of having the decision overruled would have to be taken into account and would normally be an option only when the young person was thought likely to suffer "grave and irreversible mental or physical harm". Usually, when a parent wants to overrule a young person's decision to refuse treatment, health professionals will apply to the courts for a final decision.

An interesting aside to the Fraser guidelines is that many regard Lord Scarman's judgment as the leading judgment in the case, but because Lord Fraser's judgment was shorter and set out in more specific terms - and in that sense more accessible to health and welfare professionals - it is his judgment that has been reproduced as containing the core principles.