There’s some real confusion about guidance and law relating to consent.
Gillick competence is concerned with determining a child’s capacity to consent. Fraser guidelines, on the other hand, are used specifically to decide if a child can consent to contraceptive or sexual health advice and treatment.
n law, a person's 18th birthday draws the line between childhood and adulthood (Children Act 1989 s105) - so in health care matters, an 18 year old enjoys as much autonomy as any other adult. To a more limited extent, 16 and 17 year-olds can also take medical decisions independently of their parents. The right of younger children to provide independent consent is proportionate to their competence - a child's age alone is clearly an unreliable predictor of his or her competence to make decisions.
In 1983 the judgement from the Gillick case laid out criteria for establishing whether a child under has the capacity to provide consent to treatment; the so-called ‘Gillick test’. It was determined that children under 16 can consent if they have sufficient understanding and intelligence to fully understand what is involved in a proposed treatment, including its purpose, nature, likely effects and risks, chances of success and the availability of other options.
A child may have the capacity to consent to some treatments but not others. The understanding required for different interventions will vary, and capacity can also fluctuate such as in certain mental health conditions. Therefore each individual decision requires assessment of Gillick competence. Rarely agreements cannot be reached and decisions are referred to the Court of Protection.
The ‘Fraser guidelines’ specifically relate only to contraception and sexual health. They are named after one of the Lords responsible for the Gillick judgement but who went on to address the specific issue of giving contraceptive advice and treatment to those under 16 without parental consent.
Each professional carrying out assessment of ability of a child to consent must also ensure the consent is free of coercion and there are no safeguarding concerns.
Deprivation of Liberty Safeguards only apply to over sixteens and relates to the Mental Capacity Act (2005). They are about restricting the freedoms of someone who has lost capacity to make decisions for themselves. Things like stopping people leaving care homes, the use of bed rails in hospitals, strapping someone in an armchair, the use of padded boxing gloves or taking away someone’s car keys might all need a DoLS application to the local authority.
Consent by children is not subject to the MCA. Parts of the Mental Health Act do apply to children. Children can be detained under the MHA with the same protection as adults.
Sometimes parents are able to consent for children up to eighteen years of age - if they were unconscious, for example. If they have long term conditions that affect capacity then parents can continue to consent for much longer. Otherwise at eighteen the rules about consent come into full force and nobody can consent for another person unless they have deputyship. In some complex situations children’s withholding of consent is overruled, but usually by a court.