Break it down for me Gillick Competence and Fraser Guidelines

[FemaleAndLearning]

Could we have a break it down for me style of thread on Gillick and Fraser? I see transactivists saying that because Starmer said in the interview with Mumsnet that he doesn't think children should be socially transitioned without consent of patents that this means he doesn't understand Gillick Competence or wants to get rid of it thus preventing under 16s accessing the contraceptive pill and abortions without their parents consent. But contraception seems to come under Fraser Guidelines not Gillick?

My understanding is that Gillick Competence is for medical procedures. The Cass Review cass.independent-review.uk/publications/interim-report/ says that social transitioning is not a neutral act and should occur under medical supervision (from memory). So is social transition a medical procedure? How does this relate to the Kiera Bell case where accusations of breaching Gillick Competence have also been made.

I found this by the NSPCC
learning.nspcc.org.uk/child-protection-system/gillick-competence-fraser-guidelines#article-top
But it doesn't give a lot of examples and given the case law around this would suggest this is not a clear cut piece of legislation.

It would be really useful to have a clear thread on this subject that can be referred to and used to back up discussions. Thank you.

Thank you everyone so far this has really helped my understanding. I think the propaganda and clear misinformation from activists is blurring this for many people.

I didn't know Gillick Competence needed to be assessed for each medical intervention. The problem I see is that starting on puberty stoppers is one intervention but has many risks. Is the patient Gillick assessed against each risk or the average risk of the mecical intervention? If even one element of the mecical intervention such as not knowing what an orgasm is because they are too young to have one, should this be enough to say the patient does not have Gillick Competence? The activists certainly make out that Gillick is a black and white clear cut right for children not something to be assessed on a case by case situation.

As laid out in Cass, social transitioning is a powerful psychotherapeutic intervention - in other words it is a ‘medical intervention’ that must involve careful consideration by clinical experts. Teachers and schools are in now way qualified to make such interventions. These children are also not entitled to use opposite sex facilities as those facilities are sex based and for the protection of the safety, privacy and dignity of children of that sex and would breach the equality act and undermines safeguarding. Turning single sex facilities into mixed sex facilities in this way also breaches the school’s schools duty to provide single sex facilities.

As for schools passing such information on to parents, that would be covered by the Human Rights Act - article 8

This

I found this on the government site:

www.gov.uk/government/publications/dealing-with-issues-relating-to-parental-responsibility/understanding-and-dealing-with-issues-relating-to-parental-responsibility

It doesn't deal with gender issues, but it does lean towards' parents' rights to receive information about what their child is doing at school.

If you were referring to my post, I don't want to derail the thread but, it wasn't about Covid vaccinations. It was HPV. If you want to start a separate thread about it, I'm happy to discuss there.

The issue of liability is interesting and one that schools don't seem to be considering. The Tavistock case took a position that social transitioning was not a neutral act and was the start of a pathway to medical transition. Then there is also social pressure and comorbidities which should be taken into account when assessing Gillick competence but schools seem to completely overlook both of those aspects too.

Correct

and as above a weighing up of the risk/benefits

eg pregnancy for a 15 year old girl is likely to have more significant emotional and physical harms than the medical risks of taking the pill. The same cannot be said for transition

Slightly off topic but Law in action on Radio 4 yesterday (Tuesday 1st Nov) was about the age of criminal responsibility and how this influenced sentencing.
Interestingly it is higher in Scotland and they are trying to raise it further saying that people shouldn't be treated the same way as older adults even in the late teens as their brains aren't mature enough. It was strange to hear this argument when on all other fronts the Scottish government are saying that children do have the ability to make big life altering decisions.
As it was proposed that you have to pick your gender and agree to live as it for the rest of your life, perhaps it gives children a loop hole to claim that they weren't mature enough to make the decision in the first place.

From the link above..

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. The House of Lords concluded that advice can be given in this situation as long as:

He/she has sufficient maturity and intelligence to understand the nature and implications of the proposed treatment

He/she cannot be persuaded to tell her parents or to allow the doctor to tell them

He/she is very likely to begin or continue having sexual intercourse with or without contraceptive treatment

His/her physical or mental health is likely to suffer unless he/she received the advice or treatment

The advice or treatment is in the young person’s best interests.

There are several elements in this... use of established medical treatment (contraception) where there is adequate evidence that the benefits (preventing underage pregnancy) out weigh the risks (blood clots, gallbladder disease, heart attack, high blood pressure, liver cancer, stroke, depression, mood changes, headaches, etc. )

Gilick: 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.

The principles of informed consent are often skirted over in medical situations where the doctors are deemed more capable of assessing risk than patients and consent in one scenario is assumed for another.. the discussions and arguements differ depending on the position of those arguing for or against.

Some of the arguments relate to not being able to assess the risks because those risks are not shared with the patient. It is the medical practitioner's responsibility to determine if the child is capable of making that decision and for ensuring informed consent. It is often influenced by the opinions of those enforcing or assessing the situation.

My reading of Gilick and Fraser is that tehy relate to underage contraception where the alternative is underage pregnancy... but in reality, it is applied in other situations with the presumption of Gillick competance without rigerous assessment and without clear communication of benefits, risks and alternatives.

Not specifically to do with the guidelines, but about the (false) equivalence between contraception and puberty blockers.

Contraception keeps the status quo of a healthy body as much as possible. The alternative is child pregnancy, which has multiple life long consequences both physically and psychologically.

Puberty blockers do not keep the status quo of a child's healthy body. They are proven to lead to cross sex hormones, and these lead to very serious lifelong physical and psychological problems.

Any man using access to contraception against women and children in this argument is no better than the religious right in America. It is a misogynist stance, showing that they understand all too well that across the globe, women's rights can be snatched away again by men.

This gets into the complexities of medical negligence which is a whole topic in itself.

It’s reasonable to say “no one knew” in relation to outcomes that weren’t expected. But there’s a point at which that tips over. That’s why the Keira Bell ruling was key: because even though the appeal judges said it wasn’t for the courts to decide, it clearly stated that Gillick competence has to be clearly delineated in relation to these specific treatments. Those criteria for consent from the original ruling still apply.

And those at the Tavistock know that they can’t truthfully demonstrate a child can understand those criteria.

All gender clinics around the world at this moment in time know - or should know - that the treatment they administer has no strong evidence base, or at best, a conflicting evidence base. Which means that any treatment that is commenced in November 2022 knowing the lack of outcome certainty and long term risks will not be able to plead ignorance in 5, 10 years or whenever. Because it’s in the public domain that plenty of highly noted institutions were concerned and questioned children’s ability to consent.

Ah thank you @PoundShopPrincess, and sorry I misinterpreted what you were saying. I haven't been involved in the HPV scheme so can't speak re that (although I suspect our approach is the same).

As others have said being “Gillick competent” means a child has the capacity to understand, believe and retain information in order to give informed consent for a treatment or procedure. It is specific to each event and a child may be competent to decide the colour of the plaster cast for their broken wrist but not whether they have surgery to repair a broken arm.

Fraser Guidelines provide medical professionals with guidance around what to consider when assessing whether to provide contraception to a child under 16. It’s not applied in other situations.

As I understand it part of Kiera’s case was that a child could never be considered Gillick Competent for PBs, Cross Sex hormones because they cannot provide informed consent for something where the long term risks are unknown and where they have no knowledge of what they would lose e.g fertility, sexual function etc because they are children.

Saying if you don’t let kids decide about PBs etc means you won’t let them have contraception or abortion without parental permission makes as much sense as saying if you won’t let them decide they want chemotherapy or not then you won’t let them have contraception. It’s just nonsense but a useful way of creating fear and misrepresentation of what is actually happening. Quelle surprise.

Twitter is like a flock of sheep. A sheep starts baa baaing and trots off towards the other side of the field and the other sheep notice and fall in line baa baaing in tune.

Keir Starmer before being leader of the opposition was head of the Crown Prosecution Service and a QC/KC

So for transactivists who don’t have such a legal background to question whether he understands it doesn’t seem right!

They are using a slippery slope fallacy, and they have it back to front.
Guidelines allow girls access to contraception and abortion because of the consequences of the alternative; pregnancy and childbirth are life altering for a young mother, involve a risk to life, and involve creating another person.
Girls are allowed contraception for the same reasons they are banned from taking puberty blockers. They can't consent to something they cannot understand, that is life altering, that may affect their long term health and fertility.

I propose a new test: Gillick Competence Competence. You need to demonstrate that you can accurately describe Gillick Competence before you're allowed to talk about it.

Saying if you don’t let kids decide about PBs etc means you won’t let them have contraception or abortion without parental permission makes as much sense as. ....

Back to us wasting time trying to make sense of nonsense again... a waste of energy and emotion and more importantly.. distracts us from the point we were trying to make...

We cannot consent expect children to consent to experimental medical procedures where the potential benefits do not outweigh the potential risks. We have not seen evidence that this risk assessment / this ethical evaluation / this research has been carried out to satisfaction of the wider medical peer community.

Slight derail to something posted earlier - schools have loads of rules around how names are listed on registers and who can change a child's name, it does seem oddly disconnected from that they can adopt names of the child's choice without informing parents. I think there are rules around parental alienation in the Schools Act too to prevent over reach but it's not an area I'm that familiar with.
There's a list of relevant legislation on Gov.uk

I would suggest that as we don't yet fully understand the origins or perpetuating factors of gender dysphoria and there is no robust evidence base or broad medical consensus on how it should be treated then any child being Gillick competent with regards to its treatment is vanishingly unlikely.

I don't think social transition at school in general is covered by Gillick as it isn't a medical procedure.

However interestingly pre pubescent kids as per the NHS England new proposed service specifications should not have social transition unless decided by a doctor. This is from an endocrine society review which is widely referred to (and in my view also advises very affirmative treatment for tanner stage 2 plus kids, inappropriately).

See here

www.engage.england.nhs.uk/specialised-commissioning/gender-dysphoria-services/

The endocrine society
guideline says 'We advise that decisions regarding the social transition
of prepubertal youth are made with the assistance of a
mental health professional or similarly experienced
professional.'

www.endocrine.org/clinical-practice-guidelines/gender-dysphoria-gender-incongruence

The original bell judgement the Tavistock said they never used parental only consent hence the courts just assessed ability to give gillick consent and said it was very restrictive and in practice not at all for under 16s even for puberty blockers. And for 16 and 17 y o they may wish to apply to the courts to assess competence. The appeal judgement said it was a matter for doctors and patients to assess gillick consent competence. Keira Bell was refused allowance to take it to another appeal at the supreme Court. Crucially the appeals judgement didn't rescind any of the highlighted things children have to understand in order to truly give informed gillick consent ie infertility, inability to orgasm, osteoporosis, etc. The AB vs CD case said the tavi could treat on parental consent as long as they agreed with their child. This is a work around as I can see it, as suddenly the Tavistock in the ab CD case are implying they're changing their previous practices when in bell they said they never gave out blockers /hormones without (in their view at the time) gillick competent child consent.

I'm not sure what's going on right now whether kids are actually having blockers (and hence cross sex hormones) prescribed via the Tavistock at the moment.

Sorry am on my phone sorry for poor formatting.

<Round of applause>

If there was a competency test before people could talk about issues, this entire house of cards would have fallen much sooner. The high profile men trying to push these agendas on social media have no experience or competency in single sex spaces; safeguarding; child and teen development; VAWG, etc.

Well that's interesting @Jellyjunction - thanks!

Sorry haven't read every post but in case it hasn't been said there is also a huge difference between being capable of consenting to an established treatment with broad and long term established data as to the risks, side effects, outcomes, withdrawal/cessation effects etc and an experimental treatment without any of that evidence base.

Consenting to take the pill (used for x amount of decades, x amount of age groups, ethnicities, comorbidities etc and studied inside out) and consenting to eg. off label use of a drug eg. lupron, with terrible side effects and risks even for it's on label use is not comparable. Even before you think about experimental surgeries, cross sex hormones etc used on the basis of an unproven premise to compound things.

Plus I didn't take away that KS said without parental consent - I took away (and without going back and listening again I'm not sure if my takeaway was accurate) but without parental involvement.

Can someone who watched more closely clarify please?