Intended for healthcare professionals


Gillick or Fraser? A plea for consistency over competence in children

BMJ 2006; 332 doi: (Published 06 April 2006) Cite this as: BMJ 2006;332:807
  1. Robert Wheeler, consultant paediatric and neonatal surgeon (
  1. Wessex Regional Centre for Paediatric Surgery, Southampton University NHS Trust, Southampton SO16 6YD

    Gillick and Fraser are not interchangeable

    In most countries the issue of deciding on the ability of children to make decisions about their own medical treatment causes some dilemmas. In Britain people describe the assessment of competence of children in terms of either Gillick competence or the Fraser guidelines, as if they were interchangeable. However, they are not, and their difference needs to be made clear.

    The proponents of each concept have failed to explain the differences between them and are encouraging synonymy where none exists. Research ethics committees are insisting upon the use of “Fraser,” motivated by the honourable, but false, belief that the term “Gillick competence” is unwelcome to the woman after whom it is named. National organisations are perpetuating this myth. And teachers of medical law are encountering genuine difficulty in trying to resolve this issue.

    In UK law a person's 18th birthday draws the line between childhood …

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