NUR322 Session 1 2020 Presentation: Gillick Competency and Healthcare

This presentation examines the Gillick competency, focusing on its implications for child and family-centered care within pediatric nursing. It begins with an introduction to the Gillick competency, highlighting its legal standing in relation to a child's right to consent to medical treatment. The presentation then delves into the aims, which are to critically compare and contrast child-centered care with family-centered care, analyzing the case study of Amira, a 13-year-old refugee who has refused treatment for acute appendicitis. The discussion explores age-appropriate needs, emphasizing the criteria for assessing a child's competency, including maturity, intelligence, and understanding of risks and benefits. It also addresses the role of health literacy and cultural influences in decision-making. Furthermore, the presentation explores family needs and the nurse's ethical and legal obligations to consider the decisions of multiple individuals. The conclusion emphasizes the need for pediatric nurses to integrate the Gillick competency with philosophical principles of deontology and professional nursing standards to ensure comprehensive, culturally competent care. References are provided to support the arguments presented.

NUR322
Session 1 2020
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Introduction
• The Gillick competency implies the right of a child to provide consent for
personal treatment interventions without parental consent or
permission.
• The following presentation will briefly discuss on the critical aspects of
child and family centered care with respect to the Gillick competence
and the case of Amira – a 13 year old refugee from Syria who has refused
treatment with regards to acute appendicitis.

Aims of this presentation
• To critically compare and contrast the practice of child centered
care in pediatric nursing, with respect to the Gillick competence
and the case study of Amira.
• To critically compare and contrast the practice of family centered
care in pediatric nursing with respect to the Gillick competence
and the case study of Amira.
• To provide key recommendations with respect to the child and
family centered approaches to be considered in the case of Amira
as well as underlying philosophical and professional standards
underlying associated with the same.

Introduction
The Gillick competency is mentioned only in New South
Wales (NSW) and South Australia (SA) medical law, taking
reference to the 1986 judgment of Gillick v West Norfolk
and Wisbech Area Health Authority (Young 2019). With
respect to the same, as per this medical law of
competency, a child who is under the age of 16 years has
the legal right to consent refuse any form of medical
treatment or immunization (Griffith 2016).

Discussion: Age Appropriate
Needs
In addition to merely age, a child is considered to be Gillick competent, as
per the following criteria (Griffith 2016).
• The maturity of a child
• The intelligence of a child
• The child’s ability to understand the risks and benefits of treatment as
well as his or her decisions and views concerning long term implications
on family and personal life aspects like education.
• The ability and experiences of the child with respect the role of family,
peer pressures and his or her opinions in the clinical decision making
process (Griffith 2016).

Discussion: Age Appropriate
Needs
• There is no mention on the standards and measurements to be
considered with respect to understanding the level of maturity
and intelligence in a child.
• The associated criteria of assessment is highly specific in nature
and does not consider the nuanced or subjective nature of a
child’s intelligence and maturity, as well as which experiences are
to be considered and decision-making skills are to be considered
with respect to evaluating the level of competency (McCrory and
Jacobs 2018).

Discussion: Age Appropriate
Needs
• Additionally, while the Gillick competency takes into consideration
the role of a child’s experiences in his or her decision, there is no
mention of the role of health literacy or cultural influences.
• With respect to the above, there may be a possibility that upon
the deliverance of healthcare education via consideration of the
child’s age appropriate health literacy levels and cultural
background, the concerned child may rethink or reconsider his or
her decision.

Discussion: Family Needs
• Further, it is the professional as well as legal obligation of the
nurse to consider the decision of not just one, but also the
decisions of multiple individuals which brings forth the nursing
need to not just practice person or child centered practice but
also family centered practice.
• Thus, it is unprofessional and predominantly a punishable offence
for the pediatric nurse to merely limit critical thinking and
decision-making to only Amira’s decision with respect to the
Gillick competency (Griffith 2016).

Discussion: Nursing Influence
• Ethical, moral and philosophical principles of Deontology.
• NMBA Professional Standards of 1, 2 and 3.
• Nursing practice of delivering patient healthcare education.

Conclusion
• There is need for the pediatric nurse to ensure that his or her
clinical intervention and decision is influenced by not just the
Gillick competency but also by philosophical principles of
deontology as well as nursing professional standards of family
centered and culturally competent nursing practice and nursing
education in the case of Amira.
• While the Gillick competency guides pediatric nurses on the
importance of child centered practice, there is however limited
consideration on aspects of family centered care as well as the
gravity of the situation or medical issues with regards to which a
child can refuse or provide consent.

Reference
Casby, C. and Lyons, B., 2019. Consent and children. Anaesthesia & Intensive Care Medicine, 20(1), pp.52-55.
Griffith, R., 2016. What is Gillick competence?. Human vaccines & immunotherapeutics, 12(1), pp.244-247.
Griffith, R., 2017. Assessing Gillick competence. British Journal of Midwifery, 25(4), pp.264-265.
Harling, C., 2017. England uses a competency-based approach to consent for health interventions. European Journal of Human
Genetics, 25(9), pp.1029-1029.
McCrory, P.V. and Jacobs, A.V., 2018. Child capacity and protection: Gillick research needed. British dental journal, 225(8), pp.685-
685.
NMBA, 2016. Nursing and Midwifery Board of Australia - Professional standards. [online] Nursingmidwiferyboard.gov.au. Available
at: https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards.aspx [Accessed 30 Jan. 2020].
Olarinde, E.S. and Bamidele, I., 2016. Gillick v West Norfolk and Wisbech AHA: The Right of Adolescents to Make Medical Decisions
and the Many Shades of Grey. JL Pol'y & Globalization, 54, p.13.
Pace, R.A., Ciruzzi, S. and Ferreres, A.R., 2019. The Pediatric Patient as a Self-Individual and Decision-Maker. In Surgical Ethics (pp.
231-238). Springer, Cham.
Taylor, M.J., Dove, E.S., Laurie, G. and Townend, D., 2018. When can the child speak for herself? The limits of parental consent in data
protection law for health research. Medical law review, 26(3), pp.369-391.
Townsend, R., Willis, S. and Mehmet, N., 2019. Legal and ethical aspects of paramedic practice. Fundamentals of Paramedic Practice:
A Systems Approach.
Young, L., 2019. Mature minors and parenting disputes in Australia: Engaging with the Debate on Best Interests v Autonomy.
University of New South Wales Law Journal, The, 42(4), p.1362.
Zimmermann, N., 2019. Gillick Competence: An Unnecessary Burden. The New Bioethics, 25(1), pp.78-93.