Gillick competence comes up at medical school interviews in two ways: as a direct knowledge question, and underneath any ethics scenario involving a patient under 16. Interviewers don't expect case names, but they do expect a clear definition, an understanding that consent and refusal are treated differently for under-18s, and a sensible, respectful approach when a competent young person refuses treatment. This article covers the definition, how it differs from the Fraser guidelines, what the marking criteria reward, a worked answer, and the related consent questions.
What does it mean for a child to be Gillick competent?
- A 15-year-old who has been assessed as Gillick competent refuses a treatment that the clinical team believes is in their best interests. What should happen?
- Would your answer differ between a life-saving treatment and a routine one?
Why medical schools ask it
Doctors face ethical dilemmas regularly: balancing patient wishes against clinical recommendations, navigating confidentiality, and deciding who can consent to what. Interviewers want to see that you can recognise the ethical dimensions, consider multiple perspectives, and reach reasoned conclusions. They are also testing whether you understand professional standards. Familiarity with GMC guidance and key legal frameworks shows you're preparing seriously for a career where these principles govern daily practice.
Consent in under-16s is a good test of all of that at once. It needs a precise definition, it has a detail most applicants get wrong (competence covers consent but not refusal), and it leads straight into a scenario where autonomy and welfare pull in opposite directions.
What the marking criteria reward
The marking sheet for this station has seven content points. Nobody is expected to cover all of them unprompted; the interviewer probes for the ones you miss.
- Defines Gillick competence: a child under 16 can consent to their own treatment if they have enough maturity and understanding to fully understand what is proposed; it is decision-specific and assessed case by case
- Says the first step is a calm, unhurried conversation to understand the reasons for refusal, give clear information, address fears and look for alternatives or compromise
- Involves others appropriately: encourages the young person to involve parents, and seeks advice from senior colleagues and the wider team
- Recognises that consent and refusal are treated differently: in England and Wales a competent minor's refusal can be overridden in their best interests, and that for serious treatment the team should seek legal advice and, if needed, a court decision instead of acting alone
- Weighs autonomy against beneficence and non-maleficence, including the physical and psychological harm and loss of trust caused by forcing treatment
- A refusal of routine or non-urgent treatment is normally respected, while refusal of life-saving treatment is far more likely to be overridden, with emergency treatment given to prevent death or serious harm
- Refers to professional guidance (GMC guidance on 0 to 18 years or GDC standards on consent) or to the child's welfare being the paramount consideration
Two of these do most of the work. The first is the definition itself, and the fourth is knowing that a competent minor's refusal can be overridden in their best interests, which is the point most candidates have not come across.
What you need to know
Under-16s can consent to treatment if they have sufficient maturity to understand, retain and weigh up information and communicate a decision. Competence is decision-specific. Encourage parental involvement where safe. Importantly, Gillick competence allows children to consent to treatment but does not give them the right to refuse treatment. The Fraser guidelines are different: they set conditions for providing contraception and sexual health care to under-16s without parental consent, and all five criteria must be met.
The model answer below runs through the definition, then the refusal scenario, then the life-saving versus routine distinction, in the order the three questions are asked:
1. What Gillick competence means
2. Identify the issue
A competent young person is using their autonomy to refuse something the team believes will benefit them. The conflict is between respecting that decision and the duty to protect a child's welfare.
3. Both sides
Respecting the refusal
Overriding the refusal
4. What should happen
5. The legal position
6. Life-saving versus routine
7. Conclusion and reflection
I would start by listening, because most refusals are resolved through conversation. A competent young person's view carries great weight, but the law does not make it decisive when life or serious harm is at stake, and such decisions belong to the courts, not to one clinician. It is a reminder that autonomy matters but is not the only principle, and that I should know when to ask for senior and legal advice.
Example answer
A spoken answer to the first two parts, about two minutes in total. The third part is a sentence each way.
- Definition
- Gillick competence means that a child under 16 can give valid consent to their own treatment if they have enough maturity and understanding to grasp what is being proposed, including the risks, benefits and alternatives. It is decision-specific, so someone might be competent to consent to a blood test but not to major surgery, and it is assessed case by case. It is often confused with the Fraser guidelines, which come from the same case but apply only to contraception and sexual health.
- The issue
- If a competent 15-year-old refuses treatment the team thinks is in their best interests, the conflict is between respecting a decision we would accept if it were a yes, and the duty to protect a child's welfare.
- What I'd do
- The first thing is a calm conversation to find out why. Refusals are often about fear of needles, pain or how they will look, and a lot of them resolve with time and clear information. I would check they are competent for this specific decision, look for alternatives or a safe delay, encourage them to involve their parents, and get senior advice.
- The law
- In England and Wales a competent minor's refusal is not final. The courts have held that it can be overridden in the child's best interests, so for anything serious the team would seek legal advice and, if necessary, a court decision rather than acting alone. The GMC's 0 to 18 guidance says the same. Scotland is different: a competent young person's refusal cannot be overridden by a parent.
- Routine vs life-saving
- For something routine like a vaccination I would respect the refusal, because forcing it does more harm than good and the offer stays open. For something life-saving, like a transfusion, the courts have repeatedly authorised treatment, and in an emergency with no time to go to court you treat to prevent death or serious harm.
Practise this question out loud
Try answering it with the AI interviewer: it asks the question, follows up on what you say, and marks you against the points above.
Common follow-up questions
This topic is usually tested through a scenario rather than the definition alone, so the questions below are the ones most likely to follow or replace it.
A 13-year-old asks for contraception and does not want you to tell her parents. What should you do?
The most common Gillick scenario. Reported at Keele, Nottingham, Cardiff and Manchester.
When should you breach patient confidentiality?
Asked at Sheffield and Aberdeen. The safeguarding grounds are the same ones that limit a young person's confidentiality.
What is the difference between implied and informed consent?
Asked at Bristol. Valid consent needs capacity, adequate information and no pressure; implied consent is holding out an arm for a blood test.
An 11-year-old boy with terminal leukaemia asks you what is wrong with him. His parents have asked you not to tell him.
Tests honesty against parental wishes. Explore why the parents are worried, and remember the child's welfare is paramount.
An unconscious 18-year-old will die without a transfusion and carries a card saying she is a Jehovah's Witness.
Asked at Plymouth. At 18 she is an adult, so this is about advance refusal and capacity rather than Gillick.
Common pitfalls
Things to avoid when answering the question:
- Confusing Gillick with Fraser :
- Gillick is the general test of whether an under-16 can consent. Fraser is the five-point test for contraception and sexual health advice specifically.
- Saying a competent child can refuse :
- Competence allows consent, not refusal. In England and Wales a competent minor's refusal can be overridden in their best interests.
- Treating it as all-or-nothing :
- Competence is decision-specific. A young person can be competent for one decision and not another.
- Jumping to the law :
- The first step is always a conversation. Most refusals are about fear and resolve with time and information.
- Acting alone :
- For anything serious, the answer involves senior advice, the safeguarding lead and legal advice, not one clinician's judgement.
- Not mentioning GMC guidance :
- The GMC's 0 to 18 years guidance is the professional standard here, and naming it shows you know the framework doctors work within.
Which schools ask it
The definition on its own is not tagged to a particular school in our bank, but the scenarios it underpins are: the contraception question at Keele, Nottingham, Cardiff and Manchester, the transfusion refusal at Plymouth, and consent questions at Bristol. Any school with an ethics station can ask it.
Frequently asked questions
Do I need to know the case names?
No. Interviewers credit sound reasoning, not citations. Gillick v West Norfolk (1985) is easy to remember and fine to mention, but nobody expects Re R, Re W or the 2021 case.
What about 16 and 17-year-olds?
They are presumed able to consent under the Family Law Reform Act 1969, and the Mental Capacity Act applies from 16. Their refusal can still be overridden in their best interests in England and Wales until they turn 18, although the court gives their views increasing weight as they get older.
Is Gillick competence the same in Scotland?
The consent side is similar, under the Age of Legal Capacity (Scotland) Act 1991. The difference is refusal: GMC guidance states that in Scotland parents cannot authorise treatment that a competent young person has refused.