This guide covers the complex legal landscape of Consent in Children MSRA scenarios. In the Professional Dilemmas paper, you must navigate the nuanced difference between a child who *understands* (Gillick competent) and a child who needs protection.
Consent in children and young people is built on four pillars: age, competence or capacity for the specific decision, parental responsibility (PR), and best interests. For under-16s, the key question is whether they are Gillick-competent: do they have enough understanding and maturity to grasp the nature, risks, benefits, alternatives, and consequences of the decision in front of them? If not, someone with PR usually needs to consent, and decisions must be made in the child’s best interests.
Fraser guidelines apply specifically to contraception and related sexual-health decisions in under-16s. If the criteria are met, contraception can be provided without parental knowledge, provided it is in the young person’s best interests and safeguarding has been considered. For 16–17-year-olds, the Family Law Reform Act 1969 s.8 allows them to consent to treatment as if adults, though serious refusals of life-saving treatment may still need senior and legal input.
In SJT questions, high-scoring answers follow a structured route: establish age and urgency, assess competence/capacity for the decision, clarify who has PR, encourage but do not force parental involvement for competent young people, respect confidentiality within safeguarding limits, and document reasoning, discussions, and plans. Options that ignore safeguarding concerns or automatically default to parents without assessing the child or young person’s own rights tend to score poorly.
1. Establish the young person’s age, the urgency of the situation, and whether there is any immediate risk to life or limb.
2. For under-16s, assess Gillick competence for the specific decision (understanding, reasoning, appreciation of risks, alternatives, and consequences).
3. For contraception/sexual health in under-16s, apply the Fraser criteria and consider STI risks and safeguarding.
4. For 16–17-year-olds, treat consent broadly as for adults under FLRA 1969 s.8, while recognising that serious refusals may require senior/legal advice.
5. Identify who has parental responsibility and involve them appropriately when the young person lacks competence or when this supports best interests.
6. Encourage parental/carer involvement for competent young people, but do not make it a condition of care if they reasonably refuse, unless safeguarding risk demands disclosure.
7. Explain clearly the limits of confidentiality and when information might be shared to protect them or others.
8. Consider safeguarding in all cases of sexual activity under 18, and especially under 16 (and always under 13), following local child-protection procedures.
9. Seek senior and legal advice where there is disagreement about serious treatment, especially where refusal risks significant harm.
10. Document age, PR, competence/capacity assessment, Fraser reasoning if relevant, information shared, decisions made, disagreements, safeguarding considerations, and follow-up plans.
Trap answers usually over-simplify to “parent knows best”, offer blanket secrecy, or disregard age, competence, safeguarding, and PR checks. The safe pattern is always age → competence/capacity → PR → safeguarding → documentation.
* “I encourage you to involve a parent or carer, but I will not tell them without your permission unless I am worried about your safety or someone else’s.”
* “For contraception and sexual health, there are specific checks I must go through to make sure this is in your best interests, including talking about STIs and protection.”
* “Because I am concerned about your safety, I may need to share some information with safeguarding services, and I will explain what I am doing and why.”
* “I will document our discussion, what we have decided, who holds parental responsibility, and the follow-up plan so the team is clear.”
* “This is a serious decision, so I will discuss it with a senior colleague and, if needed, our legal team to make sure we act in your best interests.”
K = Know age and urgency
I = Investigate competence/capacity for this decision
D = Determine who has parental responsibility
S = Safeguarding and confidentiality limits
C = Contraception/sexual health: apply Fraser criteria
O = Offer to involve parents/carers (without forcing)
N = Note young person’s wishes, values, and understanding
S = Share information proportionately for safety when required
E = Escalate disagreements to senior/legal advice when risk is high
N = Next steps and follow-up agreed
T = Thorough documentation of reasoning and plan
Do under-16s always need parental consent?
No. Under-16s who are Gillick-competent for the specific decision can usually consent themselves. You should encourage parental involvement, but it is not a strict requirement if they are competent and there is no safeguarding risk.
What exactly are the Fraser guidelines used for?
They are used when providing contraception (and often broader sexual-health care) to under-16s without parental knowledge. You must be satisfied that the young person understands the advice, will likely continue sexual activity, that their health may suffer without treatment, and that providing care is in their best interests, alongside STI testing and safeguarding consideration.
Can 16–17-year-olds consent like adults?
Generally yes: under FLRA 1969 s.8, they can consent to treatment as if they were adults. However, serious disputes about life-saving treatment may still require senior and legal advice, with courts able to authorise treatment in the young person’s best interests.
Do parents always have a right to know?
No. You should usually encourage involvement, but competent young people have rights to confidential care. You can share without consent when necessary to prevent significant harm or abuse, explaining the limits and documenting your reasoning.
Who usually has parental responsibility?
Typically the mother, and the father depending on marriage status or being named on the birth certificate, plus others via adoption or court orders (e.g. special guardians). If PR is in doubt or contested, check and document clearly and seek senior advice.
What should I do if I am unsure how law and guidance apply in a complex case?
Seek early advice from seniors, safeguarding leads, and legal services if needed. Do not manage high-risk disagreements alone; document all steps taken and advice received.
• Children and young people: place the child’s best interests at the centre and involve them as much as possible in decisions (GMC 0–18 guidance).
• Decision making and consent: tailor information and shared decisions to the young person’s level of understanding (GMC Decision making and consent).
• Confidentiality: understand when to maintain and when to breach confidentiality to protect children from harm (GMC Confidentiality guidance).
• Working with parents and those with parental responsibility while respecting the young person’s emerging autonomy (GMC 0–18).
• Seeking advice and working within the law when there is disagreement about serious treatment (GMC and court principles).
• Keeping clear, accurate, and contemporaneous records of assessments, discussions, and best-interests decisions.
A 15-year-old girl attends alone asking for the oral contraceptive pill. She explains the method, side effects, and alternatives clearly, intends to continue sexual activity, refuses parental involvement, and there are no indicators of coercion or abuse. She understands STI risks and agrees to testing.
Best action: Assess and record Gillick competence, apply the Fraser criteria, explain confidentiality limits and safeguarding, encourage but do not insist on parental involvement, provide appropriate contraception and STI testing, and document assessment, advice, and follow-up.
Why: This approach respects her rights, applies the correct legal and ethical framework, addresses safeguarding, and ensures care is in her best interests with a clear record.
✓ Always start with age, urgency, and immediate safety.
✓ Under-16s: use Gillick competence; Fraser guidelines for contraception/sexual health.
✓ 16–17s can usually consent as adults; serious refusals may need senior/legal input.
✓ Encourage parental involvement but respect competent young people’s confidentiality within safeguarding limits.
✓ Clarify PR, consider safeguarding, and share information without consent only to prevent significant harm.
✓ Document age, PR, competence/capacity, Fraser reasoning, safeguarding, decisions, and follow-up.
✓ In the SJT, the safest options follow the sequence: age → competence/capacity → PR → safeguarding → documentation.
* → Consent in Adults
* → Capacity Assessment (Mental Capacity Act)
* → Safeguarding & Vulnerable Groups
* → Confidentiality and Information Sharing
* → Working with Relatives & Carers
* → Sexual Health and Young People
A 15-year-old boy attends your GP clinic alone asking for condoms and advice about sex. He describes how condoms are used, understands pregnancy and STI risks, and says he has a regular girlfriend of the same age. He does not want his parents told, stating they would react angrily. There are no indicators of coercion, abuse, or significant age/power imbalance.
Options:
A. Refuse to provide any contraception or advice until a parent attends.
B. Assess his understanding, apply Fraser criteria, discuss condom use and STI prevention, provide condoms, and arrange review.
C. Tell him you must immediately inform his parents regardless of circumstances.
D. Explain confidentiality and its limits, encourage him to involve a parent or trusted adult, but agree not to disclose unless safeguarding concerns arise.
E. Provide condoms without any assessment or discussion, to avoid embarrassment.
F. Explore safeguarding issues, including age and circumstances of his partner, and document that no red flags are identified.
G. Tell him you cannot see under-16s without a chaperone and ask him to leave.
H. Discuss and offer STI testing, explaining how to access sexual-health services.
Correct three: B, D, F
• B: Applies Fraser criteria with proper counselling and provision of contraception in his best interests.
• D: Balances confidentiality with explanation of limits, encourages parental involvement without forcing it.
• F: Explicitly considers and documents safeguarding, which is crucial in under-16 sexual activity.
Why others are weaker/wrong:
• A: Incorrectly blocks care until a parent attends; ignores Gillick/Fraser principles.
• C: Blanket disclosure without considering competence or safeguarding specifics; undermines trust.
• E: Fails to assess understanding or safeguarding; too superficial.
• G: Arbitrary barrier; no requirement for a chaperone or parent for competent young people.
• H: Helpful add-on, but without the structured Fraser and safeguarding assessment it is incomplete as a primary choice.
Example SJT — Rank 5 (best → worst)
A 16-year-old girl with newly diagnosed leukaemia is offered chemotherapy with a good chance of cure. She understands the diagnosis and treatment but refuses chemotherapy, saying she is frightened of side effects. Her parents are desperate for her to accept treatment and ask you to go ahead regardless. There is time for further discussion.
Options:
A. Explore her reasons and fears, confirm her understanding, check capacity (presumed at 16–17), involve a senior colleague, and seek urgent legal advice if she continues to refuse potentially life-saving treatment.
B. Proceed with chemotherapy immediately based solely on parental consent, without addressing her refusal.
C. Tell her that because she is 16, her opinion is irrelevant and her parents will decide.
D. Arrange a calm meeting with her, her parents, and a senior clinician to revisit information, address fears, and see if a shared plan can be reached, documenting the discussion.
E. Discharge her from follow-up because she has refused treatment.
Ideal order: A (1) > D (2) > B (3) > C (4) > E (5)
• A: Best: treats her as a near-adult with presumptive capacity, explores reasons, confirms understanding, and escalates to senior/legal advice for a life-saving dispute.
• D: Strong: promotes shared discussion and support, but still needs escalation if refusal persists.
• B: Ignores her refusal and autonomy, but at least seeks to preserve life; still ethically and legally problematic.
• C: Explicitly dismisses her views and rights; contrary to law and guidance.
• E: Walks away from a high-risk situation without further effort or escalation; unsafe and unprofessional.
