There is no fixed age for adulthood in England and Wales. At age 10 you have full criminal responsibility for your actions, at 14 you can get a job, at 16 you can change your name, at 18 you can buy alcohol, at 21 you can adopt a child. Since 1986 and the case of Gillick vs West Norfolk and Wisbech Area Health Authority (judgement) there has been no fixed age at which you can consent to your own healthcare treatment, overriding parental consent. Instead the competency to consent of a child under 16 is determined by the relevant treating physician on an individual basis, known as Gillick competence. Guidelines for its application were provided by in the judgement by Lord Fraser.
Gillick brought the case which began in 1982 in an attempt to prevent her daughter from accessing contraception without her own knowledge or consent and was unsuccessful. Gillick competence has already been ruled to apply in the case of abortion (R(Axon) v Secretary of State for Health). But in December 2020, Gillick competence was under threat when the High Court ruled in a judicial review case Bell vs Tavistock that trans children could not competently consent to puberty blockers. Today, that judgement was overturned by the Court of Appeal, reinstating the previous position, In its decision, the Court of appeal ruled that the High Court had overstepped its bounds in its decision and Gillick competence applies to trans as well as cis children. A child under 16 may consent to their own medical treatment regardless of their parents’ views if “they’re believed to have enough intelligence, competence and understanding to fully appreciate what’s involved in their treatment“.
There is exactly one service, GIDS at the Tavistock, in the NHS in England which cares for trans children and refers them to endocrinologists for puberty blockers. Referrals effectively ceased in December 2020, and it is not clear when they will return.
Keira Bell who brought the case, received puberty blockers at 16 (an age where ability to consent is enshrined in legislation, “as if he were of full age” [sic]) and surgery at 20 before detransitioning by the age of 23. The lawyers acting on Bell’s behalf are hoping to overturn Gillick competence entirely at the Supreme Court.
Meanwhile the Department for Health is relying on Gillick competence in it’s position that children between 12 and 15 may be able to consent to their own Covid vaccine regardless of their parent’s views.