Consenting to Medical Treatment

DGRefHelp - NHS Dumfries & Galloway
NHS Dumfries and Galloway

Although Fraser Guidelines (see below) can be used as a guide in Scotland, the primary legislation that should be used in Scotland when determining capacity to consent to medical treatment is the Age of Legal Capacity (Scotland) Act 1991.

The Age of Legal Capacity (Scotland) Act 1991 states that a person under the age of 16 has the right to consent to treatment if he/she is capable of understanding the nature and possible consequences, benefits and risks of the procedure or treatment.

  • Do you think they understand the information you’ve given them?
  • Do you think they can assess the pros and cons of the management you’re suggesting?
  • Do you think they have the ability to make a clear choice?
  • Are they able to make that choice freely?
  • Do you think they have communicated their decisions to you clearly?
  • Do you think they have the capacity to consent to the treatment or procedure you’re proposing?
  • Is it in their best interests to offer them the proposed management?

Fraser guidelines

The Fraser guidelines refer to the guidelines set out by Lord Fraser in his judgment of the Gillick case in the House of Lords (1985), which applied specifically to contraceptive advice. These guidelines state that young people under the age of 16 can access treatment without parental consent as long as it is in the young person’s best interest. Health professionals use these guidelines to assess whether a young person can be provided with confidential contraceptive services without parental consent. Fraser guidelines originally related to contraceptive advice and treatment but they now apply to decisions about treatment for sexually transmitted infections and termination of pregnancy.

Lord Fraser stated that a doctor could proceed to give advice and treatment "provided he is satisfied in the following criteria":

  1. The young person understands the health professional’s advice.
  2. The young person is aware that the health professional cannot inform his/her parents that he/she is seeking sexual health advice without consent, nor persuade the young person to inform his/her parents.
  3. The young person is very likely to begin having, or continue to have, intercourse with or without contraceptive/sexual health treatment.
  4. Unless he/she receives contraceptive advice or treatment the young person’s physical or mental health, or both, are likely to suffer.
  5. The young person’s best interests require the health professional to give contraceptive advice, treatment, or both without parental consent.

If the above criteria are not met or there is reason to believe that the child is under pressure to give consent or is being exploited, there would be grounds to break confidentiality.

Editorial Information

Last reviewed: 31/05/2024

Next review date: 31/01/2026

Author(s): West of Scotland Managed Clinical Network in Sexual Health Clinical Guidelines Group .

Version: 3.1

Approved By: West of Scotland Managed Clinical Network in Sexual Health