The recent ruling by the Queensland Supreme Court to permit a hospital to perform a surgical abortion on a 12-year-old girl has highlighted the ongoing debate surrounding adolescent autonomy in healthcare, particularly concerning abortion. This decision acknowledges the legal concept of “Gillick competence.” It poses serious questions about young people’s rights to make their own necessary healthcare decisions. Alison Fonseca, Head of Psychosocial Health at MSI Australia, emphasized the importance of recognizing that children and young people have rights, stating, “It’s about bodily autonomy, and respecting that children and young people have rights.”
The case concerned a young woman who did not know that she was nine weeks pregnant. The court found her to be “Gillick competent,” terminology that derives from the legal doctrine established by the UK’s House of Lords in 1985. The precedent stemmed from the case of Victoria Gillick. Thus did she have to fight for guarantees that her children under the age of 16 would not be given contraceptive or abortion advice without her consent. In Australia, this statutory scheme enables a child, if found to be “Gillick competent,” to make informed decisions about their medical care.
The Concept of Gillick Competence
Gillick competence describes a child’s capacity to understand and appreciate the meaning and consequences of a medical procedure. Understood is not enough. A child would need to display an infallible awareness of every aspect of a scenario in order to be considered knowing. This sometimes involves intricate determinations by qualified health care professionals. This idea undergirds the belief that minors should have autonomy in the medical decision-making process. It gives them the flexibility when they prove their capability.
Fonseca stated, “We must be satisfied their best interests are being met, and that they are safe and supported.” That means there’s a lot more that must be taken into account in determining what makes a child ready to take such big steps. The discovery process is usually a fight over what information must be disclosed to a legal representative. The final one keeps our focus on the child’s privacy rights and agency.
In Australia, MSI Australia is able to provide medical and surgical terminations to anyone over the age of 14. Together, they function as a private not-for-profit organization. According to internal statistics, that’s because only 2% of MSI’s clients are under 18 years old. Of these, an astonishingly small 1.5 percent is under 16. The healthcare system must navigate these sensitive situations delicately while ensuring that young patients receive the necessary support.
Challenges Faced by Young Individuals Seeking Abortions
Though the legal frameworks support minors’ access to abortion services, multiple barriers remain. Dr. Danielle Mazza, a professor at Monash Health and chair of the Royal Australian College of GPs preventative medicine guidelines, noted that stigma surrounding abortion continues to hinder access. She explained, “So, access to abortion for teenagers … is limited by system issues, cost, transparency and stigma.” Nevertheless, these hurdles largely discourage youth from obtaining necessary care.
Furthermore, Fonseca pointed out that “young people aren’t always able to consider future consequences as they have a still-developing brain.” This truth requires careful assessments to make sure that teens understand the risks involved in their decisions. In cases where a child is not deemed Gillick competent, parents or guardians retain the authority to make medical decisions on their behalf.
Dr. Mazza highlighted a stark contrast in healthcare practices: “If you’ve got hypertension, you can be pretty certain that most GPs are going to manage your hypertension, but if you need an abortion … you can’t be certain that every GP is going to be able to provide that.” This discrepancy illustrates the barriers that youth encounter seeking reproductive care in complex healthcare settings.
The Role of Healthcare Providers
Healthcare providers have a critical responsibility to first assess and then support adolescents seeking an abortion. In such complicated contexts, clinicians need to do intense testing to determine if a child has the comprehension to consent to the procedure. This thorough process helps to uphold the rights of the child while still protecting their health and safety.
Mazza provided additional comment on a brief cultural context surrounding the provision of abortion services in general practice. It’s a very rare practice to prescribe MS-2 Step, used for medical abortions up to nine weeks of pregnancy. This is indicative of the culture in general practice. Consequently, thousands of young people could struggle to obtain safe, legal abortion care in a timely manner.
Surgical abortions are provided up to between 22 and 24 weeks’ gestation, varying by region’s laws. Choosing among these options can only happen with open dialogue between care team and adolescent patient. This is no small feat, and it requires that every alternative be considered—all while honoring the patients’ autonomy.
