Apparent competence, hidden influence: why Gillick competence requires a digital contextual framework

Gillick competence, established in law in 1985, remains the foundational standard for assessing whether a child under 16 can consent to medical treatment without parental involvement. The framework rests on two premises: that a child's understanding, as demonstrated in a clinical encounter, reliably indexes their decision-making capacity; and that their expressed preferences reflect genuinely self-determined choice. This paper argues that the algorithmically mediated digital environment may compromise both premises in a clinically significant subset of cases — specifically those in which a child's decision is entangled with platform content that has been systematically shaping their values, risk perceptions, and behavioural preferences. I do not claim that digital exposure invalidates Gillick competence, nor that it should trigger automatic override of children's expressed preferences. I advance the more limited but clinically important position: that the existing framework does not ask whether the conditions under which a child's understanding formed may have been distorted by concealed algorithmic influence, and that this omission creates a gap between apparent competence and real-world vulnerability. Drawing on relational autonomy theory, the manipulation literature in bioethics, and the growing evidence base on algorithmic harm to children, I propose the term 'context-compromised competence' as a hypothesis requiring empirical validation, and offer an operational definition with candidate clinical markers as a starting framework. I further propose the Digital Exposure History — a structured five-question clinical conversation — as a hypothesis-generating line of enquiry that might, after empirical testing, inform Gillick assessments in digitally entangled domains. It is offered here not as a validated instrument but as a starting point for empirical evaluation. In summary, this paper introduces the concept of context-compromised competence as a clinically nameable hypothetical state, and proposes the Digital Exposure History as a practical minimum candidate standard for Gillick assessments in digitally entangled domains.