The right to self-determination for those with adequate competence underpins a democratic society. The European Convention on Human Rights does not draw a distinction between adults and children in this respect, and in fact advances the concept of children's rights. However in the UK a combination of statute and case law places some constraints on a child's right to autonomy. Prior to the Gillick principle there was little guidance on managing children under the age of sixteen. Whilst this is much clearer now there are some anomalies, for instance is the right to refuse the same as the right to agree to surgery? The increasing 'rights culture' for children is bringing this issue before the Courts more and more and the status of children continues to evolve in the UK.