Parents also have rights to fulfil their parental responsibilities under the same Article 8(1) of the ECHR and under the Children Act 2004. in counseling. hbbd```b``~"@$S(d6XM-&$X\ 40L6AxX/dV0D } Finally, practical suggestions on how to share information are explored. PDF MINORS' RIGHTS - Maine Family Planning Teen Pregnancy and Confidentiality | Journal of Ethics | American Gillick v West Norfolk and Wisbech Area Health Authority [1986] (subsequently referred to as Gillick), where the House of Lords judged that children could consent so long as they had sufficient competency (Table 1). One occasion on which information is sometimes unwittingly shared is when letters to GPs are copied to parents. Emergency care Care for independent minors is similar to that of adults. for this article. It has become apparent that supports beyond the home and school setting must become engaged to address the varying factors that contribute to the issue of bullying. They may actually consent for information to be conveyed to the GP, but not to their parents. A study conducted by Isaacs and Stone (2001) reviewed situations in which counselors would breach confidentiality of their minor clients to their parents. For example, mandated reporters must disclose suspected child abuse to child protectiveservices. a confidentiality may increase the likelihood of the young person disclosing information that helps guide treatment, b the individual has a right to autonomy, the development of which constitutes an important part of adolescence, c confidentiality may help to protect or enhance the therapeutic relationship and service engagement, d society has an interest in maintaining trust between doctor and patient, and so confidential medical care is recognised in law as being in the public interest. A parent generally has the right to request a childs medical record. The HIPAA privacy rule and adolescents: Legal questions and clinical challenges. The steps the therapist takes to protect the childs privacy. The first scenario involves Ahmed, the 15-year-old with anxiety disorder who wants medication, but does not want his parents to know. Youth under the age of 18 can consent to all medical care if they are emancipated or living separately and without support from their parents, are/were legally married, or a member of the Armed Forces. 02 January 2018. She also has occasional suicidal ideation, although has never had any firm intent or plan. In contrast, research shows that parents value being told important information about their child. She begs her doctor not to tell her family. Various factors would indicate abuse (Box 3): the significant age difference, the use of alcohol, and Katie being an age where her maturity to consent is questionable. On one hand, there is the consideration of preserving engagement and therapeutic rapport, particularly important given Katie's eating disorder and the associated risks. English, A., & Ford, C. A. Adolescent health risk behaviour: when do pediatric psychologists break confidentiality? The importance of confidentiality in therapy. Clinical practice. They must also be confident that their therapist will not share this information with third parties. Confidentiality in the treatment of adolescents. This is particularly important given the evidence that many girls who cite concerns about confidentiality as a reason for future nonattendance reported unsatisfactory communication with their parents (Reference Lehrer, Pantell and TebbLehrer 2007). METHODS We summarized state laws and regulations on minor consent for the following: health services, substance abuse treatment, prenatal care, mental health care, contraceptive management, immunizations, sexually transmitted infection management, human immunodeficiency viruses testing and treatment, dental care, and sexual assault evaluation. other people's rights to be protected from the 19-year-old man, either victims currently being abused, or potential victims at risk in the future. During the assessment, he reports that for several months he has had repeated thoughts of killing people. Autonomy involves respecting and supporting the right of patients to make their own healthcare choices. 20 & 21). It also gives an opportunity to create a safe, supported space to encourage communication between the young person and the parents (Reference FordFord 2007). Furthermore, given the lack of suicidal intent, and considering that about 30% of adolescents report having had suicidal ideation (the overwhelming majority of whom do not attempt suicide) (Reference Evans, Hawton and RodhamEvans 2005), again the risk of serious harm here does not appear high. This is a common scenario presenting to CAMHS services, and the principles illustrated in Table 2 apply. Had Frank actually made specific threats against a person, with some intent to kill, then confidentiality should be breached, and police and children's services informed, in accordance with GMC guidelines and ethical principles (since safety and protection would generally supersede rights to autonomy). "coreDisableSocialShare": false, Finally, the clinician has weighed up the pros and cons, the rights and the consequences, and has determined that on balance, confidentiality should be breached to parents and/or other authorities. When Do Minors in Therapy Have a Right to Confidentiality? This paper examines all facets of this ethical dilemma by using Corey, Corey, and Callanan's (1998) decision-making model. The notes are for personal use rather than official documentation. Reference Magnusson, Oakley and TownsendMagnusson et al (2007) showed that, although 92% of parents agreed that 16-year-olds should always have access to confidential appointments, this figure dropped to 52% when they considered under-16-year-olds. Likewise, there are a good reasons why the sharing of information with parents can help a young person. Knowledge about ones responsibilities can make decisions easier during a crisis. pedro.weisleder@duke.edu PMID: 15072109 DOI: 10.1177/08830738040190021101 Abstract Doctor-patient confidentiality is a precept of adolescent medicine. The UNCRC stipulates that, for any action relating to a child, their best interests must be considered. Confidentiality in child and adolescent mental health is a complex and often challenging matter. f;`^&qA09DrEH R" DgY RDl/.F[0D=P $9r&*Hj5dOEe*DmlrL@__ $ !#N Although its aim would be to involve parents to help protect their child and thus reduce risk, the potential for risk exacerbation also needs consideration. Time with the young person and their parents together allows information to be shared both ways, as well as enabling psychoeducation and discussions about the care plan. Developing autonomy and individuation from one's parents is particularly critical in adolescence (Reference Erikson and NortonErikson 1968). The risks of future non-attending due to concerns over confidentiality have been previously discussed. Confidentiality in the treatment of adolescents However, 77% of the parents also acknowledged the value of adolescent confidentiality, which, as Reference TebbTebb (2011) notes, reflects some discordance in attitudes. Preserving confidentiality respects the young person's right to a private life. This situation echoes that of Gillick, assuming that Ahmed is Gillick-competent. Privacy concerns are complex legal issues that rarely have a simple answer. Select the single best option for each question stem. Is 13 Reasons Why Part of the Problem or Part of the Solution? On the other hand, breaching confidentiality would allow services (e.g. The following factors concerning possible sexual abuse would indicate the need for reporting: the young person is too immature to understand or consent, children under 13 years old are legally considered to be unable to consent to sexual activity, significant differences in age, maturity or power between the young person and the sexual partner, the young person's sexual partner having a position of trust or having a history of abusive relationships with children, the use of force or the threat of force, pressure, bribery or payment, the use of drugs or alcohol to influence a young person. hkoI2w4`3";I/vm =v6%j/u9UK P2 Therefore it is important to realize that if for some reason a child agrees to sex, it does not mean they consented. Statutes on the rights of minors to consent to health care services vary by state, and obstetrician-gynecologists and other health care providers should be familiar with the regulations that apply to their practice. Some therapists require parents to consent to a certain level of confidentiality, even when state or federal law affords the child fewer confidentiality rights. R8u A Minor's Right to Confidentiality - FAMCare Disclosure may therefore result in distress or other negative feelings that actually lead to an exacerbation of risk. Confidentiality/Minor Consent Laws For Educational Purposes Only PARENT/GUARDIAN CONSENT EXCEPTIONS A parent or legal guardian must provide consent on behalf of a minor (under age 18) before health care services are provided, with several important exceptions. http://www.gmc-uk.org/gmpinaction/case-studies/sarah/case-notes. This paper explores the ethical scenario related to confidentiality rights of a minor when his/her parents seek information from the counseling session, in this case related to exploration of sexuality. You may want to hold in confidence the idea that a teen has contemplated initiating a sexual relationship, while never hesitating to consult with parents about real and present dangers, such as the news that a child is planning to run away [or] is suicidal. As Reference JellinekJellinek (2010) notes, where judgment must play a role [] is in dissecting different degrees of danger. The presence of autism spectrum disorder could work either way. She is concerned that if they found out, they would just get angry. Deontological ethical philosophy argues that: a the consequences of an action are what defines whether it is ethical or not, b we can never know exactly the subjective experience of other beings, c the morality of an action relates to the action itself and not its consequences. Finally, let us consider Katie, the 14-year-old who discloses that a 19-year-old man had sent her sexually related messages and then had sex with her while she was drunk. International Journal of Law and Psychiatry, Toward a coherent account of pediatric decision making, Confidentiality and treatment decisions of minor clients: a health professional's dilemma & policy makers challenge, As child grows, so does need for confidentiality, Managed care and school-based health centers: use of health services, Archives of Pediatrics & Adolescent Medicine, Adolescent girls' and boys' preferences for provider gender and confidentiality in their health care, Access to medical care for adolescents: results from the 1997 Commonwealth Fund Survey of the Health of Adolescent Girls, Forgone health care among U.S. adolescents: associations between risk characteristics and confidentiality concern, Parental identification of depression and mental health service use among depressed adolescents, Journal of American Academy of Child and Adolescent Psychiatry, Parents' views on confidentiality and health advice for adolescents in general practice, Primary Health Care Research & Development. On the other hand, it feels important to protect a young person from harm, and if breaching confidentiality is necessary for protection, then so be it. A parent or legal guardian must provide consent on behalf of a minor (under age 18) before health care services are provided, with several important exceptions. Ultimately, clinicians want to do the right thing. When a minor has their own attorney, this lawyer holds the privilege for the child's therapy, and they often work with me to help keep emotional safety a priority for the child's counseling. More moderate importance was attached to the negative effects of breaching on the family and on service attendance.
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