Confidentiality and Minors
You are treating a 14-year-old girl for a back injury that she sustained while riding her bike. She is progressing well and is expected to fully recover. During the course of treatment, the girl discloses that she sustained the injury when she was hit by a car while riding her bike. She asks you not to tell her mother that a car hit her. What should you do?Legislation
There are two areas of legislation or regulation relating to this scenario. The first relates to patients' abilities to consent to their own treatment decisions. The Health Care Consent Act requires practitioners to determine if patients are capable of making their own treatment decisions. The Act does not provide any age of consent and a person's capacity to consent lies on a sliding scale-a patient may be capable in some circumstances and for some treatments but not for others. To be capable, a patient has to be able to understand and appreciate the consequences of his or her decision.The second area relates to rules around confidentiality. The College's professional misconduct regulation states that it is professional misconduct for a physiotherapist to, "give information about a patient to a person other than the patient or his or her authorized representative except with the consent of the patient or his or her authorized representative or as required or allowed by law. "
As such, consent is required for releasing confidential information to family members or anyone else except where other legislation requires or permits the release of information. There are circumstances where such breaches are required. For example, the Child and Family Services Act requires people to inform a Children's Aid Society if they believe on reasonable grounds that a child may be at risk of harm.
Policy
The Essential Competency Profile for Physiotherapists in Canada states that physiotherapists maintain confidentiality of patient information, however physiotherapists also have a duty to protect the welfare of patients.Protecting the welfare of an individual refers to protecting a patient from harm. For example, if a patient admitted to you that he or she was contemplating suicide, it may in some cases be appropriate to disclose that information to others.
Ethics
Maintaining confidentiality is a duty that we have to our patients that should not be violated without sound moral justification. Some of the values relevant in this case are as follows:- Trust and autonomy: Confidentiality is the cornerstone of the relationship of trust between a health-care provider and a patient. Competent patients have the right to disclose sensitive information to their family members on their own terms when they feel comfortable doing so. In this case, the child's age in itself is not a good enough reason to break the bond of trust. Trust should never be broken without a sound moral reason that would override one's duty to protect confidentiality.
- If confidentiality were not honored within the therapeutic relationship in general, patients might begin to routinely withhold information from their health-care providers. Missing relevant information would hinder our efforts to provide adequate and appropriate care. Research suggests that adolescents may be afraid to seek the help of health-care professionals because of confidentiality concerns.
- Protection from Harm: Society has entrusted the care of children to their parents. We hold a general belief that parents need to know significant events in their children's lives in order to help them to cope, learn and develop. As a result, therapists may believe that a child would do better to have an honest relationship with her parents.
Decision Making
What are the available options?Keeping in mind the relevant legislation, policy and values, consider the following options:
Tell the parents. Inform the child that you feel obligated to do so.
Maintain Confidentiality
Continue to explore with the patient your belief that telling her parents is the best thing to do. Maintain confidentiality during this process.In this case, policy and law demand that if the child is capable of making competent choices, her right to make these decisions be protected. Policy and law also suggest that the physiotherapist should respect the child's desire for confidentiality and thus should not actively inform the child's parents of the circumstances of the accident. An examination of the ethics in this case tells us that there are good reasons to maintain confidentiality. However this does not mean we relinquish our responsibility to help the child to work through and evaluate her choice. The physiotherapist is in a position to persuade the child to reflect on her choices and possibly disclose to her parents independently. Every effort should be made to work with the child within the relationship of trust.
