Breaching minor patient's confidentiality?

[CdwJava]

If the situation involved a 12 year old, I agree that it would be different and the doctor's ethical responsibility (and quite likely legal responsibility) would be different. But that's not what we are talking about. In an ideal world, all teenagers would be able to talk to their parents about sex and make good decisions about it. But in the real world, greater emphasis should be on preventing the most dire consequences (teenage pregnancy and STDs) than on the teenager's relationship with his or her parents.

Yet, the parent of even that 15 or 16 year old is responsible to make medical decisions for the minor child and may make the WRONG decision if their child is unknowingly being treated with medication or post-op for something the parent as unaware of. The parent retains full liability even if they are legally prohibited from being kept in the loop.

Ironically, the state is complicit in providing contraceptives to minors for an act that is criminal. Yeah, I now the argument, "They're going to do it, so we might as well make it safer for them ..." Well, let's take that further. It can be akin to giving them low tar cigarettes under the same assumption that if they are going to smoke, we might as well give them the least harmful cigarettes available ... or alcohol - maybe we provide them with a safe place to drink ... or marijuana ... or other drugs. Either the state should take over the raising of the children and the responsibility, or permit the parents to retain that control until the child is of the age of majority.

Personally, I make a point of generally not talking about personal issues with my children or their friends when I am on duty for precisely this reason. When I am ON duty, I am a mandated reporter. When I am OFF duty, I am not. Fortunately, my wife and I have pretty open relationships with our boys and even their friends (male and female). Unfortunately, this is not the case with every child and certainly not all of their friends ... some of their friends are more open to us than they are to their own parents, and that often presents quite the quandary. Hence the reason I prefer to discuss it with them when I am OFF duty as my options are wider.

 

[quincy]

The following is a link to a good article in Virtual Mentor, the American Medical Association Journal of Ethics, titled "Protecting the Confidentiality of Sexually Active Adolescents," written by Xiomara M. Santos, MD. It illustrates nicely the dilemma faced by doctors when treating young patients.

http://virtualmentor.ama-assn.org/2012/02/ccas2-1202.html