Parental Notification & the Privacy of Minors

Since it kept derailing the Gay Rights and America thread, I decided to open this one.

The base of the topic is whether a medical authority should be allowed/required to disclose what would, in an adult setting, be privileged medical information to the parents of a minor under their care.

My opinion on this is that when it comes to diagnoses, the medical professional should disclose the information. If a child is clinically depressed and requires medication, then the parent needs to know. If the child is suicidal and someone needs to keep an eye on them, the parents who are charged with the care of their child need to know.

In the case of information disclosed during a medical/psychological exam, I think, generally, privacy should be maintained, outside of exceptional circumstances. I'd have to hear some to make a decision.

Obviously, exceptions should be made in the case that the parents are the problem (e.g. abusive or neglectful parents).

Opened.

I think that there should not be barriers to minors seeking psychological and medical care. I think that the parents should be notified that they are seeking care, but not given specifics if the care provider believes it will impact the minor's home life. I think care givers should be encouraged to disclose specifics to their parents, but not forced, and not have the care provider supply information to their parents unless there are clear indications that the parents need to be involved in their treatment.

When I was 16 I had a severe case of depression so I sought professional help. The psychologist I saw started by telling me that by law she's mandated to tell my parents that I was receiving therapy for depression, unless there was a good reason why my parents should not be informed. I had no problem with the psychologist contacting my parents, so this wasn't an issue. The impression I got was that it wouldn't have been hard for me to convince her not to contact my parents if I had had a reason for it.

I think that's how it should be.

In the UK, the rules are called Gillick competence, after the leading case of Gillick v West Norfolk and Wisbech Area Health Authority [1985] 3 All ER 402, which ruled that if a child (an under 16) is capable of understanding the nature and implications of any medical treatment then they may have it.

It is rather funny that Victoria Gillick, a throwback to the sexual Dark Ages, who brought the case to stop her daughters having sex ed ever, is now associated with the case that let under 16s access contraception without parental authority.

edited 31st Jan '13 12:17:07 PM by Achaemenid

You misspelled "ironic" there.

And, that's basically why I'm of the opinion that kids' views do matter. However, I do differ on one note: I wish that doctors and other professionals had a bit more scope to inform other family members of treatment and management issues, even if the patient themselves wishes to veto it.

Even for full adults, sometimes... well... patient doesn't always know best and does need the family safety-net they'd rather avoid.

edited 31st Jan '13 12:37:44 PM by Euodiachloris

I have mixed feelings on the matter. On one hand, parents should probably know some stuff, like symptoms to watch for, warning signs, and whatnot, but on the other hand, if the parents are likely to get in the way or cause problems, they're better off left in the dark.

Most of my opinion on this comes from personal experience, as usual.

One point that I might have failed to highlight in my post (but that I wanted to get accross) was that the professional - doctor, psychiatrist, social worker, whatever - should be the one who decides whether or not the parents are to be told. The patient is to be consulted but the final decision lies with the professional because they're the one with the best tools to deal with the situation and to know what will be likely to help and what won't.

And something that I should probably add to my post:

I also think that parents should not be allowed to "sit in" while their child is at a counselor's. That's one of the things my mom would do, and she would constantly interrupt, correct me, and if the counselor told her to leave, she'd take me to a different counselor.

It's one thing to interview the parents, and get a perspective that the child might lack, but don't let them sit there and expect the kid to tell the truth.

I think the patient should at least be involved in the decision.

I think that if the kid doesn't want their parents to know, but the professional thinks they should, then they should try to explain why.

I know better doesn't really make the kid open to working with you on their problems.

Indeed. I could never have any sort of heart-felt discussion with my parents in the same room.

There are some things that they really, really don't need to know. Not even bad things, just things.

edited 31st Jan '13 1:50:55 PM by Matues

There are some times when having the parent there will be helpful, and there are other times when it obviously won't, and that's going to vary from family to family too. My mom always sat in on my counseling sessions, and while she never spoke about anything in front of the therapist, the car ride home was always full of recriminations and guilt-tripping.

What it boils down to is that the professionals in these cases need some leeway to make judgment calls as to whether to inform the parents or not. Most parents are nothing but well-meaning where their children are concerned...but the consequences of a "false negative" for child abuse are so much worse than those of a "false positive" that I really think the default should be to respect the child's wish for privacy.

Well-Meaning..

I'm sure a parent who controls every aspect of a child's life means well.

That doesn't change that this is.. less than the best way to raise a child.

I think part of the question boils down to how much control we want to remove from the hands of the parents.

Yet unless we want the state to say, "Sorry, but we don't approve of the way you're raising your kids," parents do have the right to be controlling. It sucks. I've been there. I think I've suffered some for it. But I still think that parents in general are better suited than the state to make that decision.

The question the state has to decide is where to draw the line re: abuse.

It seems that everyone here has agreed that except in extreme cases where parents are a problem or may complicate matters parents should be informed about the medical condition of their children.'

I am of the opinion that the state should legislate it such that the doctors and medical professionals must disclose information to parents most of the time unless there is belief that the parents are or may become a problem after doing so, but at the same time parents should be barred from being there when the doctor/medical professional is making a diagnosis.

It depends on what you mean by medical condition. Should they be informed of diagnosis? Yeah, but of the contents of counselling sessions and such, I’d say that should be up to the kid.

^^ I'll agree with most of that, but not the part about parents being barred from being present during diagnosis. How many kids are going to be able to explain what the doctor said, accurately, to a parent or other caregiver?

I don't think that there's any way to make a law that won't cause problems in one direction or the other. The only exception is counseling sessions when it isn't specifically "family counseling", where multiple family members are expected to attend sessions together. What's said in those should remain confidential unless there's a very good reason to tell the parent (for instance if the child is suicidal, the parents need to know that.)

edited 31st Jan '13 10:24:34 PM by Madrugada

They could be told separately by the doctor.

edited 31st Jan '13 10:23:39 PM by Matues

Why should he have to spend twice the time, saying the same thing twice, because he's legally barred from saying it once to the same people at the same time? What good does the law do, then?

In my experience, they give you a formal written diagnosis that also goes in your medical file, UNLESS they think that having a copy will do you harm.

My very first counselor (when I was 13) gave me a thirteen page summary detailing all the tests, how I scored on them, what the scores meant, and what her professional opinion was.

My last counselor flat out refused to give my mother a copy of the diagnosis because 1) I was 18, and 2) It had stuff in there that would have caused me grief if they saw it.

What good would the law do? It would keep kids from holding back in front of their parents for fear of feeling guilty, or ostracizing them, or any number of other reasons that a kid might not seek mental health care if they know their parents are going to be informed of everything that's said.

In that, I think telling parents the diagnosis is enough, and that the drawback of having to say it twice is far outweighed by the benefits.

My son is 6. He has been in counselling over a year.

I sit in with most sessions because I have to be there to tell the counselor his behavior, his progress or lack thereof, etc.

The counselor will then either ask to speak to him alone or start instructing me on a new approach while involving my son for his feedback.

Even when she speaks to him alone, she still gives me the highlights so that I can positively react to them and incorporate that info into our plan:

Example: my son doesn't feel like his chores will ever end.

Knowing this I can try to set timers or space out a better schedule to help his feelings and try and ease any stress.

Now should my son continue to need counselling as he ages (which is most likely to happen), then I hope to move the sessions to a family update, I leave, and he has full privacy. But I would also like to have group counselling between himself and me so that he can be in a safe place to disclose to me what he wishes and I can have a guide to help me understand him correctly and work out a game plan.

So I am all for kids seeing counselors and giving the tools for the counselors to evaluate if telling the family is safe or not.

But I also advocate for a child's right to either request to keep a counselor or get a new one without parents permission.

edited 31st Jan '13 11:28:44 PM by Gabrael