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Chapter: Paediatrics: Paediatrics, ethics, and the law

Paediatrics: Confidentiality and disclosure

When should you tell the whole truth? What if you make a mistake? What do you say to the team? What will you say to the family? Will you disclose your error? Will you say you are sorry?

Confidentiality and disclosure

 

When should you tell the whole truth? What if you make a mistake? What do you say to the team? What will you say to the family? Will you disclose your error? Will you say you are sorry? How will you handle this in terms of your personal feelings? How will you feel about yourself? These are questions we all have to think about—whatever our level of seniority and whatever field of practice. The General Medical Council provides guiding principles and responsibilities of the doctor in these situations. It should be remembered that deception or flawed disclosure may take many forms, e.g. presenting ‘just the facts’, or saying ‘there’s always hope’, or thinking that ‘you can’t tell a patient everything’, or omission, or evasion.

 

Confidentiality in regard to patients

 

In adolescent practice, the issue of confidentiality arises when the young person presents for certain types of advice or treatment (e.g. contracep-tion, abortion, STIs, substance misuse, mental health issues, and family problems).

 

·  The duty of confidentiality owed to a person under 16 is the same as that owed to any other person.

·  It is not absolute and may be breached where there is risk to the health, safety, or welfare of the young person or others.

·  Disclosure should only take place after consulting the young person.

·  The personal beliefs of a practitioner should not prejudice the care offered to a young person.

 

Objections to disclosure of information should be respected, although in certain situations disclosure may be required by law for the purposes of protecting the adolescent or others from significant harm.

 

Breach of confidentiality and disclosure of information

 

It may be proven legal to breach confidentiality in the following situa-tions:

·  Incompetent individual: any situation in which there is a risk of harm to the adolescent or to others.

 

·  Competent individual:

 

·  history of current or past sexual abuse;

 

·  history of current or recent suicidal thoughts or self-harm behaviour;

 

·  homicidal intentions;

 

·  where serious harm to the individual is likely to occur.

 

The patient should always be informed that the information will be dis-closed and the reason why. Attempts should be made to encourage the patient to agree to disclosure. Legal guidance from professional bodies or from medico-legal services may need to be sought.

Confidentiality and disclosure of medical information to other agencies

 

Improving children’s well-being is dependent on agencies being able to share relevant information about them. The general rule is to seek con-sent to share information unless you believe it is contrary to the child’s welfare. It is the parents (or whoever has parental responsibility) who can give consent.

 

In UK law, the parental right to determine whether a child <16yrs has medical treatment terminates if and when the child achieves sufficient understanding and intelligence to understand fully what is proposed. In practice, a young person <16yrs of age can consent to treatment, but if they refuse it, parents may override their decision. This is termed Fraser or Gillick competence. Whether an adolescent is Fraser com-petent depends on the complexity of their medical needs as well as their emotional maturity and intellect.

 

Disclosing personal information and medical information about a child to other professionals (teachers, social worker, police, other health profes-sionals) is not a problem if consent is given but should be proportionate.

 

·Judgement needs to be exercised and very personal medical information should only be shared if relevant and necessary to promote the child’s well-being.

·Medical and other sensitive information about parents needs their permission to divulge. Only share relevant facts when needed.

·If consent is not given then it can be justified if:

·there are very good reasons to do so; or

·it is in the public interest.

 

Whatever decision is made this must be in keeping with the Data Protection Act, the Human Rights Act, and the common law duty of confidence and also guidance from the General Medical Council (UK).

 

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