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.
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.
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.
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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