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Should minors healthcare information be completely confidential?

Americans have the luxury of being given many more individual rights than countless other civilians that live in other countries. One of these luxuries is the right to medical and mental health confidentiality. Adults patients in hospitals and mental health institutes can sleep soundly knowing that their insecurities and darkest secrets are kept within the confines of the hippocratic oath, which their healthcare professional is binded to. Children however, lack this basic and fundamental right, at least in its entirety. While it is true that not just any stranger can obtain their records, they are still not completely confidential. Parents of healthcare patients can easily obtain their children’s healthcare records, and while this can be superfluous in dangerous situations, this can often make the children feel intruded on and less likely to accept treatment, potentially endangering themselves in the process.

One of the problems problems with minor confidentiality is the ethical dilemma that it poses for medical healthcare professionals, and their goals for treatment. This is because children, especially youths(age 14-18) “Especially difficult since they straddle the conceptual and definitional between childhood and manhood” -Jackson, Burns, Richter, and tend to have a certain ability to think for themselves with reasonability. A specific example of this is when a child is receiving counsel from a psychologist, therapist, social worker, etc…and the patient asks that their parents specifically not be informed of the conversation between them. Several obstacles may cause the professionals best course of action to become askew. On one hand, the Health Insurance Portability and Accountability Act of 1996 compels the professional to silence whenever possible, but minors fall under the few exceptions. This exception comes in the deferment of regulation when concerning parental representation of a minor to the states.. This lack of a federal regulation from which states can base their laws around causes much confusion among mental healthcare professionals as any violation of these laws can result in reprimands or even loss of license to practice. Another complication that comes with minor confidentiality is the conflict of law and ethics that can arise. Most social workers and psychologists will agree that the patient and their treatment comes first. Often, when a parent asks to know what was said during a counseling session, the clinician will be hesitant to reveal this information, even if they are lawfully compelled to. This can cause resentment between the parent and the clinician, which is unwanted, and could lead to the parent disallowing their child to see the professional for future appointments. Conversely, revealing the minors information when the professional was asked specifically to keep their conversation confidential, it can plant seeds of distrust between the child and the counselor, damaging their relationship, which is an integral part of any treatment plan. This is why it is very important for all health professionals to remain vigilant about laws pertaining to minor confidentiality, and to use their professional judgment.

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Confidentiality is often rarely breached by any person of non familiar relation to the minor, and as such, is not of much concern to most minors. However, the ones who breach this basic right to privacy, are the ones that are closest to them. Parents tend to feel entitled to their children’s confidential information, an idea that can and often does make the feel like more of an extension of their parents, instead of their own self with their own privacy. A feeling of autonomy is essential for the growth of a child, but can also be the deciding factor of whether a child seeks necessary health care. Guttmacher institute, a research group which seeks to educated people about sexual health(and a part of planned parenthood), conducted a survey of an unknown number of single sexually active females aged 17 and younger in Wisconsin Health Clinics about their privacy. When asked if they would continue treatment plans if parental notifications, 50 percent said that they would discontinue treatment and another ten percent would delay treatment. Furthermore, only one percent of these girls reported that they would stop engaging in intercourse, despite not having access to effective contraception. In addition to this, it was found that one third of those who did not seek treatment, did so out of fear of their parents learning of their activity – Guttmacher Institute Vol. 36 Issue 2, Pgs 80-86. This cements the idea that children require some form of privacy or the likelihood of them seeking requistional treatment is lessened to an immense degree. The United States Government has recognized this and as a result has implemented such programs as Title X, a federally funded program that seeks to inform and provide for low-income communities and minors with basic preventative measures along with family planning advice. Along with this, the federal government has clearly stated that things such as drug abuse, sexual health, and emergency medical treatment among others; is to be provided to minors without the needed consent of a personal representative or parent. Now, many parents would argue that as their role as parents, they know their Children best, but this simply is not true. Often parents may neglect to get their children proper treatment for pregnancies, sexually related illnesses, or contraceptives, often due to their own morale and or religious restrictions. This means that even if a child has managed to face their parents and reveal their sexual activities, the child still may not recieve proper care. Parents may defend these decisions by saying things like “They’re my kid, they will do what I say”. Generally when a parent says this its for a good reason; perhaps to teach a lesson, but in situations as these, those words are often just an excuse to impose their views on their children. Teaching your children your cultural and religious beliefs is anything but a bad thing, but these notions can endanger your child’s life, and helps to qualify the need for easy access to sexual healthcare without the potential inhibitions of parents.

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Sexual health care is not the only area where minor confidentiality is of great contention. General Medicine that doesn’t necessarily have to deal with sexual activity can cause conflict between parents and their children, while also being a legal and ethical minefield for the medical professional. Often, things such as vaccines, which are a contentious subject on their own, can lead to problems with confidentiality. If a parent will not allow their kid to be vaccinated, but the minor wishes to be vaccinated they will find such a thing occurring unlikely. The federal government does not have a specific law or statute pertaining to vaccinations, which means that this issue defers to the states. Most states require parental consent for vaccinations as with most procedures and this is where laws regarding minor confidentiality fall short or completely fail to address the issue. The fault does not necessarily lie with the inability of the medical professional to give a minor a vaccine, or some other medical procedure, it is merely the act of parental notification that is necessitated by the state. One could argue that allowing parents to be notified could help open a pathway to discussion between the parent and the minor about getting a vaccination, this is still an invasion of privacy. Whenever a child tries to hide something, especially something as important as healthcare from their parents, there is often a reason. A common example of this is when a child is severely neglected. They then attempt to recieve some form of healthcare that requires parental consent, they are denied, their parents are notified, and when they along with the child get home, the child is severely punished. Exceptions are absolutely made for abused children when concerning confidentiality, but getting a child to admit that they are a victim of abuse is incredibly difficult, and by assuming that a minor will tell their health care provider this endangers their safety. For this reason alone it can be easily understood that even if a minor is not legally allowed to recieve some form of healthcare, parental notification should not be required.

Confidentiality is extremely important in all facets of healthcare, whether it be mental health or physical care, it has been implemented for the safety of the patient, and to ensure successful treatment. This characteristic obviously extends to minors, as evidenced by the government’s willingness to make many forms of mental and sexual health, along with substance abuse treatment, easily accessible to them without anyone having to be informed. But, as has been shown, not everything is covered by the hippocratic laws or other various statutes. This is often because a minor has requested something that requires parental consent, and a parent is informed as a result. Each branch of healthcare has exceptions to these laws however, exceptions upheld by the federal government itself, and that no state can nullify. There is no specific name for these exceptions as they are situational, however they are all designed to keep the minor safe. As previously stated, most medical procedures or operations require the consent of a parent or guardian when the patient is below the age of eighteen, but this can be bypassed. When the minor or another person in question is in danger, specifically life threatening danger, the acting healthcare professional may allow for any procedure that could save a life without parental consent or knowledge. It is doubtful that anyone would disagree with performing surgery without asking a parent first, but an opponent of full minor confidentiality might ask why a parent could not be notified afterwords? This, just as with sexual health, is to ensure that the patient will undergo a potentially vital procedure. Just as a minor may be discouraged to receive sexual health care, they may also be discouraged if the medical procedure they are about to undergo conflicts with something like their parents religion or ideology; a conflict; that should the undergoing of the procedure be revealed; could lead to anger directed towards the minor by the parents. This is just an example of the kind of situation that can lead to a medical professional to exempt their youth patient from information disclosure, however it should be noted that when these exceptions occur, they tend to be more subvert, electing to simply omit information from the parents instead of outright denying them. Mental Health Professionals like psychologists, often have to come face to face with their patients parents after their appointments, and information that has been requested as confidential is almost never life-threatening. Because of this, when a parent asks to learn about said confidential information, the interaction is more direct. In most states, psychologists are compelled to tell the parent about what has been said during consultation, and when they’re not, they still may be required by special court order, especially if the information could contain potentially dangerous admissions. However, a psychologist or any mental or medical health care professional may nullify a parents right to their child’s records or information if they have any suspicion that the parent could be destructive towards the child’s health or is bad intentioned. This can unfortunately lead to an altercation, especially for psychologists, who usually can’t afford security, but have to face these potentially dangerous individuals anyways. Despite the digression of the past sentence, these exemptions allow for a level of privacy that is necessary for the well-being of the minor, and while this level of confidentiality is not upheld for everything, is a great step in the right direction.

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