Medical secrecy: should parents know everything about teenagers

Among the many events of this summer, one, not unimportant and capable of influencing the destinies of many people, passed almost unnoticed. From August 11, 2020, all information about the medical care provided to a minor can be obtained by his legal representatives. And not only can they – hospitals and clinics are required to notify them and provide all the information.

Legal representatives are parents, trustees and adoptive parents. Those adults who have the right to sign documents for a child or teenager under 18 years of age (for example, concluding an agreement in a private clinic).

This practice exists in many countries, and here we are not unique. In a number of states, a minor, only under certain conditions, can receive medical assistance without informing his parents. It’s because he’s underage. Judging by the presence of different versions of laws on this matter, even in the “civilized world” there is no consensus on which is better, and, in fact, it is not clear who is better for whom.

What are the nuances?

To present the pros and cons, let’s look at real life stories and try to “try on” the new law.

1. “At the age of 15, after a conflict with my father, I had my first panic attack – then I thought it was a heart attack and I was dying. Then they began to repeat themselves more and more often. I was constantly worried and by the age of 16 I practically could not answer at the blackboard at school: it was getting dark in my eyes, my heart was beating, my thoughts flew away, even if I knew the topic perfectly. As a result, the grades rolled down, I began to play truant. And when I returned home, when I got off the elevator, I had another panic attack. It seemed that there was simply no safe place in the world for me,” writes George, 18.

Having reached despair, he went to the doctor. When signing the informed consent, George specifically stipulated that his father should not receive information about his illness. And since everything happened before the adoption of the new decision, the attending physician withstood the attacks of the parent and did not tell him anything.

The boy was in a hospital, where, during psychotherapy, it turned out that the psychological and physical abuse by his father contributed to his illness. After the end of treatment, the teenager went to live with relatives in order to start a normal life away from the aggressor. Question: was it necessary to give out information to such a “parent”?

2. “I was 16 and fell in love like crazy,” says 20-year-old Irina. – First love, romance and butterflies in the stomach. It all happened quite awkwardly, it was the first time for both of us and protection was not taken care of.

When the delay started, I got scared and told my boyfriend. And then he said that it was not from him, we had a fight, he stopped responding to messages and calls. I went to the gynecologist, and it turned out that I was pregnant. My parents are very religious people and if they found out, they would either kick me out of the house or force me to give birth, but I was not ready for this.

Not all adults are ready to understand and support their daughter in such a situation, to let her decide for herself. Obviously, the reactions can be different – from support and acceptance of the grandson to assault and threats against the girl who “dishonored the family.” Is informing parents guaranteed to benefit the life and health of a teenager? It seems that a lot depends on whether the relationships in the family are healthy, what are the beliefs of the parents, their values, the degree of enlightenment in some matters, and so on. But there are other nuances.

3. At the age of 17, Sergei was diagnosed with a malignant tumor. He shared this only with his best friend – relations with his parents were not bad, but not close either, and the young man wanted to prove his independence.

Whatever was behind this decision, it led to the fact that Sergei did not tell his father and mother about the cancer. That is, he hid a serious problem from those who could take him to hospitals, negotiate with doctors, pay for treatment or medicine if necessary, in general, use every chance for the teenager to cope with the disease. Should they have known about it against his wishes? Most likely, any parents would have answered in the affirmative and made every effort to help their son.

4. “It was back in the 90s, at the age of 15 I caught a cold and coughed for a long time,” says Dmitry, 40 years old. – In the end, I decided to go to the clinic so that they would give me a certificate for the school. The doctor glanced at me, said something contemptuously about my appearance (well, yes, I wore an Alice T-shirt and wore a skull ring) and prescribed penicillin.

I even honestly bought it and was going to take it, I got a cough. But at home, my mother saw the package and stopped me. In general, it turned out that I have a strong allergy to this antibiotic, but the doctor did not look, it was written in the card. And I didn’t know. Could have died from Quincke’s edema, probably. What if the parents didn’t see it?

Unanswered Questions

It seems that on one side of the scale – parental control, and on the other – the sanctity of medical secrecy. Adolescence has its own characteristics that affect decision making. For example, categoricalness, mood swings, a sense of resistance, often a tendency to see situations in the most gloomy light. A person still lacks life experience and the ability to look at life from a different perspective. And, as in the last story, there may simply be no knowledge about one’s own or hereditary characteristics.

That is why serious decisions for minors are made by adults. It is believed that they come from his interests. But the world is not perfect, and the parents themselves often become a source of threat to the child. Well, or they do not have enough strength, desire or knowledge to make a wise decision that affects his fate, health, well-being.

But even in an ideal scenario, when mother and father are excellent parents, their own ideas about the best path and the ideas of a son or daughter can be very different.

“With the new law, it seems to me that the child just remains alone”

Maria Leibovich, psychiatrist, psychotherapist

This is a complex ethical as well as practical issue. On the one hand, any parent of any teenager wants to know about the difficulties, health problems, risks and dangerous situations. This desire is quite justified, and the new law takes the side of the parents.

But… This “but” applies precisely to those teenagers who most often resorted to the protection of the former law, and he guarded the secret of their visit to the doctor. In what cases did this happen? When the children were not sure that their parents would understand, take their side, support their decision. And most often, the request to the doctor to keep the secret related to sexually transmitted diseases, pregnancy, mental disorders – that is, critical situations.

We understand that it is precisely those teenagers who have no contact with their parents who have difficulties – unfortunately, this happens quite often. As a mental health professional, I know how often parents are reluctant to accept the facts about their children’s illnesses.

Many are ready to the last to explain everything with bad character, laziness, transitional age. Thus, they prevent adolescents from receiving the necessary qualified assistance. And yet, it was confidentiality that helped so many people in need to get it.

When conflicts with parents become one of the main causes of a teenager’s unstable state, the opportunity to come and talk with an adult who is on their side – a psychiatrist, a psychotherapist – can help improve family relationships.

On the other hand, in the case of the risk of suicidal behavior, my colleagues and I always made a choice in favor of informing parents about its presence, about which adolescent patients were immediately warned. As a rule, this did not become an obstacle to the continuation of their communication with the specialist.

According to modern legislation, the doctor is obliged to tell the patient and his relatives what diagnosis has been made and what drugs he is being treated with, in contrast to the practice of the Soviet era. But there is a caveat here – except in cases where the announcement of the diagnosis will entail a deterioration in the patient’s condition. And in psychiatry, this situation is quite common.

It’s good when a child is in a hospital – the doctor sees him every day, communicates with his relatives and can assess, according to the situation, how much the message about the diagnosis or about the methods of treatment can lead to a worsening of the patient’s condition.

But if we are talking about a new law in relation to outpatient practice, then it turns out that a specialist sees a patient once and he does not have the opportunity to assess how safe it will be for the child to inform the parents, how it will affect his condition and the treatment process, whether it will harm their interference and how it will affect relationships in the family. And there are always risks in this regard.

The adoption of this law raises both professional and human concerns for adolescents who were previously protected by law and could seek help. They were often sent to me by psychologists to diagnose a mental disorder. And the teenagers were protected – a visit to the doctor did not threaten them.

When this becomes impossible without the involvement of parents, many of them, I am afraid, simply will not go. I am talking about my field, but I believe that my opinion will be shared by gynecologists who are treated by minors with suspected pregnancy or sexually transmitted diseases.

And if teenagers do not turn to specialists, this can lead to an increase in undiagnosed diseases – sexually transmitted diseases and mental illnesses, to non-medical abortions, and the development of a protracted course of diseases. This is the side of the issue that causes concern.

People who support the adoption of this law say that a teenager cannot make decisions on his own. This is true, this process is influenced by the characteristics of age – protest behavior, the desire for independence, and so on. But here is an important point – before the teenager was not left alone with the adoption of a difficult decision. He has a specialist for whom the priority is the health of the patient. With the new law, it seems to me that the child is just left alone – he needs to make a decision whether to go to the doctor in principle.

Fearing that his parents will find out, for example, about his venereal disease, he is highly likely not to go to the doctor. It turns out that earlier there were more chances that in a difficult situation a teenager would turn to a competent adult who – yes, without the participation of parents – would provide qualified medical care.