Treating children

A 15 year-old girl was admitted to A&E with an ectopic pregnancy. She says that she has had a sexual relationship with her boyfriend for the last year and had been on the pill.

When her parents arrive she says she does not want them to know about her condition. What should I do?

Sharing information with relatives is normally done only with the patient's express consent. You need to consider if the patient is competent to refuse consent for her parents to be informed in this case. Children under 16 can consent on their own behalf if they have the intelligence and maturity to understand the implications of their decision. For example, to consent to treatment, the patient would need to understand the nature, purpose, benefits and risks of any procedure, as well as the risk of going untreated and any alternatives. She would also need to be able to retain, use and weigh up this information, and to communicate her decision. If the patient has capacity to consent to treatment, then she may also have the capacity to withhold consent to disclosure of confidential information.

'You have the same duty of confidentiality to children and young people as you have to adults.'

In paragraph 21 of the GMC's guidance 0-18 years: guidance for all doctors (2007) it says 'You have the same duty of confidentiality to children and young people as you have to adults.' In paragraph 53 of the guidance, it says in Scotland anyone aged 12 or over is legally presumed to have capacity to control access to their health records. The capacity to consent may vary according to the question being considered, that is, consent to the treatment or to disclosure of her condition, as well as the individual's state of maturity and the effects of their illness or treatment.

Every reasonable effort should be made to persuade the patient to involve her parents, explaining why it may help to have their support. If she has capacity but refuses, then you may only disclose if there is an overriding public interest, or if disclosure is required by law. Disclosure in the public interest may be necessary to protect the patient or others from risk of death or serious harm, for example, if she is at risk of sexual, physical or emotional abuse.

If you are considering a disclosure in the public interest it would be wise to first discuss the case with your local named or designated doctor for child protection.

You may not be able to judge whether a relationship is abusive without knowing the identity and age of her boyfriend. You should carefully balance the benefits of knowing her partner's identity against the potential loss of trust in asking for or sharing such information. If you are considering a disclosure in the public interest it would be wise to first discuss the case with your local named or designated doctor for child protection, as stated in paragraph 60 of the GMC's guidance 0-18 years: guidance for all doctors (2007).

Whether or not you decide to disclose information to the girl's parents, record your decision and the reasons for it in the patient's notes. If you decide to disclose against your patient's wishes, you should tell her your intentions, unless you feel that this would undermine the purpose of the disclosure or put her at increased risk of harm.