The facts are:
- The patient is a 12 year old girl
- Unmarried
- Pregnant
- Lives with her parents and parents are the ones who pay’s for her obstetrical care.
Mother requests the medical document of her daughter in hope that she would get the name of the father of her daughter’s baby.
As a health care provider one of the legal rights of the patient is the confidentiality of whatever documents, diagnosis or any prognosis they may have in the hospital. Confidentiality in the health care is an obligation of the health care provider not to disclose any information regarding the patient. The Health Care provider has a right to withhold any documents to the relatives of the patient as the patient wishes so, provided that the patient is at the right age and is in good condition with the right state of mind. In the case of a minor, consent is needed by the parents or relatives regarding whatever treatment or whatever they have to undergo. Constitutionally, the rights of minors are protected; but their rights are not at the same degree as that of an adult.
There are three reasons that minors do not have the same constitutional rights as an adult: the vulnerability of children, their limited decision-making capacity, and the important role parents play in making decisions for their children. Various state codes limit minors’ rights while trying to balance the protection of the state interest, the parent interest, and the interest of the minor. Developing appropriate interventions relies on the understanding of the minors and the laws that pertain to the health care provisions implied to the minor.
Minor pregnancy evokes a great deal on the health care providers responsibility. It is the duty of the health care provider to be aware of the laws within the jurisdiction of practice. Laws that affect the minor’s right to consent to medical care have been developed under the precedent of parental autonomy. In adolescents under the age of majority who receive health care services, physicians and parents are encouraged to include adolescents in the decision-making process, but the parental autonomy and parental right to give consent for a minor is the standard.
There are several components of informed consent that are important to consider, especially when caring for adolescents. First, patients should have explanations in understandable language, including the potential risks and benefits of the proposed treatment. Second, the provider should assess the patient’s understanding of the information given to them. Third, the provider should assess the patient’s ability to make the necessary decision. Finally, the provider should determine that the patient is not coerced into a particular medical alternative.
Although adolescents are considered to have limited decision-making capacity by many policy makers, there are occasions when adolescents can give informed consent without parental intervention. Allowable treatment of minors without parental consent includes the mature minor, the emancipated minor, and an emergency situation. A mature minor exception is when a minor may decide for themselves without parental consent or notification, if the court determines that the minor has the maturity to make independent decisions.
Emancipated minors are usually 16 years of age, live apart from her parents and economically self-sufficient, pregnant or not, married or pronounced by the court emancipated. It is stated that when a minor is engaged in sex, gets herself pregnant she has the right to decide on the treatment and the care for the child she bears with or without the consent of her parents. The state considers the minor a parent and be fully competent to make major decisions affecting the health and future of his or her child.
With regards to the 12 year old girl who got her self pregnant she is entitled to the treatment whether she has consent or not because when a minor gets pregnant she has the decision on whatever she wants to do with the baby and the treatment regimen she is going to undergo. When the girl decides to be a parent she has all the decision regarding herself and the baby. The right of a minor to consent to pregnancy related services includes genetic counseling and testing services which, under the law, must be offered to all pregnant women (Health & Safety Code §125000) regardless of the parents consent. As the administrator of the hospital it is the interest of the minor that should be the concern; it is best not to provide the document that the mother wants.
Although the mother has the right on her daughter’s treatment regimen provided that her daughter is still a minor, the daughter now as a parent has the right to withhold any documents to her parents with regards to the treatment and information obtained from her. She has the right to decide for herself and her baby and it is the right of the administrator to withhold the documents as the patient requested. It is her right to keep her records privately and the confidentiality of it shall be the responsibility of the health care provider.
Health care providers who serve young people agree that parental involvement is desirable but in some instances it is not in the minors benefit. Some minor’s parents may not be their best advocators just like in the case of the 12 year old girl who got herself pregnant. Her mothers interest in the records does not at any point bring any interest to the health welfare of the child. The mothers reason for requesting the records is more on the personal interest and legal matters does not really apply to it. Although the mother may threat to sue the administrator, there is legal basis for the administrator to keep the records of the patient.
The only way that the mother can avail the records of her daughter to the health care provider is that if the pregnancy of her daughter is a result of rape or constitutes of child abuse in which the information has to be reported ( California of Medical Information Act). The expansion of minors’ authority over health care decisions was extended to the constitutional right to privacy to a minor’s decision to obtain contraceptives or to terminate an unwanted pregnancy, or adoptions (U.S Supreme Court). This law pertains to the minor’s authority to consent to medical care without their parent’s knowledge.
Social services may help teenager to avoid the costly and often the tragic consequences of unintended pregnancy and child bearing. If the mother of the pregnant girl terminates the financial support, the social service workers may aid her. They can also provide her support regarding the rearing of her child, she will be given options by the social service to either have it for adoption or keep it.
Clinicians have a window of opportunity to provide primary prevention strategies to youths who may reduce adolescent health risk behaviors, possibly even reduce the initiation of high-risk sexual behavior during an office visit provided that it is within the minor’s interest and the confidentiality should be observed. Understanding legal issues surrounding adolescent rights to care can help the health care provider make appropriate care available to this age group. Decisions made during adolescence have implications that last throughout a lifetime and affect both the inpidual and public health. Moreover, adolescents have the expanded capacity for critical thought, including the questioning of self and others, as well as for reproduction.
That is why it is important that the health care provider protect the confidentiality of all information, as personal facts and circumstances obtained from the minors receiving the service, except at necessary times in providing the care to the patient or as required by the law. A minor consent law is important as is encourages the young one to seek medical services they need and enable them to talk to their providers without hesitations. It helps assure the minor access to their confidential health care because if minors are not given the assurance they would stop seeking the care they want and need. Although some parental involvement is required by laws in the focus of the care which involves the minor, it is still the priority of the health care provider to take the responsibility to put the minor’s interest first in keeping the information and documents related to the patient.
According to the federal statute, the Health Insurance Portability and Accountability Act of 1996 (HIPAA), which deals more directly with the records was enacted, wherein the Secretary of Health and Human Services was directed to develop regulations dealing specifically with access to and disclosures of confidential medical records. At the outset, protected health information of any inpidually identifiable health information shall be kept private including the treatment record.
Although there are laws regarding the confidentiality of a patient’s record in withholding the information to the parents it is still within the health care providers hands on what the decision to make in the interest of both parties. The health care providers standards of professional practice and ethics also plays role in making the decision about the confidentiality of the minor’s records in the context of parental access. It is best that when making decision the health care provider should be aware of the different legal aspects for the minor, where it would best suit its interest and for the parents to understand the ongoing treatment regimen without interfering.
It is also advisable that the health care provider acknowledge that the minor understands that she or he has the right to the confidentiality of the obtained documents and the treatment regiment that the he or she is undergoing. The health care provider on the other hand can also, if possible, inform the parents without causing any dilemmas or unrelated issues granted that it is beneficial to the minor.
Reference:
Pozgar, George D., and Nina M. Santucci. Legal Aspects of Health Care Administration. Gaithersburg, MD, Aspen Publishers, 1996.