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Table of Contents
Think
Assess
Patient: Autonomy
Practitioner: Beneficence & Nonmaleficence
Public Policy: Justice
Conclude
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32. Minor Patients
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There is only one cardinal rule: One must always listen to the patient.
~ Oliver Sacks
Parental Dilemma
When Parental Authority Clashes with Patient Autonomy
It was a typical day in the pediatric ward when Dr. Smith received a patient, a 16-year-old girl named Emily, accompanied by her mother, Mrs. Jones. Emily was complaining of severe abdominal pain and Dr. Smith immediately ordered some tests and pain medication for her.
During the initial examination, Dr. Smith noticed that Emily appeared hesitant to answer her questions and was reluctant to be examined. Dr. Smith pulled Mrs. Jones aside to inquire about Emily’s medical history, but Mrs. Jones was not forthcoming with information, insisting that she knew everything there was to know about her daughter’s health.
Dr. Smith felt that something was amiss, but was unsure what to do. She knew that she had to prioritize the best interests of her minor patient, but at the same time, she did not want to overstep her bounds as a practitioner.
Over the next few days, Emily’s condition worsened and she became unresponsive. Dr. Smith suspected that Emily had a severe infection and needed immediate medical attention. However, Mrs. Jones refused to consent to any treatment, insisting that she knew what was best for her daughter.
Dr. Smith realized that she had to act quickly to save Emily’s life. She consulted the hospital’s ethics committee, which advised her to contact child protective services due to suspected medical neglect.
The investigation revealed that Emily was suffering from a serious medical condition that required immediate treatment. Emily had confided in Dr. Smith that she was afraid to tell her mother about her symptoms because she feared her mother’s reaction. She did not want her mother to know that she had engaged in sexual activity, and believed that her mother would punish her severely for it.
Mrs. Jones was charged with medical neglect, and Emily received the necessary treatment to save her life. Dr. Smith’s quick thinking and ethical decision-making skills helped to prevent a tragedy.
From this experience, Dr. Smith learned the importance of respecting a minor patient’s autonomy, even if it conflicts with parental authority. She realized that it is her duty as a practitioner to prioritize the best interests of her patients, especially when they are minors who may be vulnerable and unable to make decisions for themselves.
Abstract
There is a three-way relationship in regards to medical treatment for minors. This relationship includes the responsibilities of minors, parents or legal guardians, and medical practitioners. The minor’s autonomy and the right to informed assent is important, as well as the practitioner ensuring the minor’s confidentiality and privacy. If the minor does not wish to disclose information to their parents, then by the professional principle of beneficence and nonmaleficence, the practitioner should inquiring why the minor does not want their parents to be informed and instruct the minor of available social resources for services that will not show up on the parents insurance. In case of conflicts between the practitioner and the patient or parents, institutional policies for seeking ethics consultation are available, but the ultimate decision still lies with the parties involved. In case of medical neglect, laws for protecting vulnerable populations take precedence over the parent’s autonomy. It is reiterated that the practitioner has the professional and social obligation to provide the minor medical treatment in emergencies and the importance of maximizing the minor’s best interests.
**
Think
[32:1] The legal definition of a minor is a person who is under the age of 18. A minor is not considered to be legally competent to make medical decisions. Only the parent or legal guardian can consent to authorize a practitioner to provide medical treatment. With minor patients, this results in a three-way relationship involving the patient, parents (or legal guardian), and the practitioner. In this relationship, the patient, parents, and practitioner have different roles and degrees of authority, all with the common goal of maximizing the child’s best interests.
Assess
Patient: 1) Autonomy
[32:2] Medicine is a patient-centered profession, and therefore, minor patients who are capable of assent should be kept substantially informed of their diagnosis, prognosis, and treatment options, according to their cognitive and emotional maturity. Parents and the practitioner have an ethical duty to help the minor develop their autonomous decision-making skills by providing a supportive environment, simplifying the explanation of complex treatment regimens, and getting an informed assent from the minor patient. Medically, assent means an agreement from someone not legally recognized as having authority to provide consent.
[32:3] Parents need to know that within this three-way relationship their decisional authority for medical treatment is recognized but also limited to the patient’s best interests. Just as a parent has no authority to abuse or neglect a child, a parent cannot insist on harmful treatments or refuse a medical standard of care treatment if doing so would result in a significant increase of risk of harm or death of the minor. Under such circumstances, the state’s interest in protecting vulnerable populations from neglect and harm becomes activated, mandating that the practitioner provides the necessary treatment even at the parent’s objections. Because of this parental consent is not legally required to provide a minor with contraception, prenatal care, treatment for; substance abuse, HIV, or sexually transmitted infections (STIs).
32:4] The minor’s patient-practitioner relationship with confidential and private information carries more weight than the parents’ wish to be informed and to control medical treatment under the following circumstances:
[32:5]
[32:6] If a situation arises in which a patient who is a minor wants their protected health information (PHI) to be kept confidential and private from the patient’s parents, then professionally, ethically, and legally, the practitioner must keep the information confidential and private. Many states have mature minor legislation that allows minors to make medical treatment decisions if they demonstrate a sufficient understanding of the nature of the decision and consequences.
Practitioner: 2) Beneficence & 3) Nonmaleficence
[32:7] Based on the principle of beneficence (do good), if a minor patient wishes to keep their treatment confidential, then the practitioner has a professional responsibility to inquire why the minor patient does not want their parents to be informed. The practitioner should encourage patient-parent discussion and offer to help facilitate an open dialogue with the patient’s parents. If the minor still objects to parental disclosure, then the practitioner must make sure that the minor is substantially informed about what social resources are available and how they can be contacted.
[32:8] The practitioner has a professional responsibility of nonmaleficence (do no harm) to inform the patient about what information will be disclosed to the parents through their insurance company’s medical billing. Medical billing will include who, what, where, and when the patient received health care. This will include who the practitioner was, what lab tests were done, and the lab results. Publicly funded social services can bypass the need for insurance billing and are therefore much better options for the minor patient who wishes to keep aspects of their healthcare services private from parents.
Public Policy: 4) Justice
[32:9] When there are unreconcilable differences between what the practitioner as a professional determines to be the best interests of the patient and that of the patient or parents, then there are institutional policies and procedures for seeking consultation from an ethics committee. However, it is essential to know that although people on these committees are skilled at conflict resolution, precise language, and respectful dialogue between parties, an ethics consultation will never provide a medical decision, only a medical recommendation. Making medical decisions is still the parties’ responsibility and will never be usurped by agreeing to participate in an ethics consultation.
[32:10] Society has passed laws to protect vulnerable populations such as children, the elderly, and the intellectually handicapped. These populations are dependent on others for their medical and other basic needs. Medical neglect of a minor is considered a form of child neglect under the jurisdiction of child abuse laws. Most medical neglect cases arise when caregivers do not seek medical treatment when needed or do not follow the medical advice given by the practitioner. Under conditions of child neglect, social justice’s legal policies for protecting vulnerable populations as a matter of justice (be fair) has more moral weight than the parent’s autonomy (informed consent) authority.
Conclude
[32:11] Medical practitioners, in most instances, are required to get the parent’s consent before providing medical treatment. However, in emergencies with no time or opportunity to get consent, the practitioner has the legal, professional, and ethical obligation to provide the medical treatment. If a minor patient wishes to keep confidential information from parents, then the practitioner should enquire why the minor patient wishes to not inform their parents and encourage the minor patient to open a discussion and dialogue with their parents. The minor patient’s best interests limit parental consent. Professionally, the medical practitioner must be vigilant in maximizing the minor patient’s best interests.
[32:12] In summary, medical practitioners face unique challenges when treating minor patients, as they must balance the rights and responsibilities of the patient, parents, and themselves. In most cases, parental consent is required for medical treatment, but certain circumstances warrant exceptions. Practitioners should always prioritize the best interests of the minor patient, provide appropriate support, and promote open communication among all parties involved. This ensures the best possible care and protection for minors within the medical system.
**
Circumstances in Which Minors
Do Not Require Parental Consent
- • Emergency care
- • Sexually transmitted infections
- • Contraception
- • Substance abuse (most states)
- • Prenatal care
Medical
- • Homeless
- • Parent
- • Married
- • Military
- • Financially independent
Emancipated
Minor
32. Review Questions
1. With minor patients, there is a three-way relationship involving the patient, parents, and practitioner.
2. Minor patients capable of assent should be kept substantially informed of their diagnosis, prognosis, and treatment options, according to their cognitive and emotional maturity.
3. The minor patient is a vulnerable population meaning that neither the patient, parent(s), or practitioner have the authority to deny medical standards of care if doing so will significantly increase the risk of harm to the patient.
4. The minor patient does not have the right to keep health information private from the patient’s parents.
5. If a minor patient wishes to keep their treatment confidential, then the practitioner has a professional responsibility to inquire why the minor patient does not want their parents to be informed. The practitioner should encourage patient-parent discussion and offer to help facilitate an open dialogue with the patient’s parents.
6. Publicly funded social services can bypass the need for insurance billing and are therefore much better options for the minor patient who wishes to keep aspects of their healthcare services private from parents.
7. Parents have the authority to make medical decisions for their children. This is an example of how the principle of autonomy always has more moral weight than the principles of beneficence (do good), nonmaleficence (do no harm), and justice (be fair).
**
CORRECT! 🙂
[32:1] The legal definition of a minor is a person who is under the age of 18. A minor is not considered to be legally competent to make medical decisions. Only the parent or legal guardian can consent to authorize a practitioner to provide medical treatment. With minor patients, this results in a three-way relationship involving the patient, parents, and practitioner. In this relationship, the patient, parents, and practitioner have different roles and degrees of authority, all with the common goal of maximizing the child’s best interests.
Wrong 😕
[32:1] The legal definition of a minor is a person who is under the age of 18. A minor is not considered to be legally competent to make medical decisions. Only the parent or legal guardian can consent to authorize a practitioner to provide medical treatment. With minor patients, this results in a three-way relationship involving the patient, parents, and practitioner. In this relationship, the patient, parents, and practitioner have different roles and degrees of authority, all with the common goal of maximizing the child’s best interests.
CORRECT! 🙂
[32:2] Medicine is a patient-centered profession, and therefore, minor patients who are capable of assent should be kept substantially informed of their diagnosis, prognosis, and treatment options, according to their cognitive and emotional maturity. Parents and the practitioner have an ethical duty to help the minor develop their autonomous decision-making skills by providing a supportive environment, simplifying the explanation of complex treatment regimens, and getting an informed assent from the minor patient. Medically, assent means an agreement from someone not legally recognized as having authority to provide consent.
Wrong 😕
[32:2] Medicine is a patient-centered profession, and therefore, minor patients who are capable of assent should be kept substantially informed of their diagnosis, prognosis, and treatment options, according to their cognitive and emotional maturity. Parents and the practitioner have an ethical duty to help the minor develop their autonomous decision-making skills by providing a supportive environment, simplifying the explanation of complex treatment regimens, and getting an informed assent from the minor patient. Medically, assent means an agreement from someone not legally recognized as having authority to provide consent.
CORRECT! 🙂
[32:3] Parents need to know that within this three-way relationship between the patient, parent, and practitioner, their decisional authority for medical treatment is recognized but also limited to the patient’s best interests. Just as a parent has no authority to abuse or neglect a child, a parent cannot insist on harmful treatments or refuse a medical standard of care treatment if doing so would result in a significant increase of risk of harm or death of the minor. Under such circumstances, the state’s interest in protecting vulnerable populations from neglect and harm becomes activated, mandating that the practitioner provides the necessary treatment even at the parent’s objections. This is why parental consent is not legally required to provide a minor with contraception, prenatal care, treatment for; substance abuse, HIV, or sexually transmitted infections (STIs).
Wrong 😕
[32:3] Parents need to know that within this three-way relationship between the patient, parent, and practitioner, their decisional authority for medical treatment is recognized but also limited to the patient’s best interests. Just as a parent has no authority to abuse or neglect a child, a parent cannot insist on harmful treatments or refuse a medical standard of care treatment if doing so would result in a significant increase of risk of harm or death of the minor. Under such circumstances, the state’s interest in protecting vulnerable populations from neglect and harm becomes activated, mandating that the practitioner provides the necessary treatment even at the parent’s objections. This is why parental consent is not legally required to provide a minor with contraception, prenatal care, treatment for; substance abuse, HIV, or sexually transmitted infections (STIs).
CORRECT! 🙂
[32:6] If a situation arises in which a patient who is a minor wants their protected health information (PHI) to be kept confidential and private from the patient’s parents, then professionally, ethically, and legally, the practitioner must do it. Many states have mature minor legislation that allows minors to make medical treatment decisions if they demonstrate a sufficient understanding of the nature of the decision and consequences.
Wrong 😕
[32:6] If a situation arises in which a patient who is a minor wants their protected health information (PHI) to be kept confidential and private from the patient’s parents, then professionally, ethically, and legally, the practitioner must do it. Many states have mature minor legislation that allows minors to make medical treatment decisions if they demonstrate a sufficient understanding of the nature of the decision and consequences.
CORRECT! 🙂
[32:7] Based on the principle of beneficence (do good), if a minor patient wishes to keep their treatment confidential, then the practitioner has a professional responsibility to inquire why the minor patient does not want their parents to be informed. The practitioner should encourage patient-parent discussion and offer to help facilitate an open dialogue with the patient’s parents. If the minor still objects to parental disclosure, then the practitioner must make sure that the minor is substantially informed about what social resources are available and how they can be contacted.
Wrong 😕
[32:7] Based on the principle of beneficence (do good), if a minor patient wishes to keep their treatment confidential, then the practitioner has a professional responsibility to inquire why the minor patient does not want their parents to be informed. The practitioner should encourage patient-parent discussion and offer to help facilitate an open dialogue with the patient’s parents. If the minor still objects to parental disclosure, then the practitioner must make sure that the minor is substantially informed about what social resources are available and how they can be contacted.
CORRECT! 🙂
[32:8] The practitioner has a professional responsibility of nonmaleficence (do no harm) to inform the patient about what information will be disclosed to the parents through their insurance company’s medical billing. Medical billing will include who, what, where, and when the patient received health care. This will include who the practitioner was, what lab tests were done, and the lab results. Publicly funded social services can bypass the need for insurance billing and are therefore much better options for the minor patient who wishes to keep aspects of their healthcare services private from parents.
Wrong 😕
[32:8] The practitioner has a professional responsibility of nonmaleficence (do no harm) to inform the patient about what information will be disclosed to the parents through their insurance company’s medical billing. Medical billing will include who, what, where, and when the patient received health care. This will include who the practitioner was, what lab tests were done, and the lab results. Publicly funded social services can bypass the need for insurance billing and are therefore much better options for the minor patient who wishes to keep aspects of their healthcare services private from parents.
Wrong 😕
[32:10] Society has passed laws to protect vulnerable populations such as children, the elderly, and the intellectually handicapped. These populations are dependent on others for their medical and other basic needs. Medical neglect of a minor is considered a form of child neglect under the jurisdiction of child abuse laws. Most medical neglect cases arise when caregivers do not seek medical treatment when needed or do not follow the medical advice given by the practitioner. Under conditions of child neglect, social justice’s legal policies for protecting vulnerable populations as a matter of justice (be fair) has more moral weight than the parent’s autonomy (informed consent) authority.
CORRECT! 🙂
[32:10] Society has passed laws to protect vulnerable populations such as children, the elderly, and the intellectually handicapped. These populations are dependent on others for their medical and other basic needs. Medical neglect of a minor is considered a form of child neglect under the jurisdiction of child abuse laws. Most medical neglect cases arise when caregivers do not seek medical treatment when needed or do not follow the medical advice given by the practitioner. Under conditions of child neglect, social justice’s legal policies for protecting vulnerable populations as a matter of justice (be fair) has more moral weight than the parent’s autonomy (informed consent) authority.
32. Clinical Vignettes
1. Ms. Elizabeth Johnson is a 16-year-old high school student who has been referred to a pediatrician for evaluation of acute abdominal pain and vaginal bleeding. She reports that she is sexually active and has been using condoms inconsistently. She is concerned that her parents will find out about her sexual activity if she consents to the treatment. Her parents are present in the room and are insisting on being informed of all medical decisions. The differential diagnosis includes pelvic inflammatory disease, ectopic pregnancy, or a urinary tract infection.
2. Ms. Destiny Roberts is a 16-year-old high school student who has recently been diagnosed with a sexually transmitted infection (STI). She comes to her primary care provider for further information and treatment. She is mature and emotionally stable, but she requests that her medical information be kept confidential from her parents. The ethical question is, what should the practitioner do in this situation?
3. Mr. Kurt Thomas, a 16-year-old high school student, is brought in by his parents for chest pain that he has been experiencing for the past two days. Mr. Thomas is a competitive athlete and has been pushing himself hard in preparation for an upcoming competition. He is otherwise healthy and has no history of chest pain. The differential diagnosis includes musculoskeletal pain, cardiac pain, or anxiety-related chest pain. The practitioner orders an electrocardiogram, which reveals evidence of myocardial infarction, a heart attack. The practitioner informs Mr. Thomas and his parents of the medical standard of care, which is immediate transfer to a specialized hospital for cardiac catheterization. Mr. Thomas and his parents are hesitant to proceed with the treatment and suggest that he rest for a few days instead. What should the practitioner do in this situation, where a minor patient is at risk of significant harm, but the patient and parents are hesitant to proceed with the medical standard of care?
4. Ms. Wendy Rodriguez is a 16-year-old high school student who has been experiencing symptoms of depression, anxiety, and insomnia. Her parents have noticed a change in her behavior and took her to see a practitioner for treatment. Ms. Rodriguez has expressed that she does not feel comfortable disclosing all of her symptoms to her parents and wishes to keep certain aspects of her healthcare private. The practitioner informs Ms. Rodriguez that publicly funded social services can bypass the need for insurance billing and are therefore much better options for the minor patient who wishes to keep aspects of their healthcare services private from parents. What is the ethical recommendation for the practitioner in this situation?
5. Ms. Darian Taylor, a 16-year-old high school student, presents to the clinic seeking advice on contraception. She is sexually active and would like to start taking birth control pills. She explains that she does not want her parents to know about her sexual activity or her desire for contraception. Her clinical examination is unremarkable, and she has no medical history that would preclude her from using birth control pills. What is the most appropriate course of action for the practitioner?
Wrong 😕
Explanation: Ms. Johnson is a minor patient, and as such, her parents have decisional authority over her medical treatment. However, if she wishes to keep certain medical information confidential from her parents, the pediatrician must respect her autonomy and right to privacy [32:2, 32:4, 32:6]. In this case, the pediatrician should inquire why Ms. Johnson does not want her parents to be informed and inform her of available social resources for services that will not show up on the parents’ insurance. At the same time, the pediatrician should encourage Ms. Johnson to open a dialogue with her parents, and offer to facilitate a discussion with her parents [32:7, 32:8]. The pediatrician has a professional responsibility to ensure that Ms. Johnson is informed about what information will be disclosed to her parents through their insurance company’s medical billing [32:8]. The other options disregard the importance of Ms. Johnson’s autonomy and right to privacy, which are protected by ethical and legal principles [32:3, 32:5]. The pediatrician must encourage open communication between Ms. Johnson and her parents, but ultimately, the decision to inform the parents lies with Ms. Johnson [32:7].
CORRECT! 🙂
Explanation: Ms. Johnson is a minor patient, and as such, her parents have decisional authority over her medical treatment. However, if she wishes to keep certain medical information confidential from her parents, the pediatrician must respect her autonomy and right to privacy [32:2, 32:4, 32:6]. In this case, the pediatrician should inquire why Ms. Johnson does not want her parents to be informed and inform her of available social resources for services that will not show up on the parents’ insurance. At the same time, the pediatrician should encourage Ms. Johnson to open a dialogue with her parents, and offer to facilitate a discussion with her parents [32:7, 32:8]. The pediatrician has a professional responsibility to ensure that Ms. Johnson is informed about what information will be disclosed to her parents through their insurance company’s medical billing [32:8]. The other options disregard the importance of Ms. Johnson’s autonomy and right to privacy, which are protected by ethical and legal principles [32:3, 32:5]. The pediatrician must encourage open communication between Ms. Johnson and her parents, but ultimately, the decision to inform the parents lies with Ms. Johnson [32:7].
CORRECT! 🙂
Explanation: The practitioner’s professional and ethical duty is to respect Ms. Roberts’ request for confidentiality [32:6]. The practitioner must explain the potential benefits of informing her parents of the STI diagnosis, but ultimately it is Ms. Roberts’ autonomy to decide whether or not to inform her parents [32:2]. Based on the principle of beneficence, the practitioner should inquire why Ms. Roberts does not want her parents informed, and should offer to facilitate open dialogue between Ms. Roberts and her parents [32:7]. It is important to keep in mind that medical billing through insurance will disclose information to the parents [32:8], so the practitioner must educate Ms. Roberts on available social resources for services that will not show up on the parents' insurance. Disclosing the information to the parents without Ms. Roberts' consent would violate her privacy and autonomy [32:4]. While the parents have decisional authority, it is limited to the minor's best interests and is overridden in the case of medical neglect [32:3].
Wrong 😕
Explanation: The practitioner’s professional and ethical duty is to respect Ms. Roberts’ request for confidentiality [32:6]. The practitioner must explain the potential benefits of informing her parents of the STI diagnosis, but ultimately it is Ms. Roberts’ autonomy to decide whether or not to inform her parents [32:2]. Based on the principle of beneficence, the practitioner should inquire why Ms. Roberts does not want her parents informed, and should offer to facilitate open dialogue between Ms. Roberts and her parents [32:7]. It is important to keep in mind that medical billing through insurance will disclose information to the parents [32:8], so the practitioner must educate Ms. Roberts on available social resources for services that will not show up on the parents' insurance. Disclosing the information to the parents without Ms. Roberts' consent would violate her privacy and autonomy [32:4]. While the parents have decisional authority, it is limited to the minor's best interests and is overridden in the case of medical neglect [32:3].
CORRECT! 🙂
Explanation: The minor patient is a vulnerable population, and the medical standard of care must be provided to protect the patient's best interests. If Mr. Thomas and his parents are hesitant to proceed with the medical standard of care, the practitioner must attempt to persuade them to follow the treatment plan. However, if the patient's and parents' reluctance puts the patient at risk of significant harm, the practitioner must proceed with the medical standard of care, seeking court intervention if necessary, to protect the patient's best interests [32:3]. Seeking ethics consultation is an available option [32:9], but it is not the immediate course of action when the patient is at risk of significant harm. The other options are incorrect because the practitioner has a duty to protect the patient's best interests, even if the patient or parents refuse the medical standard of care, the practitioner cannot simply respect the decision of the patient and parents if it may result in harm to the minor patient, and there just isn’t enough time to seek an ethics consultation that can only provide a recommendation.
Wrong 😕
Explanation: The minor patient is a vulnerable population, and the medical standard of care must be provided to protect the patient's best interests. If Mr. Thomas and his parents are hesitant to proceed with the medical standard of care, the practitioner must attempt to persuade them to follow the treatment plan. However, if the patient's and parents' reluctance puts the patient at risk of significant harm, the practitioner must proceed with the medical standard of care, seeking court intervention if necessary, to protect the patient's best interests [32:3]. Seeking ethics consultation is an available option [32:9], but it is not the immediate course of action when the patient is at risk of significant harm. The other options are incorrect because the practitioner has a duty to protect the patient's best interests, even if the patient or parents refuse the medical standard of care, the practitioner cannot simply respect the decision of the patient and parents if it may result in harm to the minor patient, and there just isn’t enough time to seek an ethics consultation that can only provide a recommendation.
CORRECT! 🙂
Explanation: In this scenario, the practitioner has an ethical responsibility to respect Ms. Rodriguez's wish for privacy and inform her about publicly funded social services that can bypass the need for insurance billing and keep her healthcare private from her parents [32:8]. The practitioner should not disclose Ms. Rodriguez's confidential and private information to her parents without her consent [32:6]. Additionally, the practitioner should not ignore Ms. Rodriguez's wish for privacy and treat her according to her parents' wishes [32:3]. The practitioner must maximize Ms. Rodriguez's best interests while limiting parental consent and encourage her to seek treatment that will not show up on her parents' insurance [32:11].
Wrong 😕
Explanation: In this scenario, the practitioner has an ethical responsibility to respect Ms. Rodriguez's wish for privacy and inform her about publicly funded social services that can bypass the need for insurance billing and keep her healthcare private from her parents [32:8]. The practitioner should not disclose Ms. Rodriguez's confidential and private information to her parents without her consent [32:6]. Additionally, the practitioner should not ignore Ms. Rodriguez's wish for privacy and treat her according to her parents' wishes [32:3]. The practitioner must maximize Ms. Rodriguez's best interests while limiting parental consent and encourage her to seek treatment that will not show up on her parents' insurance [32:11].
Wrong 😕
Explanation: The practitioner has a professional responsibility to keep the patient’s information confidential if the patient requests it [32:6]. In this case, the patient has expressed a desire for confidentiality and has demonstrated an understanding of the nature of the decision and its consequences. The practitioner should provide the patient with information about the available social resources for services that will not show up on the parents' insurance [32:7]. The practitioner should also inform the patient about what information will be disclosed to the parents through their insurance company’s medical billing, and suggest publicly funded social services that can bypass the need for insurance billing [32:8]. Refusing to prescribe birth control pills or informing the patient’s parents against the patient’s wishes would violate the principle of patient autonomy and the professional principles of beneficence and nonmaleficence [32:2, 32:7]. Referring the patient to another practitioner who will prescribe birth control pills without informing the patient’s parents is not necessary since the practitioner can fulfill the patient’s request while also respecting her confidentiality [32:6].
CORRECT! 🙂
Explanation: The practitioner has a professional responsibility to keep the patient’s information confidential if the patient requests it [32:6]. In this case, the patient has expressed a desire for confidentiality and has demonstrated an understanding of the nature of the decision and its consequences. The practitioner should provide the patient with information about the available social resources for services that will not show up on the parents' insurance [32:7]. The practitioner should also inform the patient about what information will be disclosed to the parents through their insurance company’s medical billing, and suggest publicly funded social services that can bypass the need for insurance billing [32:8]. Refusing to prescribe birth control pills or informing the patient’s parents against the patient’s wishes would violate the principle of patient autonomy and the professional principles of beneficence and nonmaleficence [32:2, 32:7]. Referring the patient to another practitioner who will prescribe birth control pills without informing the patient’s parents is not necessary since the practitioner can fulfill the patient’s request while also respecting her confidentiality [32:6].
**
32. Reflection Vignettes
1. Dr. Jane Smith, a pediatrician, meets with a minor patient and their parent for an annual check-up. During the private conversation with the patient, the minor reveals that they have been sexually active and thinks that they have a venereal disease of some type. The minor patient is vehemently opposed to having either parent informed of their sexual activity or lab tests. Dr. Smith explains that while patient confidentiality is important, the risk of sexually transmitted infections requires a course of action that must be taken to protect the minor patient's health. Dr. Smith discusses various options for testing and treatment and assures the patient that they can seek confidential testing at a local Planned Parenthood or public health clinic without the need for insurance or parental notification.
Think
Assess
Patient: Autonomy
Practitioner: Beneficence & Nonmaleficence
Public Policy: Justice
Conclude
**
2. Dr. Maria Rodriguez, a pediatrician, is on duty in the emergency department when a minor patient is brought in and requires immediate surgery. Despite explaining the medical necessity of the surgery, both parents and the minor child refuse consent for the procedure. However, it is important to note that it is mandatory by law to treat minor patients with standard medical care in emergency situations, even without the consent of the parents or the child. The state has an interest in the protection of vulnerable populations, such as minors, and ensuring their access to necessary medical care.
Think
Assess
Patient: Autonomy
Practitioner: Beneficence & Nonmaleficence
Public Policy: Justice
Conclude
***
