Amnesty Posted March 11, 2009 Report Share Posted March 11, 2009 Whats the case with minors? Say when you see individuals under the age of 16/18 (teen)... and they do not want their parents/guardians to about a certain issue. What is the proper course of action in terms of informing the parents? I never seem to keep in my head if we can break the confidentiality between the teenage patient to inform the parent. What about in cases when your patient tells you that his/her parent might disaprove of the situation and may lead to adverse consequences. Link to comment Share on other sites More sharing options...
Remington Posted March 11, 2009 Report Share Posted March 11, 2009 That is a very good question. Is it permissible to perform an abortion on an underage female who provided informed consent, and not tell her parents? I think yes. What about rhinoplasty? A girl comes in against her parents wishes (we'll say she's 17) and is adamant about getting this done. Could you do it? I have no idea. I would probably say no, because I would use the age of majority against her. But I can't think of more solid reasons at the moment... any insight? Link to comment Share on other sites More sharing options...
medaholic Posted March 11, 2009 Report Share Posted March 11, 2009 The Law (not the user) and the CMA disagrees with you. Link to comment Share on other sites More sharing options...
srindogg@hotmail.com Posted March 11, 2009 Report Share Posted March 11, 2009 I think I remember reading in the "Doing Right" book by Dr. Hebert that there are no strict rules about dealing with underage patients. Usually, autonomy trumps other rules and it is up to the physician to assess the mental capacity of the patient to determine if they can be considered "autonomous". Link to comment Share on other sites More sharing options...
ladyluck08 Posted March 11, 2009 Report Share Posted March 11, 2009 I think so toooooo.....When it comes to minors, the physician has to look at the mental capability of the patient .ie. if the patient is competent enough to make the decisions...... Similar ques is when the patient , a minor of course, comes in with her mother. The mom asks the doc to prescribe birth pills to her daughter who is 12 years old......The patient, however says she is not sexually active and has no interest in it....What should the doc do? Hey, by the way, the minor age is until 18 years, right? Link to comment Share on other sites More sharing options...
Wolvenstar Posted March 11, 2009 Report Share Posted March 11, 2009 I think so toooooo.....When it comes to minors, the physician has to look at the mental capability of the patient .ie. if the patient is competent enough to make the decisions...... Similar ques is when the patient , a minor of course, comes in with her mother. The mom asks the doc to prescribe birth pills to her daughter who is 12 years old......The patient, however says she is not sexually active and has no interest in it....What should the doc do? Hey, by the way, the minor age is until 18 years, right? Lol Birth Control these days have a much more major use than..well preventing pregnancy. Alot of younger women are experiencing problematic (i.e. irregular or painful) menstrations. The pill has become the solution to this problems, allowing for regulation of menstration and for reasons I am unaware of mitigating much of the pain now commonly associated with that time of the month. My girlfriend, and quite a few of her mormon friends had started taking the pill during their teens, to control just that, even though most (not all) do not engage in sex until marriage. However you can not force something optional upon a child if the child is unwilling. Explain to the mother that it is the daughter's choice, and explain to the daughter the benefit. If the daughter is still doubtful, then refuse to write the prescription. A child is considered a minor until they are 18, however in for the sake of personal privacy and because of the fact that once you are 16, you can move out on your own, they can go to the doctor for many things without parental consent. The best rule of thumb is to follow your own discretion, most often you will be more cautious than the law. Remember too, that as a doctor is you are uncomfortable prescribing something to a minor, you can always refer them to someone else. Underage females are allowed to have an abortion, and the parents do not need to be informed about it. I am not what the minimum age they have to be is, normally I would say that if they are having sex, most likely they are old enough to get an abortion done on their own but considering there was a story in the news a couple years ago about a nine year old girl who got pregnant, I am not soo sure. In terms of plastic surgery, I believe you have to be eighteen years of age, but perhaps not. Again this is up to your discretion as a doctor, you can always refer them to someone else if you feel uncomfortable with it. I had a friend who was referrred because the first doc she went to wasn't comfortable tying her tubes, and she was 21. Link to comment Share on other sites More sharing options...
xi88 Posted March 11, 2009 Report Share Posted March 11, 2009 There is no legal age of consent for medical treatments in many provinces in Canada, Ontario included. Therefore, in these provinces, if you (the physician) believe that the patient is competent and able to make an informed decision, then you have to respect patient autonomy and confidentiality. Therefore, if a 7-year-old refuses or consents to a treatment for whatever reason (possible interview question), and a psychiatric assesment determines that the child is informed of the situation and any consequences of treatment or non-treatment, by law you have to respect the child's wishes regardless of what the parent say. Only NB, Quebec, Saskatchewan, and BC have age of consents for medical treatments. See http://www.cmaj.ca/misc/bio_capacity_tab1.shtml. Link to comment Share on other sites More sharing options...
w8kg6 Posted March 11, 2009 Report Share Posted March 11, 2009 You've got to abide by the patient's wishes, so long as you can ensure that they are made by a competent person who is aware of alternatives. This is true for all patients you care for, and doesn't change if the person has not yet reached age of majority. If it's evident that a patient isn't capable of making an educated decision that effectively considers the pros and cons of a treatment (eg: an 18 year old woman coming in to get her tubes tied), then 'beneficience' can override 'autonomy', but otherwise a person is entitled to choosing whatever treatment they like, so long as it's an educated choice. It doesn't even have to be a safe choice, in some cases (for example, if they choose the null treatment of not being treated). Confidentiality is paramount in all cases. While I may not give a 16 year old girl a rhinoplasty reference, the only reason is that I think she could be convinced that her bone structure is still developing, and that the procedure might not give the desired long-term results unless she waited. As far as abortion goes, if it's a safe option for her and she understands the consequences, this is a procedure she should be given (or, if it goes against your personal beliefs, she should be given a reference). Her parents should NOT be informed, unless the patient asks you to tell them. As a disclaimer though, I would strongly try to convince her to talk with her parents prior to the operation, and perhaps have the family come into my office for a consultation. Link to comment Share on other sites More sharing options...
Wolvenstar Posted March 12, 2009 Report Share Posted March 12, 2009 Only NB, Quebec, Saskatchewan, and BC have age of consents for medical treatments. See http://www.cmaj.ca/misc/bio_capacity_tab1.shtml. Ah It's good to see BC come through again. Link to comment Share on other sites More sharing options...
Remington Posted March 12, 2009 Report Share Posted March 12, 2009 The Law (not the user) and the CMA disagrees with you. Would you mind elaborating on these laws you speak of? Link to comment Share on other sites More sharing options...
A-Stark Posted March 12, 2009 Report Share Posted March 12, 2009 You've got to abide by the patient's wishes, so long as you can ensure that they are made by a competent person who is aware of alternatives. This is true for all patients you care for, and doesn't change if the person has not yet reached age of majority. The key there is "competent person", which will often not apply in the case of minors. There will be variation, of course, as one 12-year-old will be far more capable of understanding the import of major treatment decisions than another. Confidentiality is paramount in all cases. While I may not give a 16 year old girl a rhinoplasty reference, the only reason is that I think she could be convinced that her bone structure is still developing, and that the procedure might not give the desired long-term results unless she waited. As far as abortion goes, if it's a safe option for her and she understands the consequences, this is a procedure she should be given (or, if it goes against your personal beliefs, she should be given a reference). Her parents should NOT be informed, unless the patient asks you to tell them. As a disclaimer though, I would strongly try to convince her to talk with her parents prior to the operation, and perhaps have the family come into my office for a consultation. How many 16-year-olds have the money for a cosmetic rhinoplasty? And without her parents' knowledge? Link to comment Share on other sites More sharing options...
Wolvenstar Posted March 12, 2009 Report Share Posted March 12, 2009 The key there is "competent person", which will often not apply in the case of minors. There will be variation, of course, as one 12-year-old will be far more capable of understanding the import of major treatment decisions than another. No not many 12 year olds will. However there is a decent amount of 16yr olds who will walk in, and have logical reasoning for need for specific medication or a certain operations. Many times parents will discard such notions, especially if they are related in some way with sex. How many 16-year-olds have the money for a cosmetic rhinoplasty? And without her parents' knowledge? The real question is do you really want to know how money 16year olds actually have that much money? Ignoring rhinoplasty, there are other cosmetic surgeries that many teenagers would want to get. Breast enlargement for women, obese procedures for both obese teenagers and those with body misperceptions. While those with body misperceptions only need some counselling, I truly believe that cosmetic surgeries can aid people with obesity along with diet and exercise. Link to comment Share on other sites More sharing options...
medaholic Posted March 12, 2009 Report Share Posted March 12, 2009 Would you mind elaborating on these laws you speak of? Sorry, you were correct with your point. If they have the decision making capacity, it is in their ability to get an abortion with patient confidentiality. In the states, things are a bit different. Link to comment Share on other sites More sharing options...
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