Thursday, June 17, 2004
Legal requirements in treating children: confidentiality sometimes upsets parents

By Dr. Anthony Policastro
Nanticoke Memorial Hospital

Most of the things that we do in medicine are related to medical principles. Some of them are related to legal requirements. Patients do not always understand those requirements. That often makes them upset. There have been times when parents have been upset with me because I filed a report about possible child abuse. In most of those cases, there was abuse. In some there was not. However, the law is clear. If there is any suspicion, a report must be filed. Whether the report is proven false later does not matter. The physician has to file the initial report for any suspicions. A second common occurrence is related to adolescents seeking treatment for pregnancy and sexually transmitted diseases. Parents feel that they have a right to know about such visits. However, once again the law is clear. In the state of Delaware adolescents over age 12 can give their own consent for these things. The law also guarantees their privacy. Physicians can only discuss this with the parents if it is in the best interests of the adolescent. For example a teenager might come to the emergency room in shock due to a pregnancy in her tubes. This could be a life-threatening condition. It would be in the patientís best interests for her family to know the seriousness of the situation. A federal law gives adolescents the right to confidentiality if they seek help for substance abuse. One common scenario is related to parents who suspect their child is using drugs.
  They may go to the physician and ask the physician to do a drug test. We cannot legally do that without the patientís permission. While it might make sense to have a diagnosis that can be treated, it is not legal to do it. Adult patients have a legal right to decide on whether they want treatment or not. They can refuse life-saving therapy if they so desire. A Jehovahís Witness might choose to refuse blood transfusions that could save his/her life. Legally they can do that. Along the same lines, someone can refuse surgery that could save his/her life. It doesnít matter if the rest of the family wants to have the surgery done. If the patient is capable of making his/her own decisions, he/she can legally make that refusal. This is the same kind of thing that occurs when we talk about living wills. Patients can decide in advance just how aggressively they want to be treated if they develop a terminal condition. Family members may not always agree with those wishes. However, the rules are similar to those about getting treatment in the first place. If the individual is competent to make decisions at the time of signing the document, then those decisions should be carried out. While family members may not always agree with some of the laws that exist, medical personnel are required to abide by those laws. It sometimes creates confusion. It sometimes creates dissatisfaction. But, it usually means that things are being done correctly.

Dr. Anthony Policastro is medical director at Nanticoke Memorial Hospital.