Is my daughter on birth control? Tips for treating mature minors

The Oxford English dictionary defines maturity, for a person, as the full development of body and mind. For doctors with minor-aged patients who wish to be treated as adults—without input or interference from parents—determining whether these teens are mature enough to understand and provide consent on their own can sometimes be challenging. It gets even trickier when an angry parent steps into the picture, or when the young patient disagrees with the doctor’s decision on maturity. Brian Salte, legal counsel for the College of Physicians and Surgeons of Saskatchewan (CPSS), highlighted potential pitfalls—and best approaches—for doctors treating a young patient as a mature minor. Assessing for maturity: Tell me what I just told you So how can a doctor really tell if a patient passes the litmus test for mature minors? While there isn’t a foolproof way to assess for maturity, one good approach Salte presents to physicians is to ask the patient to recap the treatment being discussed, in their own words. “Listen carefully as they do this,” said Salte. “Are they just repeating what they heard without necessarily understanding it, or are they able to use age-appropriate language that shows they understand the concept?’” When a young patient asks for birth control “These challenges are arising more frequently in the context of birth control, when you have a 13-year-old who says ‘I’m sexually active’ and the physician has to decide if the patient can fully understand the risks and benefits of birth control,” said Salte. “If the physician decides that the patient is able to understand these risks, then they can provide treatment without input from parents.” Confidentiality is an implicit condition The decision to treat a young patient as a mature minor comes with an implicit condition of patient confidentiality. While that may seem both obvious and clear cut, in practice this confidentiality isn’t always respected. The CPSS, for instance, fielded a complaint recently from a teenage patient who had sought treatment at a medical clinic that subsequently forwarded the details of the visit to the patient’s family physician. The latter then disclosed this information to the patient’s mother. “The issue of confidentiality is very closely linked to consent to medical treatment,” said Salte. “When a patient is deemed capable of providing their own consent, they’re also entitled to patient confidentiality regardless of whether they’re 12 or 95.” Facing an angry parent? Consider this It’s not unusual for doctors treating mature minors to get calls from a parent—often a patient at the same practice—asking why their child was prescribed birth control or antidepressants, or demanding to know what course of treatment the physician has taken with the child. One angry parent, said Salte, called a doctor asking if her daughter had had an abortion. “I’ve taken a number of these angry calls where parents believe the doctor had no right to provide birth control to their child, or where the parent is upset because they want to know the treatment and their child won’t tell them,” he said. It’s important to exercise caution when handling these calls, he said. A common reaction is for physicians to tell parents they can’t disclose the information and that they should be talking to their child. But in certain cases, this can lead to parents putting undue pressure on their child or even becoming abusive. When things get too heated up, get outside help Physicians facing angry parents should make an effort to calm them down and explain that their child has demonstrated a clear understanding of the treatment and has the legal right to confidentiality of his or her health information. If this fails to diffuse the situation, it’s a good idea for the physician to ask the college for help. Salte said in such cases, he’ll send the physician an email confirming the law around mature minors, including the physician’s obligation of confidentiality towards the patient. “I’ll tell the physician to share this email with the parents,” he said. “So, if the parents are still angry, they can be angry with me instead of with the physician.” What if you don’t think the patient is mature enough? Physicians who have concerns about a young patient’s ability to understand and consent to treatment may want to suggest that the patient get their parents involved in the decision. “One physician I know takes this approach of telling the patient ‘you have the right to make the decision by yourself and I will support you, but wouldn’t it be better to involve your parents at this point?’” said Salte. “He tells them that at some point, their parents will find out—maybe they’ll accidentally find the receipts for the medications—so it’s probably better to get the parents involved when there isn’t that confrontation. Because usually when parents find out after the fact, there is confrontation.”

Is my daughter on birth control? Tips for treating mature minors

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