HLST 4010 Chapter Notes - Chapter 5: Sexually Transmitted Infection, October 8, Pediatrics
14 Oct 2020
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Week 5 Reading- Children Need Privacy Too: Noiseux
Thursday, October 08, 2020
10:52 PM
Justine Noiseux, et. al., “Children need privacy too: Respecting confidentiality in
paediatric practice,” Paediatrics & Child Health, 24:1 (February 2019): e8–e12,
https://doi.org/10.1093/pch/pxy047
Available at: https://academic.oup.com/pch/article/24/1/e8/4999091
Challenging Cases:
1. A 13-year-old girl presents to her local clinic for medical follow-up; she and her family are
well-known here and live nearby. This girl is often unaccompanied because her father works two
jobs, and her mother is at home caring for her 2-year-old son and newborn infant. The team
recognizes that the parents are nonetheless well-involved and caring toward this girl, who herself
impresses as resourceful and clever. During her follow-up, the girl asks for contraception but
adamantly states that she does not want her parents involved in this discussion. She feels certain
that they would not support her choice. She is confident and well-informed about engaging in a
sexual relationship, and plans to do so soon, with what appears to be an ‘age-appropriate’ partner
2. A paediatrician refers Aiden (a gender-neutral pseudonym), an 11-year old, to a psychologist
because Aiden seems depressed. Following an initial consultation with the family, the
psychologist asks to see Aiden alone; the parents agree. Aiden’s parents are described as angry
because Aiden does not want to wear boys’ clothing. Aiden reveals to the psychologist that
although raised as a boy, Aiden feels more like a girl and seems relieved to talk about these
feelings. Aiden is not seeking any specific intervention at this point, but begs the psychologist
not to tell the parents because ‘they wouldn’t understand’ and would be ‘very upset’ (1)
Introduction:
• Under the age of majority, children in Canada are generally not considered fully
autonomous with regard to consenting to medical treatment and confidentiality (NB: age of
majority varies across Canada) (2)
• In many jurisdictions, there is a developmental threshold— sometimes referred to as
mature minor—when children are considered legally capable to consent and have their
confidentiality respected in the areas of contraception, abortion, sexually transmitted
infections and, depending on local standards, other medical issues (3). In contrast, in
Quebec law, there is an age threshold rather than a developmental one, where patients who
are 14 years and over are entitled to consent and respect for their confidentiality, as per the
civil code (NB: some exceptions exist, pertaining to safety and extended stays in hospital)
• When considering consent and confidentiality outside of legal standards, the age at which a
child is considered ‘capable’ can be thought of on a continuum that depends on many
social, developmental, educational and cultural factors.
o Despite the legal issues involved, we posit here that there is ethical value to including
children of all ages (i.e., who are capable of participating) in discussions about their
medical concerns, and to (a) seek their consent or assent for treatment and (b) respect
their confidentiality, in a manner that is adapted to their capabilities. (2)
Document Summary
Week 5 reading- children need privacy too: noiseux. Justine noiseux, et. al. , children need privacy too: respecting confidentiality in paediatric practice, paediatrics & child health, 24:1 (february 2019): e8 e12, https://doi. org/10. 1093/pch/pxy047. Challenging cases: a 13-year-old girl presents to her local clinic for medical follow-up; she and her family are well-known here and live nearby. This girl is often unaccompanied because her father works two jobs, and her mother is at home caring for her 2-year-old son and newborn infant. The team recognizes that the parents are nonetheless well-involved and caring toward this girl, who herself impresses as resourceful and clever. During her follow-up, the girl asks for contraception but adamantly states that she does not want her parents involved in this discussion. She feels certain that they would not support her choice. Following an initial consultation with the family, the psychologist asks to see aiden alone; the parents agree.
