Medical practitioners' competence and confidentiality decisions with a minor: An anorexia nervosa case study

Abstract

Minors (i.e., those under 18 years of age) hold a tenuous legal position in medical settings. While recent legal authority in numerous jurisdictions affords competent minors the right to consent to medical treatment, the guidelines for assessing competence are often vague or non-existent. In addition, these changes have not adequately addressed the issue of confidentiality, and it is unclear whether general practitioners (GPs) owe a duty of confidentiality to competent minors. As medical practitioners are the first point of contact in medical settings, the present study explored GPs' competence and confidentiality determinations regarding a 16-year-old female patient who presented with symptoms of an eating disorder. Questionnaires and hypothetical scenarios were sent to a sample of 1000 GPs, of which 305 responded. Results indicated that 62% of respondents would have found the patient competent, while 82% would have maintained her confidentiality. However, analysis of the rationales provided for these decisions revealed a wide discrepancy in GPs' understanding and implementation of current legal principles. This research highlights the necessity of providing GPs with clear guidelines regarding competence and confidentiality determinations when dealing with minors.

Keywords:

• Decision making competence
• young people
• consent
• confidentiality
• eating disorder

Acknowledgements

This research was funded by a grant from the Commonwealth Department of Health and Family Services General Practice Evaluation Program. The authors would also like to acknowledge the input of Dr Lena Sanci, Professor Susan Paxton, Rachel Callinan, and Rose Blasche into the project.

Notes

1. Sixteen was the age in question in this case because UK legislation stated that persons 16 and over could consent to medical treatment (Family Law Reform Act 1969 (UK), s 8(1)). Therefore, the courts only needed to address the issue of minors under 16.

2. Victoria is Australia's second most populist state; its capital city is Melbourne.

3. To be eligible to claim services as a GP, practitioners are required to have provided more than 375 GP services within the 3 months prior. Medicare is the national public health care scheme.