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The CPSS recently received a complaint about the disclosure of a teenage patient’s personal health information to the patient’s parent.
A 15-year-old patient sought treatment at a medical clinic, and the record was forwarded to her family physician. The family physician disclosed health information to the patient’s mother. The result was a complaint to the College against the physician who disclosed the information to the parent.
Canadian law recognizes that “mature minor” patients - though under the legal age of majority - have capacity for the purposes of making their own healthcare decisions. The decision of a child who is capable of consenting prevails over a conflicting decision of their parents, and their personal health information can not be disclosed to a parent without their valid consent or another lawful reason.
The Canadian Medical Protective Association document “Consent: A guide for Canadian Physicians” describes the “mature minor” or “capable minor” principle:
The legal age of majority has become progressively irrelevant in determining when a young person may consent to his or her medical treatment… the concept of maturity has replaced chronological age. The determinant of capacity in a minor has become the extent to which the young person's physical, mental, and emotional development will allow for a full appreciation of the nature and consequences of the proposed treatment, including the refusal of such treatments.
There is therefore no bright-line distinction between a child - whose medical decisions will be made by a parent or lawful decision-maker - and a mature minor who will make their own decisions. The capacity to exercise independent judgment for health care decisions varies according to the individual and the complexity of the decision at hand.
Physicians
in close-call situations should assess whether their patient has the required
maturity to make the healthcare decision at hand, and be cautious and obtain
consent from a mature minor patient before disclosing their health information
to others.
The CPSS Guideline Confidentiality of Patient Information and CPSS Policy Informed Consent and Determining Capacity to Consent provide additional direction and resources for physicians in this area.
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