Confidentiality, sex and teenagers
Leeds Contraception and Sexual Health Services (CASH), South Leeds Primary
Care Trust, Leeds, UK
Introduction: There is opinion by some in society that children are
being encouraged to keep their life secrets from their parents.
Aims and methods: To review the current UK law and ethical debate to
test the question whether this is a recipe for disaster and harm is being done
by doctors keeping the secrets.
Results: The autonomy of the patient is being eroded by the need to
obtain information his/her medical treatment to improve the medical services.
However the need to maintain privacy is important for the individual when
seeking medical advice. The doctor is obliged to disclose information in certain
circumstances but generally will only breach confidentiality if there is likely
to be harm to a third person. Common law cases acknowledge that the sexual
activity of an individual is the most secret part of his or her life. There are
specific laws relating to sexual health that enable the patient to maintain
their right to privacy in the sexual health consultation. Recent cases in
relation to the human immunodeficiency virus are testing the duty of the doctor
to report infection to the sexual partner against the wishes of the patient. The
young person under sixteen has the same rights as the adult in seeking
confidentiality if the young person is competent to understand the advice they
are given. This right also applies to the sexual health consultation even if
technically the young person is acting outside the law. The doctor will not only
try to prevent the spread of infection to the sexual partner, but also has to
weigh up any concerns about sexual abuse. The doctor will generally only
disclose concerns to the appropriate authorities and not to the young person’s
parents. There is not much evidence that providing sexual health advice to those
under sixteen is producing a benefit. The individual may be protected, but in
general there is no overall improvement in the teenage pregnancy rates and there
is an increase in sexually transmitted infection in this age group. Because it
is difficult to get a conviction for under age sex, young people tend to
disregard laws which, in general, are there to protect them as they develop into
adults. Also the rights of privacy for young people may be in conflict with the
rights of parents to have a private and family life. There is no law of privacy
in the United Kingdom to give guidance in this area.
Conclusion: It would appear, therefore, that children are supported to
keep areas of their life secret from their parents. The recipe for disaster is
not for harm to the individual but harm to the family in society.