Adolescent Confidentiality in the USA

A 14-year-old accompanied by her mother presents with complaints of nausea and vomiting for two weeks. After her mother leaves the room, she admits to being sexually active and tells you that she has had unprotected intercourse recently with her boyfriend and missed a period. Her parents do not know she is sexually active, and she does not want her mother to know that a pregnancy test is being done or the result of that test. Pregnancy test comes back positive.


Distinction between violations of confidentiality and privacy


Violations of privacy involve the unauthorized disclosure of someone else's private information (e.g. looking at records without authorization).

Violations of confidentiality involve disclosure of someone else's private information that they voluntarily imparted in confidence and trust or when there was an implicit or explicit promise not to divulge that information without their permission.

Implicit promise means confidentiality in the therapeutic relationship is assumed. Therefore, an implicit promise exists between the patient and her physician. Absent a prior warning by the physician to the contrary, to break confidentiality is to break a promise made to the patient.


Maintaining confidentiality in adolescent


One study (Reddy) of girls ages 12 to 17 in the United States found that nearly 60% reported that if their parents were notified, they would stop using all or some sexual health services or delay testing or treatment for sexually transmitted diseases (STDs).

Other studies have found that about a third of adolescents would not seek health care for sensitive health concerns if their parents could find out (Cheng, Klein).


Laws regarding confidentiality


It varies from state to state. In Washington state, confidentiality is tied to informed consent, such that any individual who can provide informed consent (and most adolescents can provide consent for diagnosis and treatment of STDs, pregnancy, contraception and psychiatric care) is also owed the duty of confidentiality.

It is better to tell the adolescent that she needs to be aware of her mother may have questions about what is happening and why tests are being done. It is best for the adolescent to share the information with her mother willingly.



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