Prof Campbell Consent Confidentiality and Young People

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7/30/2019 Prof Campbell Consent Confidentiality and Young People

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Counselors' Conference on Mental Health of Children and Youth

Singapore, 5 August 2013

Professor Alastair V. Campbell

Chen Su Lan Centennial Professor in Medical Ethics

Director, Centre for Biomedical Ethics

National University of Singapore

Privacy, Consent and Confidentiality

How these Relate to Young People

Legal Aspects

Harm as the Key

Conclusions

Privacy: “Having control over the extent,timing and circumstances of sharing oneself (physically, behaviourly or intellectually) withothers”

Privacy is essential to relationships of

intimacy and trust

Consent is a safeguard against intrusion byothers into one’s private world

The need for consent does not relate to agebut to the capacity to understand

Confidentiality relates to the privacy of information disclosed to another in a

relationship of trust.

Like consent, confidentiality is a safeguardfor privacy.

A gradual development of a sense of privacy

Shame, modesty and need for secrets startearly

In teenage years, my world gets increasingly

important, need for a private space outsidethe world of parents

Consent and maintaining confidentiality arethe default position, irrespective of age

The onus is on the counselor to show justification for any breaches

Legal age of consent in Singapore is 21 formost matters relating to health and welfare.

So parents/legal guardians have a right tosome information

But counselor has discretion on what and how

much to disclose.

Statutory standard of “best interest” applies

Nature and extent of disclosure relates torisk of harm to self or others

Clear legal requirements in case of suspectedabuse

Effective counseling will depend on the trust the young person has

Thus (except in the extreme casesmentioned) build the relationship on consentand strict confidentiality

If disclosure becomes necessary, ordiscussion with parent/guardian, try toinvolve young person in decision to disclose

It ensures that the troubled young person willconfide fully

It treats the child/young person as anindividual of worth

It encourages self –determination (autonomy)

It promotes a sense of responsibility in theyoung person

Define the boundaries from the start (when andto whom might you divulge information)

Seek a therapeutic alliance with the parents thatallows you to protect the young person’s privacy

If a team is involved in the care, shareinformation strictly on a ‘need to know’ basis

Try to get the young person’s agreement if youneed to breach

Every case is different, so your judgementand discretion are essential

Your aim is not control but empowerment

It’s a different world out there from the onewe knew in our youth. We too need to learnhow to navigate it!

The bottom line is how the young person canbest be helped by your intervention

Prof Campbell Consent Confidentiality and Young People

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