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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
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Privacy, Consent and Confidentiality
How these Relate to Young People
Legal Aspects
Harm as the Key
Conclusions
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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
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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
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Confidentiality relates to the privacy of information disclosed to another in a
relationship of trust.
Like consent, confidentiality is a safeguardfor privacy.
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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
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Consent and maintaining confidentiality arethe default position, irrespective of age
The onus is on the counselor to show justification for any breaches
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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
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Nature and extent of disclosure relates torisk of harm to self or others
Clear legal requirements in case of suspectedabuse
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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
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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
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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
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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
