united-states medical minor
Can medical information (such as expected time until a terminal condition occurs) be witheld from minors?
<p>(not including mental issues) Do medical professionals have an obligation to tell the patient their findings, or can they just tell the parents and leave it up to their judgement whether or not the minor will be informed?</p>

<blockquote>
<p>Do medical professionals have an obligation to tell the patient their
findings, or can they just tell the parents and leave it up to their
judgement whether or not the minor will be informed?</p>
</blockquote>
<p>Generally speaking, parents are &quot;natural guardians&quot; of their children to whom medical communications can be made by medical professionals without directly informing the child. But medical ethics also don't necessarily treat all minors the same. A distinction is made between more mature and less mature minors on a sliding scale.</p>
<blockquote>
<p><strong>Physicians who treat minors have an ethical duty to promote the autonomy of minor patients by involving them in the medical
decision-making process to a degree commensurate with their
abilities.</strong></p>
<p>When minors request confidential services, physicians should encourage
them to involve their parents. This includes making efforts to obtain
the minor’s reasons for not involving his or her parents and
correcting misconceptions that may be motivating their objections.</p>
<p>Where the law does not require otherwise, physicians should permit a
competent minor to consent to medical care and should not notify
parents without the patient’s consent. Depending on the seriousness of
the decision, competence may be evaluated by physicians for most
minors. When necessary, experts in adolescent medicine or child
psychological development should be consulted. Use of the courts for
competence determinations should be made only as a last resort.</p>
<p>When an immature minor requests contraceptive services,
pregnancy-related care (including pregnancy testing, prenatal and
postnatal care, and delivery services), or treatment for sexually
transmitted disease, measures to prevent sexually transmitted disease,
drug and alcohol abuse, or mental illness, physicians must recognize
that requiring parental involvement may be counterproductive to the
health of the patient. Physicians should encourage parental
involvement in these situations. However, if the minor continues to
object, his or her wishes ordinarily should be respected. If the
physician is uncomfortable with providing services without parental
involvement, and alternative confidential services are available, the
minor may be referred to those services. In cases when the physician
believes that, without parental involvement and guidance, the minor
will face a serious health threat, and there is reason to believe that
the parents will be helpful and understanding, disclosing the problem
to the parents is ethically justified. When the physician does breach
confidentiality to the parents, he or she must discuss the reasons for
the breach with the minor prior to the disclosure.</p>
<p>For <strong>minors who are mature enough to be unaccompanied by their
parents for their examination</strong>, confidentiality of information
disclosed during an exam, interview, or in counseling should be
maintained. Such information may be disclosed to parents when the
patient consents to disclosure. Confidentiality may be justifiably
breached in situations for which confidentiality for adults may be
breached, according to Opinion 5.05, “Confidentiality.” In addition,
confidentiality for immature minors may be ethically breached when
necessary to enable the parent to make an informed decision about
treatment for the minor or when such a breach is necessary to avert
serious harm to the minor.</p>
</blockquote>
<p>Source quoted: <a href="https://journalofethics.ama-assn.org/article/ama-code-medical-ethics-opinion-adolescent-care/2014-11" rel="nofollow noreferrer">AMA Code of Medical Ethics’ Opinion on Adolescent Care</a>, Opinion 5.055 - Confidential Care for Minors, AMA Council on Ethical and Judicial Affairs (November 2014).</p>
<p>Also, it isn't entirely settled that physicians have a duty to make full disclosure to their adult patients regarding matters such as life expectancy when diagnosed with a terminal condition) if they determine that it is not in the best interests of the patient to receive the full and accurate information. The modern trend is to disfavor this practice unless a patient has given advance consent to it. But the American Medical Association ethics opinions cited below are only advisory guidance to state medical profession regulators who are not obligated by law to adopt it. Some states follow the modern trend expressed in these opinions, but others have not chosen to adopt this view.</p>
<p>Even the modern view, however, affords physicians some discretion in the timing of when disclosures are made based upon the best interests of the patient that they perceive.</p>
<p>There are at least two important ethics opinions on point:</p>
<blockquote>
<p>Opinion 8.08 - Informed Consent</p>
<p>The patient’s right of self-decision can be effectively exercised only
if the patient possesses enough information to enable an informed
choice. The patient should make his or her own determination about
treatment. The physician’s obligation is to present the medical facts
accurately to the patient or to the individual responsible for the
patient’s care and to make recommendations for management in
accordance with good medical practice. The physician has an ethical
obligation to help the patient make choices from among the therapeutic
alternatives consistent with good medical practice. Informed consent
is a basic policy in both ethics and law that physicians must honor,
unless the patient is unconscious or otherwise incapable of consenting
and harm from failure to treat is imminent. In special circumstances,
it may be appropriate to postpone disclosure of information (see
Opinion 8.122, “Withholding Information from Patients”).</p>
<p>Physicians should sensitively and respectfully disclose all relevant
medical information to patients. The quantity and specificity of this
information should be tailored to meet the preferences and needs of
individual patients. Physicians need not communicate all information
at one time, but should assess the amount of information that patients
are capable of receiving at a given time and present the remainder
when appropriate.</p>
<p>Opinion 8.082 - Withholding Information from Patients</p>
<p><strong>The practice of withholding pertinent medical information from</strong>
<strong>patients in the belief that disclosure is medically contraindicated is</strong>
<strong>known as “therapeutic privilege.” It creates a conflict between the</strong>
<strong>physician’s obligations to promote patients’ welfare and respect for</strong>
<strong>their autonomy by communicating truthfully.</strong> Therapeutic privilege does
not refer to withholding medical information in emergency situations,
or reporting medical errors (see 8.08, “Informed Consent,” and 8.121,
“Ethical Responsibility to Study and Prevent Error and Harm”).</p>
<p><strong>Withholding medical information from patients without their knowledge</strong>
<strong>or consent is ethically unacceptable.</strong> Physicians should encourage
patients to specify their preferences regarding communication of their
medical information, preferably before the information becomes
available. Moreover, physicians should honor patient requests not to
be informed of certain medical information or to convey the
information to a designated proxy, provided these requests appear to
genuinely represent the patient’s own wishes.</p>
<p><strong>All information need not be communicated to the patient immediately or</strong>
<strong>all at once; physicians should assess the amount of information a</strong>
<strong>patient is capable of receiving at a given time, delaying the</strong>
<strong>remainder to a later, more suitable time, and should tailor disclosure</strong>
<strong>to meet patients’ needs and expectations in light of their</strong>
<strong>preferences.</strong></p>
<p>Physicians may consider delaying disclosure only if early
communication is clearly contraindicated. Physicians should continue
to monitor the patient carefully and offer complete disclosure when
the patient is able to decide whether or not to receive this
information. This should be done according to a definite plan, so that
disclosure is not permanently delayed. Consultation with patients’
families, colleagues, or an ethics committee may help in assessing the
balance of benefits and harms associated with delayed disclosure. In
all circumstances, physicians should communicate with patients
sensitively and respectfully.</p>
</blockquote>
<p>Sources quoted: <a href="https://journalofethics.ama-assn.org/article/ama-code-medical-ethics-opinions-informing-patients/2012-07#:%7E:text=The%20practice%20of%20withholding%20pertinent,their%20autonomy%20by%20communicating%20truthfully." rel="nofollow noreferrer">AMA Code of Medical Ethics’ Opinions on Informing Patients</a>, Opinion 8.08 - Informed Consent and Opinion 8.082 - Withholding Information from Patients, AMA Council on Ethical and Judicial Affairs (July 2012).</p>
