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Breaking Confidentiality with Minors

Breaking Confidentiality with Minors

When do we break confidentiality when working with minors?

Brief Case

Mei Hua shared her thoughts when faced with managing the following dilemma:

Defining the issue

Ronnie and I have been working closely for the past two months, and he has put a lot of his trust in me in not revealing his gambling addiction and financial problems to his parents.

The ethical challenge I am currently facing is commonly encountered by social workers who provide services such as counselling to minors. The question of whether I should reveal the confidential information to the client’s parents/guardians is a tricky one, especially since Ronnie has explicitly asked me not to share that sensitive information with them. Often these situations occur around cases of drug and alcohol abuse, underage sexual activity, teenage pregnancy or abortion decisions, and mental health treatment.

There is no simple answer to my ethical obligations in these circumstances. On one hand, minors have a right to confidentiality, even if it is to a limited degree for their safety. They need to know that they can trust their therapists/counsellors, lest they withhold divulging critical clinically relevant information about their health.

However, a majority of parents believe that their right to know if their child is facing any risks overrides the minors’ requests for confidentiality. In those instances, it is the duty of the therapist/counsellor to share important information with them for the parent to have the ultimate decision-making power and minimise any potential risks.

Responses by social workers:

Trust is one the most important qualities of a working relationship between caseworker and client. Unless necessary such as in situations whereby client is involved in self-harm or harming others, the caseworker should not be breaking confidentiality without client’s consent. Breaking confidentiality for the gambling issue is quite tricky for this case since Mei Hua already gained trust from Ronnie; by doing so without Ronnie’s consent, Mei Hua may not only lose his trust, and this crack in relationship may worsen his emotional state especially since he is already very distressed over his parents’ poor relationship. In addition, this issue does not seem to justify for a break of confidentiality without consent, since it does not involve self-harm or harming others. However, considering that Ronnie is a minor, he probably does not have the proper abilities yet to handle gambling addiction and gambling debts. This issue then is serious enough to involve Ronnie’s parents. After all, they are also the ones who are providing for Ronnie financially and it is their money which is lost to gambling.

Considering the abovementioned ethical dilemmas, if I were to be Ronnie’s counsellor, I would explain to him honestly my views regarding his gambling issue, focusing on the importance of why we should involve his parents to work on this issue. Given our close therapeutic relationship and he is also worried about losing so much money, he may ultimately understand my intention and agree to inform his parents. However, before I go into this, I would first try to find out the reasons behind his gambling addiction and hear from him how he hopes to get helped. In this way, not only I can better understand his issue, but I am also respecting him as a client, that he deserves to be heard even though he is only a minor. Too often teenagers’ need to be heard are neglected by the adults around them, as they usually bear the mentality that minors do not know anything. Nonetheless, on the contrary, everyone including teenagers’ opinions are equally important to develop an open and trusting family relationship. After having a clearer idea about his issue, then I can determine if I have the competence to assist him. In the situation if I lack the relevant skill or knowledge, I would most likely refer him to an anti-gambling agency. This intervention then needs both his and his parents’ support and consent.

Jasmine Lee

Senior Executive
Tsao Foundation

Commentary

Reprinted and Adapted with the permission of Social Work Today ©. Great Valley Publishing, Co.

Guidelines to keep in mind

Ethical standards

According to the Singapore Association of Social Workers (SASW) Code of Professional Ethics, client confidentiality extends to the expectations of social workers to “respect and safeguard the rights of persons served … to privacy and confidentiality in their use of the service and to responsible use of all information given and received” (standard A2).

National laws and regulations

The Children and Young Persons Act (key legislation in Singapore for children and young people) clearly states that if the Director-General of Social Welfare or police officer is notified of a young person needing care and protection, the person “shall not, by virtue of doing so, be held in any proceedings before any court or tribunal or in any other respect to have breached any code of professional etiquette or ethics, or to have departed from any accepted form of professional conduct”[1].

Another notable legislation that addresses the issue of mandatory reporting of offences is Sec 424 of the Criminal Procedure Code

"Every person aware of the commission of or the intention of any other person to commit any arrestable offence punishable under Chapters VI, VII, VIII, XII and XVI of the Penal Code (Cap. 224) or under any of the following sections of the Penal Code:Sections 161, 162, 163, 164, 170, 171, 211, 212, 216, 216A, 226, 270, 281, 285, 286, 382, 384, 385, 386, 387, 388, 389, 392, 393, 394, 395, 396, 397, 399, 400, 401, 402, 430A, 435, 436, 437, 438, 440, 449, 450, 451, 452, 453, 454, 455, 456, 457, 458, 459, 460, 489A, 489B, 489C, 489D and 506,shall, in the absence of reasonable excuse, the burden of proving which shall lie upon the person so aware, immediately give information to the officer in charge of the nearest police station or to a police officer of the commission or intention.

Yet another section of the Penal Code (Sec 202 PC Cap 224) addresses intentional ommission of information:
“Whoever, knowing or having reason to believe that an offence has been committed, intentionally omits to give any information respecting that offence which he is legally bound to give, shall be punished with imprisonment for a term which may extend to 6 months, or with fine, or with both.”

Agency policy

In addition to the above, I am expected to communicate with and contact my supervisors and administrators to review internal policies regarding disclosures of confidential information to parents. Some agencies have drafted extensive policies concerning disclosure of confidential information to parents that can be examined on a case-by-case basis.

Deciding on a course of action

Confidentiality issues can be particularly challenging, more so when protecting a minor is involved. Ethics guidelines, laws, regulations, agency policies, and clinical judgment sometimes conflict, creating a daunting dilemma.

I should consult my appropriate colleagues and guidelines. I will be documenting my consultations carefully, in order to protect Ronnie, myself, and my family service centre in case any of my decisions are called into question.

Footnotes
[1] Sec 87(3)(a) Children and Young Persons Act Cap 38