Treating Minors and the Duty to Disclose Information to Parents

Miss M is a 16-year-old female high school student from a middle-income Chinese Singaporean family. She is an above-average student and is well-liked at school. However, she has been feeling down lately and has begun to feel the pressure of performing well in the upcoming O-level exams so that she can go to junior college with her friends next year. One afternoon, she presents to the school counsellor after having — in her words — “freaked out” in the library. She tells the counsellor this was the third time it has happened to her in two weeks. The other two occasions took place at her home after school while her parents were at work and the domestic helper was out with her two younger male siblings. She had not told her parents and did not want them to know. She was also worried about what her friends would think of her.

The school counsellor referred Miss M to Dr. C who is a child psychiatrist practising in a restructured hospital and who specialises in anxiety disorders. During the first consultation, Miss M tells Dr. C that she does not wish her parents to know about the contents of the therapy even though they are paying for it. Dr. C is reluctant as he thinks that she will respond to treatment better with their support and involvement but agrees not to involve her parents at this point in order to build trust with his client who seems very mature for her age. Following an assessment, Dr. C diagnoses her with an anxiety disorder with depressive symptoms and initiates treatment with medication and cognitive behavioural therapy.

Six months into the therapy, Miss M reveals that she became friends with an older Malaysian boy on Facebook and had travelled up to Kuala Lumpur to meet him while she was supposed to be at a friend’s house one weekend. They had unprotected sex and she had since discovered that she was both pregnant and had a sexually transmitted disease. She says that her parents do not know about this and is fearful of their reaction. By the next consultation, she tells Dr. C that she had terminated her pregnancy on her own accord at a private clinic using her own savings. Her parents subsequently found out about this through one of her friends. Incensed, the parents have lodged a complaint against Dr. C to both the hospital and the Singapore Medical Council claiming that he did not take the necessary steps to either protect Miss M or to inform them of her behaviour.