Ethics Commentary

The key ethical question in this case is whether it is acceptable for Dr. C to disclose information about the 16-year-old patient’s sexual and psychiatric health condition. The answer to the question is yes, if such disclosure serves the patients’ well-being and future interests.

The patient, Miss M, may have had her own reasons for asking Dr. C not to inform her parents of her condition — perhaps she was worried about their reaction, or believed that such disclosure was unnecessary, because she could already understand, have an opinion and make decisions for herself. In this respect, Article 12 of the United Nations Convention on the Rights of the Child provides assurance for “the child, who is capable of forming his or her own views, the right to express those views freely in all matters affecting” him or her. As a 16-year-old, Miss M plausibly senses her capacity for decision-making that is independent of her parents. Various developmental theories, such as those of Jean Piaget and Lawrence Kohlberg, affirm that her decision-making competence might have reached maturity by age 16.¹ Seeing her wishes respected, Miss M may be encouraged to open up to Dr. C and receive suitable medical care or services, which may not be there if confidence in her doctor is broken. Her exercise of autonomous decision-making capacity may help in her recovery and restoration.

Dependency of children on their parents is, however, arguably unavoidable as they are yet to possess capacities of decision-making equal to those of adults. Children are still, in the words of Aristotle, albeit pejorative, “incomplete adults […] unfinished human beings”, or “becomings” rather than “beings”.² If they live under the authority of their parents, they may be subject to “Constrained Parental Paternalism”. Constrained because: “It must be exercised for the good of the child and its exercise lasts only for so long as the child is incapable of making its own choices”.³

Following this line of argument, parents may exercise authority over their children in ways that guide their decision-making and thereby promote their best interests. John Locke terms this “guiding the decision-making”, “informing the mind”.⁴ Immanuel Kant justifies “promoting the best interests of children” as: those who have brought a child into the world “incur an obligation to make the child content with his condition so far as they can”.⁵ “From this duty,” Kant adds, “there must necessarily arise the right of parents to manage and develop the child.” ⁶ Thus, parents may have not only an obligation, but also a right to guide the decision-making of their children.

As persons who can understand and respond to the needs of their children, parents may be the best judges of the child’s well-being so that they may always be involved in the decision-making especially for significant decisions involving medical care the child. After all, making a medical decision can involve major life decisions. Medical choices may have long-term impact on a child’s well-being that makes parents’ involvement in such decision-making highly desirable. No amount of care by doctors for the child patient can match the invaluable insight and knowledge of the parents.

In the case at hand, Miss M’s parents should be informed of her condition as they can provide her with essential support for her recovery and the restoration of her well-being. The mere fact that her parents protested about not being informed of her condition suggests that they wanted — in the sense of taking responsibility and supporting her future interests — to be involved in the medical decision-making. They believe that any harm or injury might have been prevented had they been informed. Miss M is also still under the care and custody of her parents. Not having reached the age of maturity, her parents have an obligation and a right to guide her decision-making.

Nevertheless, in some countries, children between 13 and 16 years of age have the right to make medical decisions without parental involvement. In Singapore, parents’ participation in the medical care of...