Consent to treatment and patient confidentiality for minors
Confidentiality is a legal obligation not to disclose information obtained in confidence without the patient’s consent. This definition applies to young people as well. A capable young person has the right to determine who will be given access to their personal health information, including parents.
In this Practice
Once your child reaches the age of 14, you will no longer have automatic access to their health care records. Whether you as the parent have access to your teen's records is a discussion you must have with Dr Wright. If we are calling with results for your teen, we cannot share that information with anyone but the patient unless we have been given a directive from Dr Wright that it is okay to do so. Do not harrass staff about this as it is not their decision; it is a policy they must follow.
Once your child is 14 they are presumed to be capable under the Supreme Court's "mature minor" doctrine (unless there are reasonable grounds to suggest otherwise). This means we will ask for their consent if you wish to attend their appointment or speak with their doctor on their behalf. If they do not give their consent, then you can still discuss any concerns you have in a separate appointment with the doctor, however the doctor cannot disclose any of your teen's personal medical information with you during this conversation.
Once your child is 16 they are now presumed by Ontario law to be capable of making their own medical decisions. This means they should be booking their own appointments and any results will be given directly to them, unless explicit permission as been obtained from the patient to share those results with a family member.
Anyone 18 years of age and older must book their own appointments. Results will not be given to family members unless the individual does not have the capacity to manage their own affairs due to cognitive impairment.
Laws in Canada
In provinces where there is no definitive age of consent, the Supreme Court of Canada has endorsed the “mature minor” doctrine, where a child of any age is capable of providing consent if they have the maturity, intelligence and capacity to understand the nature and purpose of the proposed health care, along with the ability to appreciate the reasonable foreseeable consequences of such a decision. In general, children begin to show this capacity at 14 years of age, but in some cases the child may demonstrate sufficient capacity at a younger age.
If a child meets these requirements then parental consent is not required and does not override the decision of the child. If a child does not meet these requirements then the consent of the parent is required before health care can be provided to the child.
Laws in Ontario
In Ontario, the Health Care Consent Act stipulates that all persons (including minors) are presumed to be capable (i.e., able to understand treatment information and reasonably foresee consequences) of making treatment decisions unless proven otherwise. In other words, as long as a young person demonstrates capacity as a "mature minor" and understands the treatment, why it’s being recommended, and what will happen if they accept or refuse treatment, their family must respect the young person’s decision. There are certain exceptions where the court will intervene, however this is usually only in circumstances involving life-saving treatment and generally does not pertain to routine care.
The Substitute Decisions Act presumes that persons 16 years of age or more are capable of giving or refusing consent in connection with their own care, unless there are reasonable grounds to believe otherwise. This includes access to medical records.
In other words, if the child is under 16, then there is implied consent that health information can be shared with their parents and/or guardian, however this consent can be revoked at any time if the patient demonstrates capacity as a "mature minor" (usually at 14 years of age). That means if at any time a capable adolescent tells their doctor they do not wish for certain health information to be shared with their parents, then the doctor is now legally obligated to keep that information private.
Once the individual turns 16, we cannot share any health related information to anyone who is not a health care provider without the patient's explicit consent. This means that the individual must give their consent in order for a parent to attend their appointments, or speak with a health care provider on their behalf.
Once an individual has reached the age of majority (18), there is a release of information form that must be filled out in order for any family member/caregiver to have access to their records.
In cases where one parent has custody:
Custodial parents have full access rights to their children's medical records except where the children have the capacity to make a decision about the collection, use and disclosure of their medical records.
Access parents are entitled to the same information as the custodial parent unless the court orders otherwise.