A recent legal case in Melbourne, combined with the increased likelihood of an Abbott prime ministership, has resurrected fears about young people’s medical privacy.
Seventeen-year-old “Shannon” sought support from a counsellor for issues arising from domestic violence and her mother and stepfather’s mental illness. Without Shannon’s consent or knowledge, the counsellor disclosed her confidences to family members and those living with her in supported accommodation.
The privacy breach, discussed at length in a recent episode of ABC Radio’s The Law Report, brought Shannon’s already fragile life undone. She is no longer on speaking terms with any family members, and is terrified of confiding in any members of the helping professions whose support and comfort she arguably needs.
In the words of the solicitor from the Youth Law Legal Service in Melbourne who obtained both an apology and compensation for the young girl, the professional’s breach of her privacy caused her “severe…trauma…and upset.”
Health professionals and their professional bodies agree that privacy is a critical component of effective healthcare for adolescents. Even Francis Sullivan, the former CEO of Catholic Health Australia, an industry body not known for its emphasis on patient rights where these conflict with Catholic teachings, has noted that non-consensual disclosure of young people’s healthcare information risks exacerbating “…the very causes that led some teenagers to seek help outside the family.”
At the heart of the near-universal support for adolescent health privacy is an extensive body of data. The research shows that the greatest barrier to young people seeking medical help is the fear their parents may find out.
The converse is also true. “Young people are more willing to disclose sensitive personal information and return for follow-up care,” says Professor Susan Sawyer, director of the Centre for Adolescent Health at the Royal Children’s Hospital, “when services are known to be confidential.”
In Australia, “mature minors” are authorised to make decisions about their medical treatment. A mature minor is a tween or teen with sufficient understanding and intelligence to understand the nature and consequences of the medical intervention proposed, and to give informed consent to it.
While all those under 18 must be accessed on such criteria, it is generally assumed that those over 17 are mature minors, that those 14 to 16 are reasonably likely to be, and that those under 14 may not have capacity to consent, particularly in relation to more serious treatments. The requirement for confidentiality is a corollary of the mature minor framework.
Never one to let evidence muddy the waters of ideology, the now Opposition leader Tony Abbott was part of a government that in 2003 lifted the age at which information about a child’s healthcare visits could be accessed by their parents from 12 to 14. As Health Minister he vigorously argued for this threshold to be lifted again, from 14 to 16. Had he succeeded, an entire group of Australians would have been denied independent and confidential medical care, despite most qualifying for it.
Luckily, Abbott failed. But his vigorous pursuit of the change reveal much about the values and priorities of the man polls tell us is most likely to be Australia’s next Prime Minister.
For Abbott, the right of parents to know what doctors their kids are visiting and when takes priority over the right of that “child” – the term he diligently applies to 14 and 15 year olds – to privacy.
While conceding that some 14 and 15-year-olds might “wish to conceal from their parents” the medical procedures they have had or the prescription drugs they are on, he contends that “children should not be presumed to be the best judges of their own long-term interests and should not have the right to go behind their parents’ backs.”
When parents and children are at odds, says Abbott, “the responsibility of government – and doctors – is to support parental authority.” This is because adolescents can’t act in their own best interests and so require adults to make their decisions, and “judgmental parents” should not be assumed to be capable of inflicting more harm on their children than “permissive doctors.”
It is noteworthy that the “children” to whom Abbott refers are largely young women. Both logic and anecdotal evidence suggest that young men have less need of medical advice, and fewer privacy concerns. “Guys don’t have as much to worry about,” one 16 year old girl told The Canberra Times. “… they can’t get pregnant.”
In a final and characteristically clueless fiscal flourish, Abbott notes that giving parents the power to purvey their (mostly daughters’) medical records was really not that much power at all. He scoffs at the claim that such privacy invasions might cash out in suicide or backyard abortion because “The worst that might happen is a teenager accessing a service but not claiming a rebate.”
What is she going to pay medical bills or script costs worth hundreds of dollars with, Tony? Her parentally-controlled trust fund? Grandma’s backyard stash?
The Liberals are doing their best to keep Autocratic Abbott under wraps, and to repair Abbott’s relations with women (he breakfasted not long ago with feminist blogger Mia Freedman). I suspect he’s also been out mending fences with others in the community who have memories better than goldfish about life under Abbott and Howard.
I’m having none of it. Leopards don’t change their spots. Tony Abbott is still the Mad Monk or, as his daughter put it, “a lame… churchy loser.” If he comes to power, the Christian right will still have his ear and just as it was in the past, women, gays, single mothers, young people, Aborigines, religious minorities, migrants and those with the audacity to be disabled or unemployed will need to watch out.
Labor needs to stop making elliptical references to the nightmare of an Abbott-led government and start spelling out exactly whose rights are likely to cancelled, and whose best interests will be decided by others.
They need to explain not just what an Abbott-led Liberal government is likely to mean for “working families” and unionists, but the impact it would have on the rights, privacy and freedoms of all of us.
Youth privacy at risk under the Mad Monk ABC - The Drum - Unleashed