Uzodinma,
Adolescents are at the beginning of their lifelong journey of adult learning. They learn intuitively using their evolved genetic consciousness and choosing from the knowledge that surrounds them. I have attached [*] a presentational representation of the history of health knowledge. HIFA strives to improve the supply and availability of accurate health literacy material at the various levels of health literacy of the adult or adolescent. Adolescents are exposed t6o cultural and peer pressures.
I have attached an excellent piece of work on the access to medical records by parents, children and adolescents and have pasted a great piece on adult learning that I came across when teaching medical students and trainee GPs. Josefin explains in her PhD thesis “A growing concern – online access to minors’ health records” Josefin Hagstrom refers to three sharing alternatives of access to minors’ records described by Thompson LA, Martinko T, Budd P, Mercado R, Schentrup AM. (2) A model of delineation of adolescent health portal models describes three access models:
In one alternative, parents agree to a confidential relationship of record access between healthcare provider and minor: the minor has access and the parent relinquishes access. In another alternative, parents agree to a confidential relationship between healthcare provider, parent and minor: both parent and minor have access. In the last alternative the parent chooses access to the minor’s record, and the minor has no access.
Access could happen at an earlier age for a minor if the minor shows that they wish to access the record, and that they have the mental capacity to do so. We consider the English Gillick ruling concerning minors. (3) Gillick competence is a term originating in England and Wales and is used in medical law to decide whether a child (a person under 16 years of age) is able to consent to their own medical treatment, without the need for parental permission or knowledge. Gillick competence - Wikipedia The standard is based on the 1985 judicial decision of the House of Lords with respect to a case of the contraception advice given by an NHS doctor in Gillick v West Norfolk and Wisbech Area Health Authority. Gillick's case involved a health departmental circular advising doctors on contraception for people under 16. The issue before the House of Lords was whether the minor involved could give consent. The majority held that in some circumstances a minor could consent to treatment, and that in these circumstances a parent had no power to veto treatment, building on a previous judgement.
Lord Scarman required that a child could consent if they fully understood the medical treatment that is proposed: as a matter of law the parental right to determine whether, or not their minor child below the age of sixteen will have medical treatment terminates if, and when the child achieves sufficient understanding and intelligence to understand fully what is proposed. The ruling lays down that the authority of parents to make decisions for their minor children is not absolute but diminishes with the child's evolving maturity. The legal right to make a decision concerning the child, shifts from the parent to the child when the child reaches sufficient maturity to be capable of making up their own mind on the matter requiring decision. A child who is deemed "Gillick competent" is able to prevent their parents viewing their medical records. Thus, medical staff will not make a disclosure of medical records of a child who is deemed "Gillick competent" unless consent is manifest. Gillick competence - Wikipedia
In early childhood in Sweden the Swedish Parental Code 6 chapter 2 states that a person who has custody of a child is responsible for the child's personal circumstances and shall ensure that the child's needs for care, security, and a good upbringing are met. In Adolescence in Sweden The Patient Act 3 chapter 3 3 states that the child’s views shall be given due weight in accordance with the child’s age and maturity.
Thompson LA, Martinko T, Budd P, Mercado R, Schentrup AM wrote in their article “Meaningful use of a confidential adolescent patient portal” in the Journal of Adolescent Health. 2016;58(2):134-140, that “While adolescents can receive confidential health care without parental or guardian notification, they are rarely asked about their experiences and opinions regarding their care because participation in research often requires parental consent. Anonymous research with adolescents via confidential patient portals may ameliorate this research gap.”
HIFA profile: Richard Fitton is a retired family doctor - GP. Professional interests: Health literacy, patient partnership of trust and implementation of healthcare with professionals, family and public involvement in the prevention of modern lifestyle diseases, patients using access to professional records to overcome confidentiality barriers to care, patients as part of the policing of the use of their patient data Email address: richardpeterfitton7 AT gmail.com
[*Note from HIFA moderator (NPW): HIFA does not carry attachments. Please contact Richard to request a copy.]