Informed Consent with children and mature minors
Child and adolescent counselling and psychology raises some interesting ethical questions that do not relate to working with adults. In particular, it is important to establish a balance between keeping the child’s confidentiality and keeping parents informed so that they can best support their child.
Below is a section from the https://psychology.org.au/about-us/what-we-do/ethics-and-practice-standards/aps-code-of-ethics regarding working with children.
Working with minors
The APS Code of Ethics Clause B5 states:
“When working with young persons or other clients who are unable to give voluntary, informed consent, psychologists must protect these clients’ best interests and will regard their responsibilities as being directed to the parents, next of kin or guardians. The psychologist shall endeavour to obtain the consent of young people and these other clients.“
Minors are classified as being unable to give voluntary informed consent and as such psychologists must protect their interests. There is no single definition of ‘minor’ and common law regards minors as being capable of giving voluntary informed consent if they have sufficient maturity. ‘Maturity’ is a professional judgement but around age 14 or 15 years is generally regarded as a good ‘rule of thumb’. Minors, however, are regarded as legally incompetent. That is, minors cannot legally have rights that are not contained in law.
It is recognised that in providing professional services, psychologists may obtain consent from a minor and that confidentiality should then be respected. That is, psychological services can be sought and consented to, and a wish for confidentiality expressed, by a minor. In places such as schools, there may be other legal requirements and obligations that limit the extent to which a minor may be regarded as mature or autonomous. These include the Principal’s duty of care, parental payment of fees and dues, and the psychologist’s responsibilities to the school, the parents and the minor. Opportunities should be provided for the minor to understand the limits of confidentiality in such circumstances.
All the general principles outlined above apply to confidentiality with minors; however the following specific principles also apply:
If, in the judgement of the psychologist, the minor is sufficiently mature to give voluntary informed consent for a psychological service, then the duty to maintain confidentiality must be respected (to the extent permitted legally and generally to adults as listed above).
The context within which the psychological service takes place and the nature of the psychological service offered or proposed (e.g. assessment, counselling), should also be taken into account when making a decision about accepting consent and hence respecting confidentiality.
Any disclosure must be in the minor’s best interests, and consent should normally be obtained from the mature minor prior to any communication of information.
Any breach of confidentiality must be justified by the psychologist using professional judgement regarding the particular circumstances, taking into account the psychological maturity/immaturity of the minor.
If, as well as the minor, parents, guardians or next of kin are considered clients, then the psychologist has an obligation to consult them in instances where confidentiality is to be breached or information otherwise disclosed.
Parental legal responsibility for the minor’s interests overrides any expressed wish for confidentiality on the part of the minor, taking into account the maturity/immaturity of the minor, the context of the psychological service and statutory or other obligations.
Any parental responsibilities that are determined by the Family Court must be taken into account when obtaining informed consent for minors or disclosing or communicating information. The minor’s best interests must remain paramount in any decision made.
Working with mature minors
If we are seeing a child who is over 14 years old, even if there is an Order stating that the parents have equal shared parental responsibility there are some extra steps we might go through in making a decision about whether to provide treatment without the written consent of both parents. In the case of a mature minor, the psychologist, the parents/guardians need to understand the child is the client, and that it is not necessary to provide information to parents unless there is risk of serious harm, and that this needs to be discussed with the child and the paying parent as part of informed consent and the limits of confidentiality at the commencement of the therapy.
In the Family Law Courts, children’s views when they are aged usually around 14, 15, 16 or more carry significant weight. That is, the Courts take their views and wishes very much into account unless there is a reason to consider that they are not developmentally at their chronological age or there is some other kind of deficit that would make their developmental age much younger.
Please refer to the documents Your Rights as a Client of a Psychologist and Code of Behaviour for Psychologists published by the Psychologists Registration Board of Victoria and the APS Charter for Clients of Psychologists published by Australian Psychological Society (APS). These sites will explain your rights and the ethical standards to which we – as registered psychologists – must adhere.