Tina Tan
My daughter was a peer support leader in her secondary school days, and she once asked me a question that most of us who work with adolescents would have encountered: what if a peer/friend of hers was struggling in terms of their mental health but refuses to inform their parents for some reason? Could this person seek help on their own without anyone else being informed?
I must admit, I had no simple solution for my daughter, who was asking this on behalf of real people in her life.
It is timely for me then that this issue features two articles on the broader topic at hand – an adolescent's ability to make their own treatment decisions. One article has been coauthored by our former SMA Centre for Medical Ethics and Professionalism director, the esteemed Prof Thirumoorthy, and the other by a respected colleague of mine, A/Prof Daniel Fung.
The gist of the answer to my daughter’s question seems to be this: protect the individual’s confidentiality as far as possible, always ask what is in the patient’s best interests, and have ongoing conversations that will enable family to be involved to provide the adolescent with the care they need.
Lim Ing Haan
This issue highlights two thought-provoking articles – one on adolescent decision-making by Prof T Thirumoorthy and the other on adolescent autonomy by A/Prof Daniel Fung. Both offer valuable insights into the complexities surrounding young people’ s capacity to make healthcare decisions, which I found particularly enlightening.
In Singapore, the age of majority is 21 under the common law, and physicians are obligated to act in the patient’s best interests. Challenges arise when adolescents under 21 with mental health, sexual health or substance abuse issues wish to exclude their parents from healthcare decisions. Although they may be capable of making informed decisions, they remain below the age of legal consent.
I recall a 16-year-old patient referred to me for hypertension who later confided his wish for gender reassignment, requesting confidentiality from his parents. Understanding the social stigma associated with sex change, I advised him to focus on completing his examinations before making any major decisions. At a subsequent visit, he agreed to let me broach this sensitive topic with his father, which allowed us to address concerns related to his upcoming National Service. Fortunately, I was able to encourage him to seek psychiatric support to better navigate the decisions ahead. In my view, he needed time to develop psychological and emotional maturity before making significant decisions, in line with the concept of Gillick competency.
This case underscores the physician's role as a first point of contact for adolescents. By upholding confidentiality and building trust with my patient, I was able to facilitate parental involvement. Ultimately, doctors must balance acting in the best interests of minors with respecting their growing autonomy, recognising that they will eventually assume full decision-making upon reaching adulthood.
