A mature 10-year old

I really had to swallow a couple of times when our hospital’s updated guidelines regarding patient files instructed that that 10-17 year olds can decide that their parents cannot obtain information about the minor’s health and treatment. I really ask: what developmental milestone is reached at age ten that makes such a child competent to decide, better than her/his parents, about appropriate treatment for her/his illness so severe that it requires specialist level health care? Since if parents can be left in darkness regarding their child’s health, it must mean that the child is fully competent to negotiate all the treatment decisions, weigh risks and benefits, and bear full responsibility of all consequences.

I appreciate that older adolescents may have health issues where privacy from parental involvement is relevant, for example in questions related to sexual health. But if we think about the two classical dilemmas in the confidentiality debate, a minor seeking abortion, and a minor intoxicated in emergency station, then just keep in mind that meeting a 13 year old in need for abortion, or a 15 year old intoxicated in emergency station are situations where health care professional has a duty to inform child welfare. Very unlikely that child welfare does its duty, and parents never learn about that. Prioritizing confidentiality in such situation paves way to cases like revealed recently in Northern Finland: a minor had repeated abortions after continuous sexual abuse, and nobody intervened.

Some years ago this hospital guideline set the lower limit at 12. As chief adolescent psychiatrist and researcher in field of adolescent development I criticized already that (see My writings: Sinun lapsesi eivät ole sinun). But obviously children mature all the earlier in Finland. We have not noticed that in adolescent psychiatric clinic or research, but surely somewhere in politics or jurisprudence this has been proved?

According to the Convention on the Rights of the Child, a child (under the age of 18) needs protection and care due to her/his bodily and mental immaturity. In Finland we are busy guaranteeing to minors a right to be left unsupported in times of trouble, for example when ill. As part of the huge reform of health and social services, politicians are fanatic to focus on citizens’ right to choose their service providers. This will improve the quality of services throughout the system. Of course, minors, our future hope, need the best of services. Therefore, it is currently suggested that from age 12, children can choose their health service providers independently of their parent’s opinion (http://alueuudistus.fi/lakiluonnokset-12-2016 ). I wonder if the society also provides, for example, to the 12-14 year olds escort to their chosen services and money to pay for those interventions that are on the citizen’s own responsibility, or do the parents have to serve and pay even if they do not have a say?

In my home town parents can manage in the Internet dental care contacts on behalf of their children, but only of those under 12. This obviously implies that from age 12, dental care is on the responsibility of the children. No doubt that for example all 13 year old boys appreciate as their highest priority to take care that they have their dental check-ups and treatment regularly… I really think that this guarantees to early adolescents a right to rotten their teeth.

 Surely in ordinary families where children receive age appropriate care, parents actually have active roles in their children’s health care, and the more the more severe the minor’s health issue. But I find the guidelines and ideas criticized above symptomatic. This is a society that actively attempts to push parents out of life of all the younger adolescents and children. Why is this needed? So that young minds can be influenced without parental protection? Does this somehow serve business life? No wonder that all increasing number of minors are looked after and placed outside of the home in Finland.