Exceptions to Professional Secrecy

Youth Protection

Under review

Clinical Case 
Ms. Chantal P. wishes to see the record of her minor daughter. But you know that the record contains details concerning physical abuse committed by Ms. Chantal P.’s new spouse, and that the daughter has concealed everything from her mother.
What do you do?

The person having parental authority may be refused access to her child’s record once the child is the subject of an intervention by the director of youth protection (DYP), yet the physician is obliged to disclose to  the authorities concerned information leading him or her to think that the security or development of a minor is in danger. In fact, the law, in order to safeguard the inviolability of the vulnerable minor, obliges every citizen to alert the authorities. The Youth Protection Act stipulates that the obligation applies to physicians regardless of their obligations to professional secrecy. In institutions, the law allows the DYP to have access to the medical record of the child involved without any further authorization.

However, the DYP must obtain a court order to have access to the medical record of a third party (parent or tutor). Only information necessary to the assessment of the situation of the child may be disclosed, in keeping with the principle of minimal infringement on professional secrecy.

In private practice, the law has nothing to say on the powers of the DYP. It is up to the physician to decide to divulge the secret, subject to protecting her privacy, on the one hand, and protecting the child from serious harm, on the other. In case of doubt, the physician may request information by telephone from the Collège des médecins du Québec or solicit the opinion of a legal advisor with his or her professional liability insurer.

Given that Ms. Chantal P.’s daughter had confided to you that her mother’s new spouse had sexually abused her and that she had concealed everything from her mother, there was reasonable cause, not only to refuse access to the record, but to believe that the security of the child was in danger. You should therefore have alerted the DYP the moment this information was confided in you. While waiting for the DYP to intervene, you should have done your utmost to protect the daughter, drawing up with her a list of the dangers to her security and development. This action is part and parcel of your commitment to provide follow-up care for your patients. 

Clinical Case  
Jonathan, a four-year-old boy, is brought in by his mother because he told her a story about sexual abuse at the day care centre.
What do you do?

Even if the investigation with respect to  youth protection is not the physician’s responsibility, this does not exempt him or her from checking to see whether there is
just cause to launch an alert. Doubt is enough to legitimize calling the DYP. The physician’s obligation to report situations of abuse against children is mentioned in the Youth Protection Act and confirmed in the Code of Ethics of Physicians (sec. 39):

“A physician must report to the director of  youth protection any situation where there is reasonable cause to believe that the security or development of a child is or may be considered to be in danger; he must then transmit to the director any information he deems pertinent to protecting the child.

The physician himself may also report to the police authorities the situation of a child whose physical integrity or life appears to him to be in danger.”

The seriousness of situations of this kind should be enough to discourage irrational or groundless denunciations motivated by nothing but vengeance. It does happen, however, that quarrels over shared custody result in scenarios of this kind.