1.12 Lack of respect for parents

Does participation lead to disrespect?

Will it undermine parental authority?

Listening to children is about respecting them and helping them learn to value the importance of respecting others. It is not about teaching them to ignore their parents. Indeed, the UN Convention states that education should teach children respect for their parents. Listening is a way of resolving conflict, finding solutions and promoting understanding – these can only be beneficial for family life. It can be difficult for some parents to respect children’s rights to participate when they feel that they, themselves, have never been respected as subjects of rights. This does not imply the need to retreat from encouraging children to participate but, rather, the need to be sensitive in doing so. Children should not be led to believe they alone have a right to have a voice; wherever possible, their families should be involved too.

Activity 1.4: Involving children in health care decisions

Think about a situation where you have had a difficult decision to make in your practice. You may have had to override the wishes of a child or his or her parents by insisting on a treatment, or you may have had to breach confidentiality or report an incident. What did you decide to do and why?

If you are unable to identify a case from your own practice, you could think about what you would do for one of the following examples:

  • a.A 13-year-old wanting contraception but does not want her parents to be informed. Should her privacy be respected?
  • b.An 8-year-old child has HIV, which was transmitted from the mother. Should the child be told even though the mother does not want this?
  • c.In a school vaccination programme should individual children be consulted and asked to give their permission?

Now, for your own situation or one of the examples above, consider these questions:

  1. Would you create time to explain what was happening to the child or would you simply provide information to the parents?
  2. How would you determine whether the child is competent to make a decision about his or her health care?
  3. When would you breach a child’s privacy?

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There are no right and wrong answers to these questions. However, there are some issues that it would be useful for you to consider when faced with such cases.

  1. Some of the negative implications of providing information to the child are that it would take time, it might cause the child distress, and the parents might object. Some of the benefits are that the child might be less anxious, feel more in control, and be better prepared for what is happening. In addition, the child might be more able to co-operate and better able to talk about problems if she or he knows what is happening. Parents would also be better equipped to help the child where there is openness and honesty.
  2. You could check their level of understanding about the kind of treatment being proposed and its implications. You could make time to talk with the child about their feelings and views and why they are concerned about the treatment proposed or the request for confidentiality. You could assess the child’s ability and competency as an individual and try to avoid assumptions based on their gender or age.
  3. On the one hand, you may feel it is necessary in order to ensure that a child gets the treatment he or she needs, or in order to ensure their protection. On the other hand, there is a danger that if children feel the health worker will not respect confidentiality, they will not seek help when they need it. This may cause even more harm to the child. As a general guide, you should always respect a child’s privacy unless it is in the child’s best interests not to do so, or where the law requires you to breach privacy.

1.11 The right to protection versus the right to privacy