Don't disclose this information to my doctor!
A dietitian is working in an outpatient eating disorders program with a 14-year old client. Recently, she has been losing weight at an alarming rate and you are concerned. She tells you that she has been purging but she does not want further treatment for now and does not want you to tell her family doctor. What should the dietitian do?
The Health Care Consent Act, 1996 specifies that there is no minimum age of consent. The dietitian needs to determine the client’s capacity to make an informed and knowledgeable decision and whether client is capable of understanding that refusing further treatment could potentially result in her death.
Respecting the client, the dietitian can have a conversation to understand her concerns further. The dietitian can inform her about the risks of refusing further treatment and keeping her weight loss from her doctor.
With respect to the client’s request not to disclose this information to her family physician, the dietitian should consider the client’s specific needs, and be open to the client’s input. If the dietitian is confident in the client’s capacity to consent to treatment and to the collection, use and disclosure of personal health information, then the dietitian must respect the client’s wishes.
However, given the complexity of eating disorders, it is possible that concurrent comorbid conditions are impacting the client's capacity to make an informed decision about her healthcare. If the dietitian feels the client is not capable of making a nutrition treatment decision, she should inform the incapable client that they require a substitute decision-maker who will be responsible to make decisions (i.e. to assist them in understanding the proposed nutrition treatment and the disclosure of personal health information to the client’s doctor). In this case the substitute decision-maker would likely be a parent, unless someone else has been assigned (Refer to the Professional Practice Standard, Consent to Treatment, Standards 3-5).