When Oak Bay teen Elliot Eurchuk died of an overdose last year, he became yet another victim in the rising tide of opioid fatalities. The 16-year-old had nearly succumbed to an overdose two months earlier, grim testimony to the vice-like grasp of opioid addiction.
But his death, tragic in itself, raised other issues. A coroner’s inquest has been examining the circumstances of Eurchuk’s death.
During the hearing, Dr. David Harrison, the boy’s physician, testified he felt uncertain where his professional duty lay.
On one hand, the teen had refused to have his medical files shared with his parents.
Island Health interprets the governing legislation to say that any child over the age of 12 years can impose such a prohibition, and that prohibition must be complied with.
On the other hand, Harrison had explained to Eurchuk the gravity of the risks he was running after his first overdose. But the boy was unresponsive and did not appear to understand what he was being told. In such a circumstance, could he, or could he not, inform the parents?
That a physician should find himself in such a state of uncertainty is intolerable. Nor is it necessary.
The legislation in question — the B.C. Infants Act — does not tie a doctor’s hands in the manner Island Health Island has laid out.
It merely says that an infant, meaning someone under the age of majority, can agree to a medical procedure without the parents’ consent, so long as the child understands what is involved.
Nowhere is there a prohibition on physicians taking parents into their confidence if the well-being of a child requires it. Indeed, any reasonable reading of the act would support Harrison if he chose to confide in the parents.
Certainly there are cases where a child’s right to privacy should be respected. If a teenage girl wants to take birth-control pills, or have an abortion, she is entitled to do so without her parents knowing about it.
If a child is being sexually abused at home, again there is an absolute necessity for confidentiality.
But this case in no way raises such issues. Indeed, it points in the opposite direction.
Eurchuk’s very life was at risk, a fact he could not absorb. If involving the parents would have helped in his care, there was every justification for taking that step.
In fairness to Island Health, the interpretation placed on the act almost certainly came from above — either the Attorney General’s ministry or the Health ministry. Neither would offer comment while the inquest is ongoing.
But the solution is obvious.
It is unfair, both professionally and morally, that physicians should find themselves unable to tell what route they can follow. The Infants Act should be redrafted to clear up what is evidently an ambiguous state of affairs.
No doubt, it is impossible to make provision for every conceivable circumstance, but the broad principles are clear.
Confidentiality is required when it is in the child’s best interest. It would be no great task to define such circumstances.
On the other hand, confidentiality is not obligatory if the child’s health or life is at imminent risk, or if the child, for reasons of addiction, mental illness, or other incapacitating circumstances, cannot make an informed decision.
This still imposes a burden on doctors — to determine whether, or to what extent, such a situation exists. But there is no way to avoid that.
Someone has to make a decision, and no one is better placed than a physician.
We’ll see what recommendations, if any, the coroner’s jury proposes. But in the midst of an opioid epidemic, the rules for treating youngsters in harm’s way cannot be left in a state of confusion.