Confidentiality: Parental responsibility - getting it right

WHAT information can be shared with an estranged parent? Which parent has the right to make decisions about a child’s health and wellbeing?

These are two of the most common questions the MDDUS advisory team is asked by healthcare professionals who are navigating the world of parental rights and responsibilities (PRR). It is a tricky area that can present many challenges for clinical teams when relationships end and children require care.

Most healthcare professionals do not want to be seen to be taking sides or get caught in the middle of two feuding parents, but it’s important to understand your professional duty to both child and parent in this situation.

What are parental rights and responsibilities?

All mothers and most fathers have legal rights and responsibilities as a parent – known as ‘parental rights and responsibilities’. A mother automatically has PRR for her child from birth. This is not the case for fathers and the position differs in each part of the UK.

Births registered in England and Wales

If the parents of a child are married when the child is born, or if they’ve jointly adopted a child, both have PRR and they both keep PRR if they later divorce. For unmarried parents, a father can get PRR if he:

• has jointly registered the birth of the child with the mother (from 1 December 2003)
• makes a parental responsibility agreement with the mother
• obtains a parental responsibility order from a court.

Births registered in Scotland

A father has PRR if he’s married to the mother when the child is conceived, or marries her at any point afterwards. An unmarried father has PRR if he’s named on the child’s birth certificate (from 4 May 2006).

Births registered in Northern Ireland

A father has PRR if he’s married to the mother at the time of the child’s birth. If a father marries the mother after the child’s birth, he has PRR if he lives in Northern Ireland at the time of the marriage. An unmarried father has PRR if he’s named, or becomes named, on the child’s birth certificate (from 15 April 2002).

Same-sex parents

Same-sex partners will both have PRR if they were civil partners or married at the time of any fertility treatment. For same-sex partners who are not civil partners, the position differs across the UK but there are various means by which the second parent can get PRR, including by applying to the court.

Information sharing

If you receive a request for information about a child (who is assumed not to be competent to make a decision for themselves), the first step is to establish whether the individual requesting this information does indeed have PRR. You are entitled to ask to see proof of this.

It is a common misconception that consent of the mother is needed in order to see a child with their father, or to provide a father with a copy of the child’s medical records. If the father has PRR, you do not need to inform the mother, or seek her consent to do this – consent is only required from one person who has PRR.

However, it is important to ensure that information pertaining to the mother or any third party is redacted in line with the data protection act unless appropriate consent has been obtained to share it.

It is also imperative that you put the wellbeing of the child first. For example, if disclosing information about a child could cause them harm, you should consider if such as disclosure is indeed appropriate or even necessary.

Caught in the middle

Healthcare professionals often deal with queries from one parent – perhaps asking for more detailed information about their child or a particular health condition – because this information has not been provided by the other parent. It is not uncommon for one parent, for example, to ask the practice not to share certain medical information about a child with the other parent.

This can create difficulties for all involved and practice teams should try their best to avoid getting “stuck in the middle” of such a situation. Encourage the parents to find a reasonable and amicable way of discussing and reaching agreement on their child’s health and wellbeing before involving the healthcare team. This may be done informally or via mediation.

Separated parents

When dealing with parents who have separated, do not make assumptions about who has PRR for the couple’s children. A parent may still have PRR for a child even if they no longer live together.

Consent from one, both or none?

As explained earlier, healthcare professionals usually only need one person with PRR to give consent for them to provide treatment that is in the child’s best interests.

However, there are a handful of important decisions where both parents should be consulted, usually those that are contentious and irreversible (e.g. immunisation or non-medical circumcision).

If agreement about a particular treatment or what is in the child’s best interests cannot be reached, it may be necessary to seek a view from the courts.

In an emergency situation, where treatment is vital and waiting for parental consent would place the child at risk, treatment can proceed without consent.

The GMC makes clear it in its Protecting children and young people guidance that: “Good communication with parents is essential. Parents generally want what is best for their children and are experts in identifying when their child’s behaviour is not normal for them and may be due to ill health. You should acknowledge parents’ understanding of their children’s health, particularly where a child’s age or disability makes it difficult to communicate with them."

Understanding both sides

When parents part ways, things can get very stressful and become difficult for both parents and their children. Whilst parents may not intend to, they can often bring their children into the middle of their disputes and disagreements. It is important for healthcare professionals to fully understand the legal rights of both parents, in order to support families and provide parents with the information they require and have a legal right to.

So, if you’re faced with a request for information about a child from a parent or see them for a consultation without the parent with whom they usually reside, it is important to consider two important elements: does this individual have PRR? Is the action in the child’s best interest? 

ACTION POINTS

• Familiarise yourself with GMC guidance, Parental responsibility and the child’s best interests.
• Children who are deemed competent to make decisions about their own care should be consulted.
• It is okay to ask a parent for proof of PRR.
• A child does not need to live with a parent for that parent to be involved in decisions about their health and wellbeing.
• Always prioritise the child’s best interests.
• Always remain professional and do not take the side of one parent over another.

Dr Roopinder Brar is a medical adviser at MDDUS