DOCTORS FACE FENTANYL DILEMMA
Is reporting addicted minors the best approach? Paula Simons asks
Thursday, the College of Physicians and Surgeons of Alberta officially notified its members that they have a legal duty to report youth who are using fentanyl to provincial child welfare authorities.
At a time of growing concern in Alberta about fentanyl abuse, it’s a directive that challenges our understanding of patient confidentially.
The bulletin refers to an unidentified Alberta doctor who was reportedly treating a minor, under the age of 18, for addiction. According the college, the doctor had known for three years that the young patient was using fentanyl. But the doctor never contacted Children’s Services.
“In this case, the physician had an obligation to notify proper authorities because of the significant risk of an accidental fentanyl overdose by the minor,” Dr. Michael Caffaro, the college’s assistant registrar and complaints director, told his members.
“I hope this reminds all physicians of their duty to report in such circumstances.”
The province’s Child, Youth and Family Enhancement Act requires everyone and anyone who has reasonable and probable grounds to believe that a child is in need of intervention services to report the matter. That law trumps any other privacy legislation. It even trumps doctor/ patient confidentiality. If you’re a physician — or a nurse, a teacher, a grandparent, a neighbour, a hair stylist, a waiter — and you have good reason to believe a child is being abused or neglected, you have a legal obligation to report your suspicions. And properly so.
But what if you’re a doctor treating a 16-year-old with a serious drug addiction?
If your highest duty is to protect your patient, is calling Children’s Services always the right move?
Addiction treatment is all about trust and relationships.
Getting at-risk teenagers to develop enough faith to confide in a physician about drug use is hard enough as it is. If teens know doctors have a legal obligation to turn around and call Children’s Services, it will be even harder to convince them to seek care.
And suppose you’re a loving parent, desperately seeking help for your addicted child. Would you take them to the doctor, knowing you might be reported to Children’s Services?
Confiding in a physician would mean a youth could be apprehended and taken away from the parents and their home. It could even mean the young person would risk being confined against their will in a provincial “safe house,” under the terms of Alberta’s Protection of Children Abusing Drugs Act.
And given the worries many First Nations families already feel about having their kids apprehended, the consequences of this well-intentioned directive could be particularly deadly in indigenous communities.
If parents and teens are afraid to see their doctors, we could make our fentanyl crisis worse, not better.
“Physicians want to maintain a level of trust in a therapeutic relationship,” says Tim Caulfield, research director of the Health Law Institute at the University of Alberta. “The law creates a really tough tension, which could have a real detrimental impact on relationships.”
And when, exactly, is an medical doctor obligated to report a youth who uses drugs to provincial authorities? What about a youth who is using pot or ecstasy? Crystal meth? Is it only fentanyl use — more dangerous and more newsworthy — which should trigger a call to Children’s Services?
Unfortunately, the bulletin from the college never spells that out. It’s vague, more likely to confuse front-line physicians than clarify their conflicting ethical duties.
Neither Caffaro nor college registrar Trevor Theman agreed to speak with me. Meanwhile, the official response from Children’s Services seems to contradict the college’s interpretation.
“Substance use alone does not necessarily meet criteria for Children’s Services involvement with a youth or their family,” Aaron Manton, who speaks for the department, told me via email.
“For example, a health care professional considering whether a young person is at risk would consider whether that youth is choosing to access treatment and accept support in their community.”
Doctors, said Manton, should use their best judgment to decide when to call Children’s Services. Youth, he notes, wouldn’t always be apprehended. Workers might decide, for example, to provide more supports to families at home.
So what should a good doctor do? It’s just not clear.
Fentanyl is a deadly threat. But in our haste to protect our children, we need to consider all the unintended consequences of our policy decisions — and to ensure health and social welfare agencies work together, not at cross-purposes.