Resources » Ethics 101 » Ethics Scenarios

Ethics 101

Ethics Scenarios

Withholding Medical Information from a Child's School

1/5/2012 2:13:00 PM

Last week, while seeing patients in your family practice, a patient brought in her five-year old daughter.

The child was born in South East Asia and adopted at 18 months of age.

Your patient has just learned her daughter is Hepatitis B positive, and is waiting to see an infectious disease specialist to discuss treatment options.

While registering her daughter for kindergarten, she had to fill out a medical form, which requested information on blood borne viral illnesses, but she did not disclose her daughter’s status.

She is now wondering if she did the right thing and comes to you for advice.

You are wondering what to tell her and also wondering what your obligations are to the school should she elect to withhold this information.

What should you do?

Please Note: Comments that appear on our site reflect the opinion of the writer and not necessarily the position of the College of Physicians & Surgeons of Alberta. Offensive language, personal attacks and unsubstantiated allegations are not allowed.
All comments are reviewed before posting to ensure they adhere to these rules and are not spam.

Comments 5

Dr. Ulrich Lauf 3 Feb, 02:29 PM
•Do you mean Hep B sAg-IgG positive from past immunization or reflective of old infection?
•Do you mean Hep B sAg positive?
•Do you mean Hep B eAg positive?
A telephone consultation with ID or HEPATOLOGY would help sort out the issues in a hurry. If the risk of infectivity is high, then public health should be involved. There is currently no formal recommendation in Alberta for immunizing all infants or preschoolers for Hep B. In some countries that is the case. I thought that some US information I saw suggested that immunization of preschoolers be routine in some jurisdictions due to the potential risks of Hep B carriers in some sub-populations.
Dr. Richard Ziegler 3 Feb, 02:30 PM
The school director HAS to know.
Dr. David Richards 3 Feb, 02:30 PM
•Advise the mother that it is her obligation to tell the school, even though there is a low risk of transmission.

•Public health will automatically be informed.

•If the mother does not inform the school the family should be discharged from the practice and notification made to public health who will take appropriate steps to safeguard the other pupils at her kindergarten.
Dr. Doug Johnson 3 Feb, 02:32 PM
Love the Ethics 101 scenarios.

It has occurred to me that I don't recall seeing the advice: Call the College for advice.
Can't be said enough in my opinion.
I think every one of these scenarios would do well to end with something like: "And as always, if you're unsure, call the College".
I've experienced an awkward situation with respect to a colleague in the past and felt I knew exactly what to do after a very brief phone conversation with Dr Theman.
Dr. Judy MacDonald 28 Mar, 05:36 PM
First of all, it is important to determine if this child has acute or chronic hep B infection. If the latter, this information should be provided only on a need to know basis; the parents can elect to disclose or not to the school administration. I would question whether the school has the right to ask this kind of health information. Yes, public health will know about the case, but the doctor can refer the mother to public health so that the mother can review her options with a school nurse or the Medical Officer of Health. Public health can then undertake any interventions needed based on the risk that child presents (e.g., biting behaviour). School staff should already be aware of standard precautions through school policies and protocols, but the school nurse could use this as an opportunity to review these with staff so they know how to prevent potential exposures to blood or body fluids, and what to do should an exposure occur in general terms without revealing there is a chronic hep B student in the class.