Consent, Confidentiality and Safeguarding – A Health and Social Care Dilemma

(Radu-Constantin Sofronescu)

Consent and confidentiality are foundational principles in health and social care. However, they can become ethically complex when working with adolescents who may be at risk of harm. This blog post reflects on a scenario involving a 15-year-old and explores how reflection and critical thinking support ethical decision-making in safeguarding dilemmas.

Scenario

In a school-based health and wellbeing service, a young person named Sasha, aged 15, requests to speak to a social care practitioner during a drop-in session. She discloses that she has been struggling with anxiety and occasionally stays out overnight to “clear her head.” When asked about where she goes, Sasha hesitates but eventually admits to staying at a 21-year-old friend’s flat. She insists that nothing inappropriate is happening and begs the practitioner not to tell anyone, particularly not her parents or the school.

This creates a difficult situation. On one hand, Sasha is seeking support and disclosing sensitive information in confidence — something that practitioners aim to encourage. On the other hand, the circumstances raise potential safeguarding concerns, particularly regarding risk of exploitation, unsafe environments, and the adolescent’s emotional wellbeing. The practitioner must now consider whether to break confidentiality, and if so, how to do so ethically and lawfully.

The Ethical and Legal Tension

At the heart of this dilemma lies the tension between respecting confidentiality and the duty to safeguard. Confidentiality helps build trust and encourages young people to seek help. However, this right is not absolute. According to Working Together to Safeguard Children (HM Government, 2018), practitioners must share relevant information if a child is at risk of significant harm.

In situations involving adolescents, the issue of Gillick competence becomes relevant. Under this principle, a young person under 16 may consent to their own treatment or support if they have sufficient understanding and intelligence to fully comprehend the situation (Department of Health, 2009). Sasha may well be considered competent, but that alone does not negate the practitioner’s responsibility to act if there is credible risk.

Reflecting on this scenario through the lens of ethical frameworks can be helpful. The principle of autonomy suggests that Sasha should have control over her personal information. However, the principle of beneficence — acting in someone’s best interests — may require intervention to prevent harm (Beauchamp and Childress, 2013). This balance must be critically assessed using the context and the evidence available.

Critical Thinking in Action

In such cases, critical thinking is essential. Practitioners must avoid making assumptions based on age alone or interpreting the situation purely through procedural lenses. Instead, they should ask:

• What is the nature of the risk? Is there potential harm?

• Does Sasha understand the consequences of her decisions?

• Are there patterns of behaviour that raise safeguarding red flags?

• How can Sasha be involved in the decision-making process even if confidentiality is broken?

Effective decision-making in this case might involve consulting with safeguarding leads, reviewing thresholds for child protection intervention, and documenting professional reasoning clearly. As Thompson (2020) suggests, critical practice requires practitioners to assess both what they know and what they don’t know, to challenge their own biases, and to seek supervision when faced with uncertainty.

Reflective Insight

One of the reflective lessons from this scenario is that confidentiality, while critical, must be situated within a wider safeguarding context. When young people share concerning information, the aim is not simply to protect their privacy, but also their safety.

It also raises important questions about relational practice. The practitioner must consider how to preserve Sasha’s trust while also making decisions she may not agree with. Communicating transparently — explaining the limits of confidentiality from the outset, and involving Sasha in the next steps — is a key part of ethical, trauma-informed practice (Wilkins and Whittaker, 2018).

Furthermore, this scenario underscores the value of multi-agency collaboration. The best outcomes for young people often come when social care, education, health, and family professionals work together to share concerns, assess risk, and coordinate appropriate support.

Conclusion

Safeguarding dilemmas often involve competing ethical responsibilities, particularly when working with adolescents who straddle the boundary between child and adult status. In the scenario above, critical thinking and reflective practice are not abstract concepts — they are essential tools for navigating complex decisions in a compassionate and lawful way.

Practitioners must be equipped to assess risk, understand legal thresholds, and make decisions that prioritise both safety and empowerment. By reflecting on such dilemmas and drawing on frameworks like Gillick competence and safeguarding protocols, professionals can uphold ethical practice while building trusting relationships with young people.

References

Beauchamp, T.L. and Childress, J.F. (2013) Principles of Biomedical Ethics. 7th edn. Oxford: Oxford University Press.

Department of Health (2009) Reference Guide to Consent for Examination or Treatment – Second Edition. London: DH.

HM Government (2018) Working Together to Safeguard Children: A Guide to Inter-agency Working to Safeguard and Promote the Welfare of Children. London: HM Government.

Thompson, N. (2020) The Critically Reflective Practitioner. 3rd edn. Basingstoke: Palgrave Macmillan.

Wilkins, D. and Whittaker, C. (2018) Doing Child Protection Social Work: Contemporary Themes, Practice Issues and Emerging Challenges. Bristol: Policy Press.