Child-headed households in South Africa: The legal and ethical dilemmas when children are the primary caregivers in a therapeutic relationship

Child-headed households (CHHs) have become a common and integral part of South African society. Millions of children have lost their parents and/or primary caregivers due to a variety of reasons of which the HIV/AIDS pandemic can be singled out as a major cause. It is therefore not uncommon today to have minors (under the age of 18 years) care for their younger siblings and/or ill parents or family. A child-headed household (CHH) refers to a living situation/arrangement where a child has taken charge of a household in terms of decision-making responsibilities as well as the responsibility to provide for the physical, social and emotional needs of others living with that particular child, in that household, and regardless of familial relationship.
This paper is concerned with the legal and ethical dilemmas that arise in a therapeutic relationship where a minor is the primary caregiver of a patient unable to care for him-/herself. Where do a medical practitioner’s responsibilities lie in communicating important medical information about the patient’s condition to the patient’s minor caregiver? While the patient’s rights to privacy and confidentiality are important, the patient’s particular condition and medical care may also necessitate that certain information be disclosed to the minor caregiver. However, the minor caregiver may not always be a willing party to this collaborative therapeutic relationship and the ability of such a minor to consent to medical treatment on behalf of the patient, or take on responsibilities in terms of this therapeutic relationship can also be called into question. The various therapeutic approaches, roles, skills and conditions of this unique form of agency should therefore be given due consideration from both a legal and ethical point of view.