As health care becomes more digital, access has become the default good. More convenience. More transparency. More information at our fingertips.
For most patients and families, that is progress. But when it comes to adolescents, easier access is not always better.
In Alberta, a recent change to MyHealth Records expanded parent and guardian access to children’s online health information. Parents can now request access to their child’s records; youth can open their own accounts at 14; they can choose to remove previously granted parent or guardian access at 16; and that access ends automatically at 18.
For many families, this will seem entirely reasonable. Parents often coordinate appointments, track medications, review test results and help children navigate a health system that can be confusing even for adults. In homes where trust is strong and communication is open, access to records can support care rather than interfere with it. That is the easy part of the argument.
The harder part is this: policies should not be judged only by how they work in ideal families. They should also be judged by how they affect patients who are vulnerable, frightened or unsafe.
That is especially true for adolescents.
The Canadian Paediatric Society has been clear that confidential care is a hallmark of good adolescent medicine. Privacy is not a fringe concern or a bureaucratic technicality. It is often the condition that allows a young person to speak honestly in the first place. Teens are more likely to disclose sensitive information when they trust that their health information will be handled carefully and that they will have time alone with a health-care provider.
That matters because adolescent health care is not limited to sore throats and sports injuries. It can involve mental-health crises, substance use, sexual health, pregnancy, abuse, coercion and family violence. A teenager who fears automatic disclosure may simply avoid seeking care, omit important details or delay getting help until a situation becomes more dangerous. The risk is not theoretical. It is built into how trust works in medicine.
This is why Alberta’s change matters nationally.
The real issue is bigger than one province and bigger than one portal. Across Canada, federal and provincial governments are modernizing digital health systems faster than they are thinking through the ethical consequences for young patients. The impulse is understandable: build a better portal, increase engagement, reduce friction. But convenience for the system can create new barriers for the patient. Alberta has simply exposed a problem that the rest of the country is also heading toward.
A good digital health policy should be built around a simple principle: information-sharing rules for minors should protect both family involvement and confidential access to care. Those goals are not mutually exclusive. In fact, in most cases, they go together. Parents should usually be involved. Adolescents should also know that there are circumstances in which privacy will be respected, clinical judgment matters and safety comes first.
What we should resist is the false choice between treating every parent as a threat and treating every family as safe. Most families are trying to help. Some are not. Public policy must be built to recognize both realities.
That means provinces should stop relying on blunt age cutoffs and all-or-nothing access rules as a substitute for careful design. They should create clearer safeguards for sensitive encounters, stronger pathways for youth to control access where appropriate, and better systems for clinicians to protect confidentiality when disclosure could place a patient at risk. The details will vary across jurisdictions, but the principle should not: digitizing records must not mean digitizing away clinical judgment.
As a medical student, I am taught that confidentiality is not about excluding families. It is about making care possible. The goal is not to drive a wedge between adolescents and parents. In the best cases, medicine helps strengthen that relationship. But clinicians also have a duty to protect patients whose home lives are not safe, whose concerns are not easily spoken, or whose first honest conversation may depend on knowing that every word will not automatically travel further than the exam room.
Canada’s digital health systems will keep expanding. They should. But we should be careful about the values we hardwire into them while we still can.
If Alberta’s recent change teaches us anything, it is that digital access is not neutral. It reflects a choice about whose convenience matters most, whose vulnerability is taken seriously and what kind of trust we think health care requires.
Before more provinces rush ahead, they should answer a simple question: when a teenager finally decides to ask for help, will our health systems make that easier or harder?
