Case vignette: Niki goes to school -- autonomy, control, and psychiatric hospitalization.

The following is a description of a case and a discussion by professionals of the ethical issues raised. Niki turned 18 years old just 3 months ago. She is a freshman student at Central State University, where her father is also a faculty member. Niki has been residing in her parents' home. On Monday afternoon, Niki arrives at the college health service asking for a walk-in appointment. An intake evaluation reveals that she is showing signs of anorexia nervosa and is having suicidal ideation. A decision is made to refer Niki for admission to a local psychiatric facility. She agrees to accept a voluntary admission but advises the staff at both the health center and the hospital that she does not want her parents to know where she is. By Monday evening, Niki's family is very anxious regarding her whereabouts and is telephoning everyone they can think of to try to locate her. Although staff members have been urging Niki to allow them to inform her family of her admission to the hospital, she is still refusing to authorize such disclosure. What should the professionals involved in the case do or say if they are contacted by the parents? What are the parameters of confidentiality in cases of children who are living at home but have attained the age of legal majority?