Consent in adolescent health care
- Kelly A Olson, MD, MA
Kelly A Olson, MD, MA
- San Jose Clinic
- Amy B Middleman, MD, MPH, MS Ed
Amy B Middleman, MD, MPH, MS Ed
- Section Editor — Adolescent Medicine
- Professor of Pediatrics, Chief of Adolescent Medicine
- University of Oklahoma Health Sciences Center
- Section Editors
- Abigail English, JD
Abigail English, JD
- Section Editor — Adolescent Medicine
- Director and President
- Center for Adolescent Health & the Law
- Diane Blake, MD
Diane Blake, MD
- Section Editor — Adolescent Medicine
- Associate Professor of Pediatrics
- University of Massachusetts Medical School
The concepts of informed consent and confidentiality are complex when the patient is an adolescent. This is particularly true when the needs and wishes of the adolescent conflict with the opinions and preferences of the parents .
The laws governing consent and confidentiality in adolescent health care vary from country to country; within the United States, they vary from state to state. The specific provisions of consent laws and confidentiality laws also vary and are not identical to each other. The information in this topic focuses on consent in adolescent health care in the United States.
Clinicians who treat adolescents must be aware of the federal and state laws related to adolescent consent and confidentiality. The circumstances in which adolescents may consent for their own care and in which confidentiality is protected vary from state to state depending upon the adolescent's status as a minor or adult, the service involved, and the provider's level of concern regarding harm to the patient or others.
The basic laws governing consent for health care are state laws; clinicians who treat adolescents need to be aware of the laws in their state. Confidentiality provisions are found in both state and federal law. Clinicians who treat adolescents also must be aware of the guidelines governing federal and state funding sources for particular services, particularly when funding source guidelines contain specific requirements related to confidentiality. They should also be familiar with the consent and confidentiality policies of the facility in which they practice, and they must be aware of potential ways in which confidentiality can be compromised (eg, record keeping, billing statements, insurance claims).
After a review of important aspects of minor status, and the definitions of consent, notification, and judicial bypass, this topic will discuss how minor status affects the ability to consent to medical services and the different types of medical services for which minors are able to give their own consent. Confidentiality, a closely related but separate concept, is discussed elsewhere. (See "Confidentiality in adolescent health care".)
- Cutler EM, Bateman MD, Wollan PC, Simmons PS. Parental knowledge and attitudes of Minnesota laws concerning adolescent medical care. Pediatrics 1999; 103:582.
- English A, Bass L, Boyle AD, et al. State Minor Consent Laws: A Summary, 3rd ed, Center for Adolescent Health & the Law, Chapel Hill, NC 2010.
- English A. Understanding Legal Aspects of Care. In: Adolescent Health Care: A Practical Guide, 5th ed, Lippincott Williams & Wilkins, Philadelphia 2008.
- Sigman GS, O'Connor C. Exploration for physicians of the mature minor doctrine. J Pediatr 1991; 119:520.
- Levesque RJ. Adolescents, Sex, and the Law: Preparing Adolescents for Responsible Citizenship, American Psychological Association, Washington, DC 2000.
- Greydanus DE, Patel DR. Consent and confidentiality in adolescent health care. Pediatr Ann 1991; 20:80.
- English A. Treating adolescents. Legal and ethical considerations. Med Clin North Am 1990; 74:1097.
- ACOG educational bulletin. Confidentiality in adolescent health care. Number 249, August 1998. American College of Obstetricians and Gynecologists. Int J Gynaecol Obstet 1998; 63:295.
- Keshavarz R. Adolescents, informed consent and confidentiality: a case study. Mt Sinai J Med 2005; 72:232.
- Krowchuk DP, Satterwhite W, Moore BC. How North Carolina laws affect the care of adolescents. Issues of confidentiality and consent. N C Med J 1994; 55:520.
- Holder AR. Legal Issues in Pediatrics, Yale University Press, New Haven, CT 1985.
- Leikin SL. Minors' assent or dissent to medical treatment. J Pediatr 1983; 102:169.
- Diaz A, Neal WP, Nucci AT, et al. Legal and ethical issues facing adolescent health care professionals. Mt Sinai J Med 2004; 71:181.
- Weddle M, Kokotailo P. Adolescent substance abuse. Confidentiality and consent. Pediatr Clin North Am 2002; 49:301.
- King NM, Cross AW. Children as decision makers: guidelines for pediatricians. J Pediatr 1989; 115:10.
- Campbell AT. Consent, competence, and confidentiality related to psychiatric conditions in adolescent medicine practice. Adolesc Med Clin 2006; 17:25.
- Confidential health services for adolescents. Council on Scientific Affairs, American Medical Association. JAMA 1993; 269:1420.
- Mccabe MA, Rushton CH, Glover J, et al. Implications of the Patient Self-Determination Act: guidelines for involving adolescents in medical decision making. J Adolesc Health 1996; 19:319.
- Policy Compendium on Confidential Health Services for Adolescents, 2nd ed, Morreale MC, Stinnett AJ, Dowling EC (Eds), Center for Adolescent Health & the Law, Chapel Hill, NC 2005. Available at: www.cahl.org/policy-compendium-2nd-2005/ (Accessed on October 07, 2014).
- American Academy of Family Physicians, American Academy of Pediatrics, American College of Obstetricians and Gynecologists, and Society for Adolescent Medicine. Protecting adolescents: Ensuring access to care and reporting sexual activity and abuse. J Adolesc Health 2004; 35:420.
- Jones RK, Purcell A, Singh S, Finer LB. Adolescents' reports of parental knowledge of adolescents' use of sexual health services and their reactions to mandated parental notification for prescription contraception. JAMA 2005; 293:340.
- Henshaw SK, Kost K. Parental involvement in minors' abortion decisions. Fam Plann Perspect 1992; 24:196.
- Morrissey JM, Hofmann AD, Thrope JC. nt and Confidentiality in the Health Care of Children and Adolescents: A Legal Guide, The Free Press, New York 1986.
- The adolescent's right to confidential care when considering abortion. American Academy of Pediatrics. Committee on Adolescence. Pediatrics 1996; 97:746.
- Guttmacher Institute. State policies in brief. An overview of minors' consent law. Available at: www.guttmacher.org/statecenter/spibs/spib_OMCL.pdf (Accessed on October 07, 2014).
- Hofmann, AD. Legal issues in adolescent medicine. In: Adolescent Medicine, Hofmann, AD, Greydanus, DE (Eds), Appleton and Lange, Stamford, CT 1997.
- Weinstock R, Weinstock D. Child abuse reporting trends: an unprecedented threat to confidentiality. J Forensic Sci 1988; 33:418.
- Guttmacher Institute. State policies in brief. Minors' access to contraceptive services. Available at: http://www.guttmacher.org/statecenter/spibs/spib_MACS.pdf (Accessed on October 07, 2014).
- Guttmacher Institute. Minors' access to STI services. Available at: http://www.guttmacher.org/statecenter/spibs/spib_MASS.pdf (Accessed on October 07, 2014).
- Guido R. Human papillomavirus and cervical disease in adolescents. Clin Obstet Gynecol 2008; 51:290.
- Guttmacher Institute. Minors' access to prenatal care. Available at: http://www.guttmacher.org/statecenter/spibs/spib_MAPC.pdf (Accessed on October 07, 2014).
- Crosby MC, English A. Mandatory parental involvement/judicial bypass laws: do they promote adolescents' health? J Adolesc Health 1991; 12:143.
- Guttmacher Institute. Parental involvement in minors' abortions. Available at: http://www.guttmacher.org/statecenter/spibs/spib_OAL.pdf (Accessed on October 07, 2014).
- Lallemont T, Mastroianni A, Wickizer TM. Decision-making authority and substance abuse treatment for adolescents: a survey of state laws. J Adolesc Health 2009; 44:323.
- Committee on Substance Abuse, American Academy of Pediatrics, Council on School Health, American Academy of Pediatrics, Knight JR, Mears CJ. Testing for drugs of abuse in children and adolescents: addendum--testing in schools and at home. Pediatrics 2007; 119:627.
- Testing for drugs of abuse in children and adolescents. American Academy of Pediatrics Committee on Substance Abuse. Pediatrics 1996; 98:305.
- Guttmacher Institute. Minors' rights as parents. Available at: www.guttmacher.org/statecenter/spibs/spib_MRP.pdf (Accessed on October 07, 2014).
- Center for Disease Control, National Immunization Program. Vaccine Information Statements. Available at: www.cdc.gov/vaccines/pubs/vis/vis-facts.htm (Accessed on February 06, 2008).
- Society for Adolescent Health and Medicine, English A, Ford CA, et al. Adolescent consent for vaccination: a position paper of the Society for Adolescent Health and Medicine. J Adolesc Health 2013; 53:550.
- Sterilization of minors with developmental disabilities. American Academy of Pediatrics. Committee on Bioethics. Pediatrics 1999; 104:337.
- Rozovsky FA. Consent to Treatment, a Practical Guide, Little Brown & Co, Boston 1990. p.255.
- Larcher V. Consent, competence, and confidentiality. BMJ 2005; 330:353.
- MINOR STATUS
- Emancipated minor
- Medical emancipation
- Mature minor
- Who gives consent?
- - Minors
- - Emancipated minors
- - “Medically emancipated” minors
- - Mature minors
- Consent versus notification
- CONSENT FOR SPECIFIC SERVICES
- Emergency care
- Contraceptive services
- Sexually transmitted infections
- - Cervical dysplasia
- Prenatal care
- - Judicial bypass
- Drug or alcohol care
- - Parent-requested drug testing
- Mental health services
- Minors as parents
- REFUSAL TO CONSENT
- LIABILITY FOR PAYMENT