pediatric housecalls Robert R. Jarrett M.D. M.B.A. FAAP

Medical Consent by Children and Teens 

This is a “link post” which, as you know, enables me to provide “sidebar” information to you which I find useful from other sites on the web. Also, as you know, I do not link to sites full of “agendas,” “ads” or monetary gain – no matter how good they are. Today’s link: Medical consent by children for their own care.

Usually I merely give a sentence intro; BUT this topic does require some background information so don’t click until you’ve read the short info below – it’s not long.

The topic of when your children can give their own consent for their own medical care has been a hot topic for a couple of decades now, and is still mostly left up to state law which means that it’s still a jumbled and somewhat confusing issue. Parents must check with authorities in their own state for actual wording but there are some underlying issues which are common to all and which are displayed in the chart I’m linking to.

Medical Consent by Children for Their Own Care

Early on in practice I had several forward-thinking parents ask about my policy for treating unaccompanied minors – i.e. when they were under the care of a relative or baby sitter during their absence. I thought about it and decided to distribute a legal consent form they could use flexible enough for them to set dates if they chose, or list specific individuals who could give consent, or allow their older children to seek care through me at any time.

It worked well and was easy to renew or update; but, I have to say that it was (fortunately) rarely used although the few times it was made it a much less stressful episode for everyone – especially the children.

Then the state/federal initiatives began making some things easier and some things, well let’s say, a lot more confusing.

Of course there is the treatment for medical injuries and illnesses, which ought to be straightforward but often is not; but is usually not a big problem and common sense prevails. This article is NOT about that.

Then, there is the issue of puberty/sex related issues as physical changes way out-strip emotional/intellectual development in most teens. Experimentation with high-risk behaviors not infrequently place them in terribly awkward/dangerous/frightening/embarrassing situations. And it may NOT be the case that parents are not available but rather that the teen chooses NOT to want them involved.

Each pediatrician has their own ethics and systems of dealing with these issues but universal to all is our, sort of, schizophrenic attempt to be confidential to everyone yet keep everyone informed of the needs of the child and over-all keep everyone safe and the family unit intact and functioning!

We’ve got to keep the kids confiding and consulting us with their problems even if they are unwilling to do so with their parents. Parent’s should realize that, even if they don’t really like it. We want them to come to the office (even without an appointment) when they think they might be pregnant or ill with an STD – so, we need to keep confidentialities.

BUT, we also don’t want them to ruin their lives. We’re usually parents ourselves and so clearly understand the issues; meaning, that we also have limits that we know are best to encourage and even facilitate communication back to parents.

Confidentiality

Good pediatricians usually begin preparing their child patients for medical decision making around 10 or so by directing communications to them, asking their preferences (within ranges) and encouraging them to tell us of their problems directly.

This increases to ascertaining they can give their own “past medical histories” and “review of systems” when they are teens as well has understanding how and when to access medical care at the various levels. We do that as part of what we do and demonstrate to them that we keep confidences.

We let them know up front that there are problems which do go beyond our ability to solve between just the two of us and which will need to involve mom and/or dad. And we are transparent in that we will always let them know what we are doing but that the government has laws which demand that we break confidentiality, such as: Suicidal ideation, Homicidal ideation, Physical abuse, Sexual abuse and Behaviors that put one at risk of physical harm.

State Rules

Even though they are still quite confusing from a global standpoint, nearly all states have some law covering medical consent from minors concerning sexually related matters. And, those usually begin at age 12 or when other “maturity” indicators take effect – like pregnancy or STDs.

We are also transparent with parents about the laws which put us in the middle and prevent us from disclosing certain confidential information to them about their child’s medical activities. Sometimes we’re blind-sided by a parent finding out from some other means (like insurance payments, neighbors, teachers etc.) and wondering “whose side we’re on.”

We’re uniformly on the child’s side; and, we also recognize that it’s a rare instance where appropriate parenting can’t make solving issues much easier. We truly do attempt to encourage dialog with parents although that is not always chosen (as the law gives them the right to do). Deep down that’s really what you want us to do… right?

In general, parental consent is required to provide medical treatment to minors in most all states. However, there are several types of services for which minors are frequently authorized to give their own consent, such as: Emergency care, Pregnancy related care (sometimes including abortion), Contraceptive services, Diagnosis and treatment of STIs, HIV/AIDS testing and treatment, Treatment and counseling for drug and alcohol problems, Inpatient and out patient mental health services and Immunizations.

This link is to a listing of all the various state’s minors consent laws in the six sexually related categories of: contraception, STDs, prenatal care, adoption services, medical care for their own children and abortion.

Laws do vary about consent of minors from state to state. For example in Main only some kids can give consent for contraception but ALL kids can give consent for abortions! And their laws are silent on all the other categories.

In Utah some can consent for contraception, parental consent and notice is needed for abortion and all can consent for all other categories of sexually related medical issues. In Wisconsin the laws are silent on every category except STD services where all can consent and abortion where parental consent is needed.

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