Case and Commentary
Jan 2005
Adolescent patients create a particularly troublesome set of concerns about confidentiality. Minors are not legally empowered to make health care decisions independent of a parent or legal guardian. And yet, minor patients are regularly encouraged to make, or at least help make, their health care decisions, and minors are tried as adults in a court of law with increasing regularity.
Opinion 5.055, "Confidential Care for Minors"
When minors request confidential services, physicians should encourage them to involve their parents...Physicians should permit a competent minor to consent to medical care and should not notify parents without the patient's consent...Use of the courts for competence determinations should be made only as a last resort.
When an immature minor requests contraceptive services, pregnancy-related care..., or treatment for sexually transmitted disease, drug and alcohol abuse, or mental illness, physicians must recognize that requiring parental involvement may be counterproductive to the health of the patient...When the physician does breach confidentiality to the parents, he or she must discuss the reasons for the breach with the minor prior to the disclosure.
...Confidentiality may be justifiably breached in situations for which confidentiality for adults may be breached, according to Opinion 5.05, "Confidentiality."
Parents generally are responsible for making health care decisions for their children, but, as children mature and approach adolescence, this patient-physician-parent relationship changes. While it is true that young minors lack the capacity to make autonomous health care decisions, many older minors are mature enough to do so. In general, adolescents 14 and above should be evaluated carefully to determine whether they are mature enough to make decisions about their medical care.
Minors who are determined to be capable due to their maturity are entitled to the same degree of autonomy and confidentiality as an adult patient. Parental involvement should always be encouraged, but parental consent should not be required for the treatment of mature minors, and information disclosed in the patient-physician interaction must not be disclosed to the parents or third parties without patient consent.
Because Mandy is in a position where she may request an abortion if she has the Huntington's allele, it is also important to consider whether or not her parents should be informed if she requests an abortion.
Opinion 2.015, "Mandatory Parental Consent to Abortion"
Physicians should ascertain the law in their state on parental involvement to ensure that their procedures are consistent with their legal obligations.
Physicians should strongly encourage minors to discuss their pregnancy with their parents...
Physicians should not feel or be compelled to require minors to involve their parents before deciding whether to undergo an abortion....Physicians should explain under what circumstances (eg, life-threatening emergency) the minor's confidentiality will need to be abrogated.
Physicians should try to ensure that minor patients have made an informed decision after giving careful consideration to the issues involved...Minors should be urged to seek the advice and counsel of those adults in whom they have confidence, including professional counselors, relatives, friends, teachers, or the clergy.
Where law does not require it, parental consent need not be obtained before providing contraceptive services, treatment of sexually transmitted diseases, pregnancy-related care (including pregnancy testing, prenatal/postnatal care, delivery services, and abortion), drug and alcohol abuse treatment and mental illness treatment to minors who request these services. The absence of confidentiality may keep adolescents from seeking health care that is necessary to prevent serious harm.
An important consideration to be weighed when deciding whether to breach a minor's confidentiality is the possibility that disclosing sensitive information such as sexual behavior, pregnancy, or drug use to the parents might place the minor in danger.
