Knowledge Library

Many states allow third parties (e.g., relatives and nannies) to consent for a minor’s medical treatment so long as the parent’s/guardian’s authorization is already in place. Clinicians are sometimes tempted to bend the minor consent rules when the adolescent is older or when the patient comes in with a relative who appears to be a caretaker, even though that caretaker does not have legal standing to consent for the adolescent’s medical treatment. Consider the conflicting interests of the parties in the following case.

Not all adolescent consent issues involve sensitive treatment scenarios. As adolescent patients become drivers, they are more likely to present for treatment without a parent. Although a patient may seem mature enough to consent for general treatment, a parent’s consent is still required. Consider the following case.

In most states, adolescent patients have legal capacity to consent to substance abuse treatment. However, in a small minority of states parents have a right to seek substance abuse treatment for their child, even when the child objects. Additionally, treatment information is often legally available to parents, even when the adolescent patient provided the consent for it.¹ Consequently, consent for diagnosis and treatment associated with substance abuse should be handled carefully. Consider the following case.

Adolescent privacy laws vary in significant ways from state to state and may conflict with federal laws.¹ In addition to minor consent laws, clinicians treating adolescent patients should be familiar with state and federal medical information privacy laws as they relate to adolescent healthcare. With these laws as a guide, the process of working out the sometimes competing interests of adolescents and their families should be made in the context of promoting the wellbeing of the adolescent patient.²

Adolescent autonomy and privacy is affected by a tangled web of state and federal laws that clinicians are expected to know and abide by. As a general rule, adolescent patients cannot give consent for their own medical treatment before they reach the legal age of majority, which in most states is 18 years. The circumstances in which adolescent patients can consent to their own medical treatment vary by state. However, most states have consent exceptions based on an adolescent’s legal status (e.g., married, emancipated) and select medical conditions (“sensitive medical conditions”). With these laws as a guide, the process of working out the sometimes competing interests of adolescents and their families should be made in the context of promoting the wellbeing of the adolescent patient.¹ Therefore, policies and procedures should be consistent with the laws, but should allow some flexibility to accommodate unanticipated scenarios.