Virtual Mentor. January 2005, Volume 7, Number 1.
Case 3.3: Confidential Care for Minors and Protecting Genetic Information
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.
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.
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.
The people and events in this case are fictional. Resemblance to real events or to names of people, living or dead, is entirely coincidental. The viewpoints expressed on this site are those of the authors and do not necessarily reflect the views and policies of the AMA.
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