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Adolescent Health Services: Missing Opportunities
In addition to the importance of confidentiality to adolescents’ willingness to seek health services and disclose information to health care providers, it is necessary to ensure access to these confidential services.
The protection of confidentiality cannot be considered outside of the legal framework for consent, as it is in the law governing consent to care that difficulty arises in protecting the secrets of adolescents. As the twentieth century progressed, it became clear that there was some role for children in medical decision making, especially for adolescents approaching adulthood. Scholars increasingly argued that medical care decisions were infused with value considerations and that adolescents had strong feelings about these values. Scholars also pointed out the overlapping interests of child, parent, physician, and the state in how these decisions are made (Bennet, 1976).
By common law, at least one parent had to consent to medical care for a child under age 18 except in an emergency, when no parent might be available and when it was assumed that the parent would consent if available. In addition to this emergency exception, a doctrine known as the mature minor doctrine was developed by statute and in the courts and became an accepted part of the law in many states (Johnson, 1998–1999). According to this doctrine, an older adolescent may give consent to care when it is exclusively for his or her benefit; it is in the mainstream of medical practice; and the minor has been informed of the risks and benefits, is capable of giving informed consent, and has not been coerced into agreement.
By statute, every state has established a right for minors to consent to their own care in a variety of circumstances. The circumstances vary from state to state, but each state has at least some laws that allow minors to consent on the basis of one or more categories of status (mature, emancipated, living apart from parents, over a certain age, married, or parenting) and one or more categories of services being sought (general health care, contraception, pregnancy-related care, STI/HIV care, drug and alcohol care, or outpatient mental health services). Although not every state recognizes each of these categories, every state recognizes some. The most commonly recognized and those supported by the American Medical Association are diagnosis and treatment for STIs, contraceptive services, pregnancy-related care (excluding abortion), and counseling or treatment for drug and alcohol problems (American Medical Association, 1997).
By constitutional precedent, the right of privacy protects minors’ choices regarding contraception and abortion. With respect to contraception, the U.S. Supreme Court has decided that access to contraception is protected.