With respect to abortion, minors must be allowed, at a minimum, to give their own consent for abortion without first involving their parents. The majority of states have enacted statutes requiring parental consent or notification, but creating a judicial bypass procedure that allows minors to make their own decision if they are mature and to receive an abortion with court approval and without parental involvement if it would be in their best interest.

Thus, through a combination of common-law decisions, statutory enactments, and constitutional precedents, the legal framework for health care consent developed over the past half-century has authorized adolescents who are minors to give their own consent for health care in a wide variety of circumstances. This framework not only is consistent with ethical principles applicable to consent for medical care, but also is the foundation for confidentiality protections in adolescent health services (English, 1999).

Confidentiality

Legal protections of confidentiality in adolescent health services derive from numerous sources in federal and state law, including evidentiary privileges, funding statutes, medical privacy and medical records laws, minor consent laws, and the constitutional right of privacy. It is also important to recognize that a host of nongovernmental institutions, especially universities, have their own regulations that may involve parental notification, especially with respect to substance use and mental health. Universities responding to lawsuits increasingly notify parents or even expel students facing such problems (Bombardieri, 2006; Kinzie, 2006).


Federal-level provisions At the federal level, there are (1) specific programs that fund health services incorporating confidentiality provisions that protect adolescents, and (2) general privacy regulations that affect adolescents. The major federal funding programs at issue are Medicaid and the Title X clinics funded under the Public Health Service Act, both of which provide for minors’ receipt of confidential family planning services (“without regard to age” in the case of Title X, 42 Code of Federal Regulations § 59.5). Other programs, such as SCHIP, either defer largely to states or, like the Maternal and Child Health Block Grant, simply are less explicit in their requirements for confidentiality protection for adolescents (Dailard and Turner Richardson, 2005; English and Morreale, 2001; Jones and Boonstra, 2004).

Also at the federal level, the Privacy Rule of the Health Insurance Portability and Accountability Act includes general regulatory requirements governing the disclosure of private health information, including information pertaining to minors. The rule generally provides a “floor” of



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