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Parents Should Be Able to Make Health Care Decisions

Case

16-year-old female comes into the clinic with her mother for evaluation of acne and headaches. When the doctor is taking the history, the young girl discloses that she has a boyfriend, that she is sexually active, and her partner occasionally uses condoms. Her last menstrual period was two months ago, and she is concerned about being pregnant. She would like to get a pregnancy test. She also would like to get contraceptive pills if she is not pregnant. She asks that you do not tell her mother that she is sexually active or that she is getting a pregnancy test. What is the doctor obligated to do in this matter? Go straight to the girl's parents, or treat the girl without consulting the parents on the proper path of treatment?

Questions:

1. Can you do a pregnancy test without the mother's permission?
2. Can you do a pelvic examination without the mother's permission?
3. Who is responsible for payment of her pelvic examination and testing?
4. Does the insurance company have to keep her information confidential?

Solution Preview

Analysis:

There is growing concern among policymakers and professionals about adolescents' health and health problems. There are some problems with this interpretation of history. The legal requirement that doctors should obtain consent for medical procedures from patients, even when adult, has been enforced regularly only in this century, and the concept of informed consent is even more recent. Similarly, the view that parents used to have total control over their children's health but now they do not, ignores both legal precedents and the views of some of the major figures who have shaped our modern views on the appropriate balance between the rights of the individual and the family, such as John Stuart Mill, John Locke, and the jurist Blackstone.

Exceptions to Parent Consent Presumption
The recent working paper by Gittler, Quigley-Rick and Saks (1990) presents a very useful review and taxonomy of the current status this subject. The authors found there were two categories of exceptions to the general rule that you must have parental consent for health care. The first category dubbed boundary maintenance, deals with the capacity or characteristics of certain individual adolescents to consent to health care themselves without parent's consent. This group includes emancipated minors, a category defined somewhat differently in each state but usually meaning married minors, those serving in the military and so forth, and psychologically mature minors. This concept of exception for maturity was affirmed by a Supreme Court decision in 1979 in an abortion case.

The second category of exception involves the type of treatment being provided and thus rests on a public health rationale rather than on ...

Solution Summary

There is growing concern among policymakers and professionals about adolescents' health and health problems. There are some problems with this interpretation of history. The legal requirement that doctors should obtain consent for medical procedures from patients, even when adult, has been enforced regularly only in this century, and the concept of informed consent is even more recent. Similarly, the view that parents used to have total control over their children's health but now they do not, ignores both legal precedents and the views of some of the major figures who have shaped our modern views on the appropriate balance between the rights of the individual and the family, such as John Stuart Mill, John Locke, and the jurist Blackstone.

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