Last Updated: Dec 20, 2023

Generally, adolescent patients cannot give consent for their own medical treatment before they reach the legal age of majority which, in most states, is 18. 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”). Sensitive medical conditions that adolescents are less likely to seek treatment for if doing so requires them to disclose the medical condition to their parents may include sexually transmitted infections (STIs), pregnancy, family planning, substance abuse, and mental health.¹

Consent and confidentiality laws provide a framework within which to consider particular clinical situations. Many states allow clinician discretion in making a decision that is in the best interest of the adolescent patient.² Consequently, it is important to know the adolescent consent and privacy laws that apply in your state. A proactive approach to patient and parent education about changes to decision-making autonomy and privacy that occur at adolescence can reduce parent/adolescent/clinician conflict. It is important to remember that adolescent consent and privacy will be novel concepts for many patients and their parents. Practices that treat adolescent patients often find these areas challenging relative to obtaining consent:

• Drug testing
• Exams of private or sensitive areas
• Treating adolescent patients who come to their appointment unaccompanied
• Treatment of patients brought to their appointment by someone other than a parent or guardian (i.e., third-party consent)
  

Risk Reduction Strategies

Careful planning and sound office policies and procedures can help prevent situations where clinicians and staff will be tempted to treat an adolescent patient without proper consent. Consider the following strategies:^3,4

• Review state laws related to consent for minor healthcare, and only adopt policies and procedures consistent with those laws.
• Educate physicians and staff about consent policies and procedures.
• Discuss the risks, benefits, and alternatives with the person authorized to consent.
• Document in the minor’s medical record who consented, who obtained the consent, manner obtained (in-person, by phone, etc.) and who witnessed it.

• If the practice will allow third-party consent, create a third-party consent policy.
• Consider creating a template form that can be used for third-party consent. The American College of Emergency Physicians Consent for Medical/Surgical Care/Emergency Treatment and Child’s Medical Information⁵ may be helpful as a sample.

Adolescent autonomy and privacy are affected by a tangled web of state and federal laws which clinicians are expected to know and abide by. With these laws as a guide, the process of working through the sometimes-competing interests of adolescents and their families should focus on promoting the well-being of the adolescent patient.⁶ Policies and procedures should be consistent with the laws but allow flexibility to accommodate unanticipated scenarios. Proactive conflict management during this period in the patient’s healthcare journey is accomplished through parent and adolescent patient education about changes that occur in patient autonomy and privacy at adolescence. This education can diminish stress and frustration for patients, parents, and clinicians. When in doubt about an adolescent issue, a physician or other practitioner can look to the Risk Management department or contact a healthcare attorney for legal advice about their own state’s laws.

Endnotes

1. Amy L. McGuire and Courtenay R. Bruce, “Keeping Children's Secrets: Confidentiality in the Physician-Patient Relationship,” Houston Journal of Health Law & Policy 8 (2008), https://www.law.uh.edu/hjhlp/volumes/Vol_8_2/McGuire.pdf.

2. American College of Emergency Physicians, Evaluation and Treatment of Minors: Policy Resource and Education Document, revised 2021, https://www.acep.org/siteassets/new-pdfs/preps/evaluation-and-treatment-of-minors---prep.pdf.

3. Paul E. Sirbaugh et al., “Consent for Emergency Medical Services for Children and Adolescents,” Pediatrics 128 no.2 (August 2011),  https://doi.org/10.1542/peds.2011-1166.

4. Gary N. McAbee et al., “Consent by Proxy for Nonurgent Pediatric Care,” Pediatrics 126, no.5 (November 2010), https://doi.org/10.1542/peds.2010-2150.

5. “Consent for Medical/Surgical Care/Emergency Treatment and Child’s Medical Information,” American College of Emergency Physicians (Website), accessed July 10, 2023, https://www.acep.org/siteassets/uploads/uploaded-files/acep/clinical-and-practice-management/resources/pediatrics/medical-forms/consent.pdf.

6. Timothy M. Smith, Pediatric Decision-Making: Help Parents Protect, Empower Kids, citing American Medical Association, Code of Medical Ethics, Opinion 2.2.1, 2019, https://www.ama-assn.org/delivering-care/ethics/pediatric-decision-making-help-parents-protect-empower-kids.

The information provided in this article offers risk management strategies and resource links. Guidance and recommendations contained in this article are not intended to determine the standard of care, but are provided as risk management advice only. The ultimate judgment regarding the propriety of any method of care must be made by the healthcare professional. The information does not constitute a legal opinion, nor is it a substitute for legal advice. Legal inquiries about this topic should be directed to an attorney.