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Consent in adolescent health care

Authors
Kelly A Olson, MD, MA
Amy B Middleman, MD, MPH, MS Ed
Section Editors
Abigail English, JD
Diane Blake, MD
Deputy Editor
Mary M Torchia, MD
Disclosures: Kelly A Olson, MD, MA Nothing to disclose. Amy B Middleman,
MD, MPH, MS Ed Grant/Research Support: Novartis [immunizations;
developing student curricula]; Merck [immunizations; public demonstration
project]. Abigail English, JD Nothing to disclose. Diane Blake, MD Nothing
to disclose. Mary M Torchia, MD Employee of UpToDate, Inc. Contributor
disclosures are reviewed for conflicts of interest by the editorial group.
When found, these are addressed by vetting through a multi-level review
process, and through requirements for references to be provided to
support the content. Appropriately referenced content is required of all
authors and must conform to UpToDate standards of evidence. Conflict of
interest policy
All topics are updated as new evidence becomes available and our peer
review process is complete.
Literature review current through: Nov 2014. | This topic last updated: Oct
23, 2014.
INTRODUCTION The concepts of informed consent and confidentiality
are complex when the patient is an adolescent. This is particularly true
when the needs and wishes of the adolescent conflict with the opinions
and preferences of the parents [1].

The laws governing consent and confidentiality in adolescent health care


vary from country to country; within the United States, they vary from
state to state. The specific provisions of consent laws and confidentiality
laws also vary and are not identical to each other. The information in this
topic focuses on consent in adolescent health care in the United States.

Clinicians who treat adolescents must be aware of the federal and state
laws related to adolescent consent and confidentiality. The circumstances
in which adolescents may consent for their own care and in which
confidentiality is protected vary from state to state depending upon the
adolescent's status as a minor or adult, the service involved, and the
provider's level of concern regarding harm to the patient or others.

The basic laws governing consent for health care are state laws; clinicians
who treat adolescents need to be aware of the laws in their state.
Confidentiality provisions are found in both state and federal law.
Clinicians who treat adolescents also must be aware of the guidelines
governing federal and state funding sources for particular services,
particularly when funding source guidelines contain specific requirements
related to confidentiality. They should also be familiar with the consent
and confidentiality policies of the facility in which they practice, and they
must be aware of potential ways in which confidentiality can be
compromised (eg, record keeping, billing statements, insurance claims).

After a review of important aspects of minor status, and the definitions of


consent, notification, and judicial bypass, this topic will discuss how minor
status affects the ability to consent to medical services and the different
types of medical services for which minors are able to give their own
consent. Confidentiality, a closely related but separate concept, is
discussed elsewhere. (See "Confidentiality in adolescent health care".)

MINOR STATUS Whether an adolescent patient is able to provide


consent for medical care and services often depends upon his or her
status as a minor or adult. Various categories of minors unemancipated,
emancipated, medically emancipated, or mature minors may be able to
give their own consent depending upon the specific circumstances. The
laws governing minor status vary from state to state. Information
regarding the laws in individual states pertaining to emancipation is
available through the Legal Information Institute at Cornell University Law
School. Information about the laws governing minor status as it pertains to
consent for health care is available through the Center for Adolescent
Health & the Law.

Minor In most states of the United States, minor status is defined by


age under 18 years; 18 years is the "age of majority," the age at which
adolescents are legally considered to be adults. In a few states, 19 years is
the age of majority [2].

Emancipated minor Emancipation refers to the process by which minors


can attain legal adulthood before reaching the age of majority. Most states
have statutes or court cases that specify the circumstances under which a
minor can be considered emancipated from his or her parents before he or
she reaches the age of majority. This may or may not require obtaining a
formal court declaration of emancipation. The most common means of
attaining emancipation are marriage, military service, or living separately
from parents and managing one's own FINANCIAL affairs [3,4].

In most cases, legal emancipation enables the minor to establish a


personal residence and enter into legally binding contracts. It relieves the
emancipated minor's parents from legal liability for contracts entered into
by the minor [3,5]. Emancipation also generally enables a minor to
consent for medical care. Proof of emancipation is not generally required
for an emancipated minor to give consent for medical treatment.

Medical emancipation Medical emancipation is not a specific legal


status. However, as a concept, and in practical terms, it is recognized to
some degree in all states. If a minor is considered "medically
emancipated," he or she would be allowed to consent for medical care,
either generally for all care or for specific services as outlined below [6,7].
The medically emancipated minor maintains minority status in other
domains (eg, he or she cannot enter into legally binding contracts). (See
'Consent for specific services' below.)

The following minors are often considered medically emancipated and


allowed to consent for medical care generally based upon their status, but
not every state has recognized all of these categories [2,3]:

Minors who are married or were married at one time


Minors who have a child (may consent for child, and sometimes for self)
Minors who have reached a specific age (eg, 15 years)
High-school graduates
Minors living away from home without parental permission/FINANCIAL
support
Homeless minors and runaways

Mature minors
Mature minor "Mature minor" is a category of minor status that is
recognized in some states as an exception to the rules requiring parental
consent for medical care [8]. The mature minor doctrine, which was
originally created by courts and has been incorporated into statutes in a
few states, allows mature minors to consent to routine, nonemergent care,
especially when the risk of treatment is considered to be low [6,9].

Mature minor status is typically defined by [8,10,11]:

Being at least 14 years old; by the age of 14, most adolescents have
cognitive skills and medical decision-making capacities similar to those of
adults [3,12]. Individual states may require a different minimal age for
mature minors in their statutes or court decisions.
Ability to understand risks and benefits of the proposed treatment
(based on the clinician's judgment).
Ability to provide the same level of informed consent as an adult (based
on the clinician's judgment) and actually giving consent.
Several factors must be considered when a clinician is assessing an
adolescent patient for maturity. These include chronologic age; the risk,
necessity, and benefit of the proposed treatment; and the adolescent's
emotional and cognitive capacity for understanding the treatment
information [13].

Although the following factors may not be legally required to conclude that
a minor is mature under the mature minor doctrine, when considering the
adolescent's emotional and cognitive capacity for understanding the
treatment information, it is important for the clinician to consider [14,15]:

What kinds of decisions has the adolescent made in the past?


Is the adolescent impulsive or developmentally delayed?
Does the adolescent have significant emotional issues that might impair
judgment?
Does the adolescent have the ability to learn from past mistakes?
How does the adolescent perceive the problem?

Does the adolescent have the means (transportation, FINANCIAL means,


etc.) or access to the means required to complete the management plan?
When a clinician makes the determination that a minor adolescent does
not meet the criteria for "mature minor" status, the adolescent should be
informed that his or her parents must be involved in the decision-making
process [14] unless there is another clear legal basis on which the
adolescent can provide his or her own consent. (See "Confidentiality in
adolescent health care".)

CONSENT

Overview The clinician has a legal and an ethical duty to obtain


informed consent when providing treatment [7,11]. Those who treat or
perform procedures on a patient without consent may be liable for battery,
negligence, or malpractice [3,7].

The provision of informed consent implies that the patient voluntarily


agrees to medical care with a full understanding of his or her condition,
the nature of the proposed treatment, the risks and benefits of the
proposed treatment, available alternative treatments, and the risks of
foregoing treatment [13,14,16,17].

Clinicians must be aware of the ways in which obtaining consent or


providing parental notification, as required by federal or state law, federal
or state funding source, or an individual facility's policies, affect patient
confidentiality in various circumstances. (See "Confidentiality in
adolescent health care".)

Although it is important for clinicians to respect their adolescent patients'


privacy, it is also important to encourage the adolescent to talk with his or
her parents about issues that affect health [8,18-20]. Many adolescents
willingly inform their parents regarding their health care decisions [21].
Parental support can help to ensure that the adolescent's health care
needs are met [20]. However, mandatory parental consent or notification
may have an adverse effect on some families, particularly those with a
history of family violence (child abuse, sexual abuse, domestic violence)
[19,22].

Clinicians are often uncertain whether they can be held legally responsible
if they provide care based on the consent of a minor. If a minor is
authorized by law to provide consent, there is little likelihood that a
clinician would be held liable based on a failure to obtain parental consent.

Who gives consent? Consent for medical care of minors may be


provided by a number of parties (including the minor himself or herself),
depending upon the status of the minor and the state laws regarding
consent for specific services, as outlined below.

Minors If the patient is an unemancipated minor, consent for medical


treatment usually is provided by the parents or legal guardian. In varying
circumstances, consent also may be provided by other family members,
foster parents, probation officers, social workers, or family and juvenile
courts.

Emancipated minors Emancipated minors generally are able to provide


their own consent for beneficial services. They may not provide their own
consent for services that would benefit someone other than themselves
(eg, blood or organ donation) [23].

Medically emancipated minors Certain groups of minors are


sometimes able to consent for care generally based on their status. They
may be referred to as medically emancipated minors. (See 'Medical
emancipation' above.)

Mature minors In the states that permit mature minors to consent for
medical care, several criteria should be met before treatment [7,23]:

Age of minor as applies to that state's doctrine (usually at least 14


years).
Minor is of sufficient maturity and intelligence to understand and
appreciate the benefits and risks of the proposed treatment and to make a
reasoned decision based on that knowledge.
The treatment is for the minor's benefit and not someone else's (eg,
blood or organ donation).

The treatment is deemed necessary by a professional, and the treatment


is not complex or high risk.
In states where policies regarding consent are ambiguous, the clinician's
best assessment is usually upheld in court. Since the mid-1980s, there
have been no reports of a clinician being held liable when non-negligent
care was provided to a mature minor who had given informed consent
[8,13].

Consent versus notification Notification differs from consent in that a


third party (eg, the parent or guardian of a mature or medically
emancipated minor) is simply being told of the action rather than being
asked to provide consent. However, an adolescent may view consent and
notification as the same, since both can violate confidentiality [24]. (See
"Confidentiality in adolescent health care".)

CONSENT FOR SPECIFIC SERVICES In addition to state laws determining


minor status and the ability of the minor to consent for medical care and
services based on their status, individual states have different laws
regarding the specific health services to which minors may consent [14]. It
is critical that clinicians verify the laws regarding specific services in the
state in which they practice.

Information regarding individual state laws concerning specific services is


available through the Guttmacher Institute [25] and the Center for
Adolescent Health & the Law [2].

Emergency care In all states, a person in need of emergency medical


treatment may be treated without consent if an attempt to secure such
consent would delay treatment and risk the patient's life or health
[5,7,13]. This applies to children of all ages, including adolescents. When
emergency care is required, the patient should be treated and the parents
or legal guardians notified as soon as possible.

In acute cases of rape, incest, and sexual abuse, the laws governing
emergency care apply [6,26,27]. Clinicians may be required to notify
parents or guardians except when there is suspicion that they may be one
of the perpetrators [6].

Contraceptive services In 1977, the US Supreme Court ruled that the


right to privacy protects a minor's access to nonprescriptive
contraceptives. Although there has been no subsequent ruling to include
prescriptive contraceptives, they are generally considered to be included
[5,7]. Most states allow minors to consent to contraceptive services,
although some restrict the ability to consent to minors of a certain age or
status [2,28]. For updated information, please see the Guttmacher
Institute Website.

Federal statutes and regulations for the Title X Family Planning Program
and the Medicaid program require that confidential family planning
services be available to adolescents as well as adults. This effectively
precludes requiring parental consent for these services, as they would no
longer be confidential. Two states (Texas and Utah) specifically prohibit the
use of state funds for contraception without parental notification; a small
number of other states allow for, but do not require, notification by the
provider under certain circumstances (eg, if it is necessary to protect the
health of the minor) [3,28].

Sexually transmitted infections All states and the District of Columbia


allow minors to consent for diagnosis and treatment of sexually
transmitted infections (STI). However, some states require that a minor be
at least 12 or 14 years old before being allowed to consent [25,29]. The
majority of states include HIV testing and treatment as part of this service.
Some states allow clinicians to inform parents their minor is seeking STI
services, but only one state (Iowa) requires notification (specifically in the
case of a positive HIV test) [2,5,25,29]. For updated information, please
see the Guttmacher Institute Website.

Cervical dysplasia The issues related to consent for biopsy or treatment


of cervical dysplasia depend upon whether the biopsy or therapy is
considered part of the evaluation and treatment for STI and on the
specifics of state law [30]. Even if the minor is allowed to consent,
confidentiality may not be assured. (See "Confidentiality in adolescent
health care", section on 'Parental notification' and "Confidentiality in
adolescent health care", section on 'Potential threats to confidentiality'.)

Prenatal care Approximately two-thirds of states explicitly allow minors


to consent for prenatal care, but some require the minor to be a certain
age or to be classified as mature minors [31]. The remaining one-third of
states have no relevant policy or case law. In such states, a pregnant
minor may be able to consent for prenatal care under the mature minor

doctrine unless she is unable to give informed consent. Among the states
that explicitly permit minors to consent, approximately one-third permit a
clinician to inform the minor's parents under certain circumstances (eg, if
it is necessary in order to protect the health of the minor) [31]. For
updated information, please see the Guttmacher Institute Website.

Abortion Since 1979, a series of decisions of the United States Supreme


Court have allowed states to require consent or notification of at least one
parent when a minor is seeking an abortion. However, under these
decisions, when states do have such a requirement, an alternative must
also be in place that allows minors to obtain an abortion without first going
to their parents if they are mature enough to make their own decision or
the abortion is in their best interest. This procedure is most commonly a
"judicial bypass," discussed below [3,32].

The majority of states require some parental involvement in a minor's


decision to have an abortion (approximately two-thirds of these require
parental consent, and one-third require parental notification, but not
consent) [33]. Most of these states permit a minor to obtain an abortion in
a medical emergency, and some in cases of abuse, assault, incest, or
neglect. For updated information, please see the Guttmacher Institute
Website.

All of the states that require parental involvement (consent or notification)


permit judicial bypass if requiring parental involvement may bring harm to
the minor.

Adolescents also can refuse to consent for an abortion that is desired by


their parents [6].

Judicial bypass In cases where requiring parental/guardian involvement


(consent or notification) may bring harm to the minor, it is possible for the
minor to obtain consent without parental/guardian involvement through
the process of judicial bypass [1]. Judicial bypass is a process by which a
minor petitions the court to allow for an abortion to take place without
notifying the minor's parent(s). Each state has its own guidelines for this
process. States may allow for a court-appointed lawyer for free, and a time
limit is provided for the decision to be handed down by the court. Some
organizations, such as Planned Parenthood, help minors through this
process by providing either guidance or a lawyer.

Drug or alcohol care Nearly all states allow minors to consent for
services related to counseling or treatment for substance abuse, and
many of these permit, but do not require, parental notification [14,34].
When minors and parents disagree about treatment for substance abuse,
some states defer to the minor and some to the parent, but the majority
do not specify whether the minor's or the parent's decision is controlling
[34].

Parents may not be aware that adolescents can provide consent for the
treatment of drug or alcohol dependency [14]. In a survey of the parents
of adolescents from one Midwestern state, only 13 percent of parents
knew their state law permitted adolescents to consent for treatment of
drug or alcohol dependency; 23 percent thought such a law was bad, 52
percent thought it was good, and 24 percent thought it was neither [1].

When considering whether to notify parents in the states where parental


notification is permitted, clinicians must consider whether the adolescent
is capable of providing informed consent and whether parental
involvement would affect treatment positively or negatively [14]. In most
cases, effective treatment is difficult without family participation [6].

Parent-requested drug testing Parents sometimes request that a drug


test be performed on a minor child or adolescent without the knowledge of
the minor. The decision of whether the clinician should obtain the consent
of the minor before testing is often left to clinician discretion.

When a parent requests testing without the minor's consent, it is of utmost


importance to spend time with the parent(s) to [14]:

Understand why they think the test is necessary.


Help the parent(s) understand the limitations of drug testing and more
appropriate methods of detecting substance use. A negative drug screen
does not exclude substance use: many drugs that are cleared quickly from
the body may not be detected on a spot test. A positive test may be
falsely positive [35]. Drug testing provides no information about the
pattern of use, dependence, or mental or physical impairments that may
result from drug use. Problem drug use is more likely to be detected

through a careful history: changes in friends, grades, school attendance,


social patterns, sleep, weight, and appetite.
Help the parent(s) understand the potential harms of such testing (eg,
erosion of trust between the minor and his or her parents or health care
provider) [35]. Because minors are legally able to consent for drug or
alcohol treatment, it may be better to allow the health care provider to
explore the possibility of substance use within the privacy of the providerpatient relationship.
The provider also should interview the adolescent alone, ideally after
obtaining the parents' consent to share their concerns with the adolescent
[14]. Adolescents often consent to testing when their parents' concerns
are shared with them. If testing is to occur, it is essential the provider
develop a plan with the parents and adolescent before the test results are
obtained.

The American Academy of Pediatrics advises that only in rare exceptions


should such tests be performed without the consent of the older
adolescent [35,36]. These include:

The patient lacks the decision-making capacity to provide consent


The information gained by either the history or examination is strongly
suggestive of a substance abuse problem [3,6,36]
Mental health services Approximately one-half of states allow minors to
consent for outpatient mental health counseling or treatment, and some
allow them to consent for voluntary inpatient treatment [16]. Many states
allow minors to consent for mental health care following sexual or physical
abuse.

Most states allow parents to admit their minor child to an inpatient facility
without the minor's consent [3,23].

Minors as parents Approximately 60 percent of states explicitly permit


all minors to consent to medical care for their child [25,37], and even
without a statute, a minor parent would almost certainly have a
constitutional right to consent for medical care for his or her child. The
remaining states have no relevant, explicit policy or case law.
Interestingly, some states allow a minor to consent for her child's medical
care, but not for her own [5]. For updated information, please see the
Guttmacher Institute Website.

Immunization There are no federal requirements to obtain signed


parental/guardian consent before administration of immunizations, but
individual states may require it [13,38]. Health care providers should verify
the laws governing immunization in the state in which they practice [39].
By federal law, however, all vaccine providers must give patients, or their
parents or legal representatives, the appropriate Vaccine Information
Statement (VIS) whenever a vaccination is given.

Even in states that require parental consent for immunizations, minors


may be allowed to consent to the administration of hepatitis B vaccine and
possibly the human papillomavirus vaccine because these vaccines
prevent sexually transmitted infections [1,10]. This is most likely in states
where the law explicitly allows minors to consent for services to prevent
sexually transmitted infections or reportable communicable diseases.

Sterilization Regulations regarding consent for sterilization vary from


state to state [40]. They also depend upon the funding source and clinical
status of the patient.

Most states allow a woman to undergo voluntary sterilization upon


reaching the age of 18 years.
If Medicaid is paying for the procedure, it cannot be performed until the
patient is 21 years old and at least 30 days have elapsed since the
consent was signed.
The requirements for a court order and/or parental consent for
sterilization of a person with developmental disabilities vary from state to
state. Clinicians should be familiar with the laws in their state [40].
REFUSAL TO CONSENT In some circumstances, the adolescent or the
parent may refuse treatment [6,41]. The reasons for refusal are variable
(eg, side effects of chemotherapy, religious beliefs). The approach to
refusal to consent depends upon the nature and need of the medical
intervention [6]. In cases where treatment is necessary, all attempts
should be made to identify and address the underlying cause of refusal.
Legal intervention may be necessary when resolution cannot be achieved
through consultation and negotiation [42].

LIABILITY FOR PAYMENT Treatment for which an unemancipated minor


consents usually is the FINANCIAL responsibility of the minor [6]. The

parents are usually not FINANCIALLY liable unless they have agreed to pay
for treatment, are involved in the treatment decision, or the minor lives at
home and the treatment is considered necessary [3,7,23].

Emancipated minors are typically FINANCIALLY responsible for the care to


which they consent (whether or not it is emergent) [23]. The parents are
unlikely to be liable unless they have agreed to pay.

RESOURCES Resources related to consent and confidentiality in


adolescent health care are provided below:

The Guttmacher Institute provides updated information regarding state


policies for specific services
The Center for Adolescent Health & the Law
The Legal Information Institute at Cornell University Law School provides
information regarding the emancipation laws in individual states
The National Conference of State Legislatures provides information on a
number of related topics, including:
Pharmacist conscience clauses
Emergency contraception
Immunization legislation
Human papillomavirus legislation
SUMMARY

Whether an adolescent patient is able to provide consent for medical


care and service depends upon his or her status as a minor and what
services are sought; the laws governing minor status and consent for
specific services vary from state to state. (See 'Minor status' above and
'Consent for specific services' above.)
The provision of informed consent implies the patient voluntarily agrees
to medical care with a full understanding of his or her condition, the nature
of the proposed treatment, the risks and benefits of the proposed
treatment, available alternative treatments, and the risks of foregoing
treatment. (See 'Overview' above.)

Consent for medical care of minors may be provided by a number of


parties (including the minor himself or herself), depending upon the status
of the minor and the state laws regarding consent for specific services.
(See 'Who gives consent?' above.)
Notification differs from consent in that a third party is simply being told
of the action rather than being asked to provide consent; it may result in
violation of confidentiality. (See 'Consent versus notification' above and
"Confidentiality in adolescent health care".)
Individual states have different laws regarding the specific health
services for which minors may consent. Clinicians should verify the laws
regarding specific services in the state in which they practice. (See
'Consent for specific services' above.)
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REFERENCES
Cutler EM, Bateman MD, Wollan PC, Simmons PS. Parental knowledge and
attitudes of Minnesota laws concerning adolescent medical care. Pediatrics
1999; 103:582.
English A, Bass L, Boyle AD, et al. State Minor Consent Laws: A Summary,
3rd ed, Center for Adolescent Health & the Law, Chapel Hill, NC 2010.
English A. Understanding Legal Aspects of Care. In: Adolescent Health
Care: A Practical Guide, 5th ed, Lippincott Williams & Wilkins, Philadelphia
2008.
Sigman GS, O'Connor C. Exploration for physicians of the mature minor
doctrine. J Pediatr 1991; 119:520.
Levesque RJ. Adolescents, Sex, and the Law: Preparing Adolescents for
Responsible Citizenship, American Psychological Association, Washington,
DC 2000.
Greydanus DE, Patel DR. Consent and confidentiality in adolescent health
care. Pediatr Ann 1991; 20:80.
English A. Treating adolescents. Legal and ethical considerations. Med Clin
North Am 1990; 74:1097.
ACOG educational bulletin. Confidentiality in adolescent health care.
Number 249, August 1998. American College of Obstetricians and
Gynecologists. Int J Gynaecol Obstet 1998; 63:295.
Keshavarz R. Adolescents, informed consent and confidentiality: a case
study. Mt Sinai J Med 2005; 72:232.

Krowchuk DP, Satterwhite W, Moore BC. How North Carolina laws affect
the care of adolescents. Issues of confidentiality and consent. N C Med J
1994; 55:520.
Holder AR. Legal Issues in Pediatrics, Yale UNIVERSITY Press, New Haven,
CT 1985.
Leikin SL. Minors' assent or dissent to medical treatment. J Pediatr 1983;
102:169.
Diaz A, Neal WP, Nucci AT, et al. Legal and ethical issues facing adolescent
health care professionals. Mt Sinai J Med 2004; 71:181.
Weddle M, Kokotailo P. Adolescent substance abuse. Confidentiality and
consent. Pediatr Clin North Am 2002; 49:301.
King NM, Cross AW. Children as decision makers: guidelines for
pediatricians. J Pediatr 1989; 115:10.
Campbell AT. Consent, competence, and confidentiality related to
psychiatric conditions in adolescent medicine practice. Adolesc Med Clin
2006; 17:25.
Confidential health services for adolescents. Council on Scientific Affairs,
American Medical Association. JAMA 1993; 269:1420.
Mccabe MA, Rushton CH, Glover J, et al. Implications of the Patient SelfDetermination Act: guidelines for involving adolescents in medical decision
making. J Adolesc Health 1996; 19:319.
Policy Compendium on Confidential Health Services for Adolescents, 2nd
ed, Morreale MC, Stinnett AJ, Dowling EC (Eds), Center for Adolescent
Health & the Law, Chapel Hill, NC 2005. Available at: www.cahl.org/policycompendium-2nd-2005/ (Accessed on October 07, 2014).
American Academy of Family Physicians, American Academy of Pediatrics,
American College of Obstetricians and Gynecologists, and Society for
Adolescent Medicine. Protecting adolescents: Ensuring access to care and
reporting sexual activity and abuse. J Adolesc Health 2004; 35:420.
Jones RK, Purcell A, Singh S, Finer LB. Adolescents' reports of parental
knowledge of adolescents' use of sexual health services and their
reactions to mandated parental notification for prescription contraception.
JAMA 2005; 293:340.
Henshaw SK, Kost K. Parental involvement in minors' abortion decisions.
Fam Plann Perspect 1992; 24:196.
Morrissey JM, Hofmann AD, Thrope JC. nt and Confidentiality in the Health
Care of Children and Adolescents: A Legal Guide, The Free Press, New York
1986.

The adolescent's right to confidential care when considering abortion.


American Academy of Pediatrics. Committee on Adolescence. Pediatrics
1996; 97:746.
Guttmacher Institute. State policies in brief. An overview of minors'
consent law. Available at:
www.guttmacher.org/statecenter/spibs/spib_OMCL.pdf (Accessed on
October 07, 2014).
Hofmann, AD. Legal issues in adolescent medicine. In: Adolescent
Medicine, Hofmann, AD, Greydanus, DE (Eds), Appleton and Lange,
Stamford, CT 1997.
Weinstock R, Weinstock D. Child abuse reporting trends: an unprecedented
threat to confidentiality. J Forensic Sci 1988; 33:418.
Guttmacher Institute. State policies in brief. Minors' access to
contraceptive services. Available at:
http://www.guttmacher.org/statecenter/spibs/spib_MACS.pdf (Accessed on
October 07, 2014).
Guttmacher Institute. Minors' access to STI services. Available at:
http://www.guttmacher.org/statecenter/spibs/spib_MASS.pdf (Accessed on
October 07, 2014).
Guido R. Human papillomavirus and cervical disease in adolescents. Clin
Obstet Gynecol 2008; 51:290.
Guttmacher Institute. Minors' access to prenatal care. Available at:
http://www.guttmacher.org/statecenter/spibs/spib_MAPC.pdf (Accessed on
October 07, 2014).
Crosby MC, English A. Mandatory parental involvement/judicial bypass
laws: do they promote adolescents' health? J Adolesc Health 1991; 12:143.
Guttmacher Institute. Parental involvement in minors' abortions. Available
at: http://www.guttmacher.org/statecenter/spibs/spib_OAL.pdf (Accessed
on October 07, 2014).
Lallemont T, Mastroianni A, Wickizer TM. Decision-making authority and
substance abuse treatment for adolescents: a survey of state laws. J
Adolesc Health 2009; 44:323.
Committee on Substance Abuse, American Academy of Pediatrics, Council
on School Health, American Academy of Pediatrics, Knight JR, Mears CJ.
Testing for drugs of abuse in children and adolescents: addendum--testing
in schools and at home. Pediatrics 2007; 119:627.
Testing for drugs of abuse in children and adolescents. American Academy
of Pediatrics Committee on Substance Abuse. Pediatrics 1996; 98:305.

Guttmacher Institute. Minors' rights as parents. Available at:


www.guttmacher.org/statecenter/spibs/spib_MRP.pdf (Accessed on October
07, 2014).
Center for Disease Control, National Immunization Program. Vaccine
Information Statements. Available at: www.cdc.gov/vaccines/pubs/vis/visfacts.htm (Accessed on February 06, 2008).
Society for Adolescent Health and Medicine, English A, Ford CA, et al.
Adolescent consent for vaccination: a position paper of the Society for
Adolescent Health and Medicine. J Adolesc Health 2013; 53:550.
Sterilization of minors with developmental disabilities. American Academy
of Pediatrics. Committee on Bioethics. Pediatrics 1999; 104:337.
Rozovsky FA. Consent to Treatment, a Practical Guide, Little Brown & Co,
Boston 1990. p.255.
Larcher V. Consent, competence, and confidentiality. BMJ 2005; 330:353.
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