Physicians who treat minors have an ethical duty to promote the developing autonomy of minor patients by involving children in making decisions about their health care to a degree commensurate with the child’s abilities. A minor’s decision-making capacity depends on many factors, including not only chronological age, but also emotional maturity and the individual’s medical experience. Physicians also have a responsibility to protect the confidentiality of minor patients, within certain limits.
In some jurisdictions, the law permits minors who are not emancipated to request and receive confidential services relating to contraception, or to pregnancy testing, prenatal care, and delivery services. Similarly, jurisdictions may permit unemancipated minors to request and receive confidential care to prevent, diagnose, or treat sexually transmitted disease, substance use disorders, or mental illness.
When an unemancipated minor requests confidential care and the law does not grant the minor decision-making authority for that care, physicians should:
- Inform the patient (and parent or guardian, if present) about circumstances in which the physician is obligated to inform the minor’s parent/guardian, including situations when:
- Involving the patient’s parent/guardian is necessary to avert life- or health- threatening harm to the patient.
- Involving the patient’s parent/guardian is necessary to avert serious harm to others.
- The threat to the patient’s health is significant and the physician has no reason to believe that parental involvement will be detrimental to the patient’s well-being
- Explore the minor patient’s reasons for not involving his or her parents (or guardian) and try to correct misconceptions that may be motivating the patient’s reluctance to involve parents.
- Encourage the minor patient to involve his or her parents and offer to facilitate conversation between the patient and the parents.
- Inform the patient that despite the physician’s respect for confidentiality the minor patient’s parents/guardians may learn about the request for treatment or testing through other means (e.g., insurance statements).
- Protect the confidentiality of information disclosed by the patient during an exam or interview or in counseling unless the patient consents to disclosure or disclosure is required to protect the interests of others, in keeping with ethical and legal guidelines.
- Take steps to facilitate a minor patient’s decision about health care services when the patient remains unwilling to involve parents or guardians, so long as the patient has appropriate decision-making capacity in the specific circumstances and the physician believes the decision is in the patient’s best interest. Physicians should be aware that states provide mechanisms for unemancipated minors to receive care without parental involvement under conditions that vary from state to state.
- Consult experts when the patient’s decision-making capacity is uncertain.
- Inform or refer the patient to alternative confidential services when available if the physician is unwilling to provide services without parental involvement.
AMA Principles of Medical Ethics: IV
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