Any parent or guardian who brings their child to receive medical care may have to sign a consent form, especially if a procedure or medical test is involved. Consent to undergo care is usually signed even before a child is seen by a doctor, evaluated in an emergency department, or is being admitted to a hospital. When it comes to teen minors (ages 13 through 17), the areas of consent, dissent, and assent become remarkably gray, especially when it comes to undergoing any type of medical or surgical intervention. For example, what is the law (versus the ethics) when it comes to forcing a teen (or a child, for that matter) to undergo a medically indicated, albeit elective, surgical procedure? Can the parents and treatment team physically or pharmacologically, using sedatives, restrain a developmentally appropriate teen refusing surgery, regardless of the teen's reason to hold off? The answer is, it depends. It partially depends on the medical indication for the procedure, but more specifically it depends on the state in which the procedure is performed.
There are no federal guidelines regarding a minor teen's rights when it comes to medical care, and each state medical board has different regulations. In many treatment facilities across the country, a pre-procedure pregnancy test is performed on all females of menstruating age, even if the individual is pre-menstrual or menopausal. The only indication to forego this test is absence of a uterus. In my institution, pre-procedure urine pregnancy testing is performed in females between ages 10 and 53. The tricky part ensues when a minor's urine pregnancy test is positive. In the state of California, by law, the treatment team is not permitted to disclose the positive pregnancy test results to the patient's family without permission of the pregnant minor. And simultaneously, the treatment team cannot proceed with any intervention, as the parent or guardian is not able to give informed consent, given the treatment team's newly recognized additional risks of anesthesia and surgery on a pregnant individual and fetus. One of the most bizarre medical treatment conundrums: medical professionals cannot, by law, inform the parents of the pregnancy test results. And they cannot, by law, provide informed consent for an intervention without informing the added risks to the pregnant patient or the fetus of undergoing an intervention. Therein lies the rub. The treatment team has to cancel the procedure, but they cannot tell the pregnant teen's parents why.
The latest issue regarding minor teen consent (as opposed to assent or dissent) is the hot button issue of vaccines. There are currently 17 states, including those with active measles outbreaks, which allow parents to opt out of vaccinations for their children based on personal beliefs. The state of California requires medical exemptions to opt out. But even these became inordinately widespread, whereby some doctors would essentially “sell” medical exemptions to families who, in reality, did not have a medical indication to opt out.
A recent story of an 18-year-old un-vaccinated young man deciding to receive vaccinations against his parents' wishes made headlines. The fact that he was 18, the age considered to be a legal adult in the world of health care and medical consent forms, made his decision easier to carry out. But what about teens ages 17 years and younger? As the laws regarding teen consent for medical procedures vary from state to state, so do the laws for a teen requesting a vaccine when parents have refused. With new cases of measles popping up in multiple communities with high rates of un-vaccinated children, the issue of taking one's health into one's own hands has been raised in the teen population.
It turns out that not only does the age a teen can make this decision vary from state to state, the specific vaccine in question also varies. For instance, in California, minors ages 12 years and older can independently receive treatment for sexually transmitted infections (STI's) as well as receive the HPV vaccine, which prevents human papillomavirus (HPV)-induced lesions of the genital tract in both females and males, as well as cervical cancer, recurrent respiratory papillomatosis in offspring of HPV-positive mothers, laryngeal cancers, and sinus cancers. California minors can also receive the Hepatitis B vaccine without parental consent. In Oregon, where a public health emergency has been declared due to measles outbreaks, teens ages 15 and up may receive hospital care, dental and vision services, and any immunization without parental consent. In Washington state, teen minors may receive vaccines without parental consent if the treating physician deems the teen "mature," which seems a bit up for grabs regarding a true legal descriptor. Almost every state enables teen minors to make medical decisions regarding reproductive health, drug and alcohol dependence issues, and mental health support without the need for parental permission. And, while in the past, parents would readily want to protect their children from infectious diseases by immunizing, teens are now having a say in protecting themselves against illnesses they've never seen. Until now.
Previously published in Forbes.
Image by GrAl / Shutterstock