When it comes to health care for adolescents, patient autonomy and parental responsibility are at times forced into opposition, and when adolescent patients in the U.S. seek care for sensitive issues — sexually transmitted infections, mental health problems, drug use, contraception, etc. — the health care team’s ability to render treatment without involving a parent will depend on which jurisdiction they’re in.
A paper published May 9 in Pediatrics outlines how laws concerning adolescent patient confidentiality and independent adolescent consent for health care services vary substantially from state to state, are often unclear, and often run counter to patient confidentiality standards advocated by medical societies.
“Adolescents are at high risk for sensitive medical issues. Redressing rampant confusion and inconsistency with regard to patient privacy for this group should be a national public health priority,” said the paper’s senior author, pediatrician and internist Trent Rosenbloom, MD, MPH, professor of Biomedical Informatics, Pediatrics, Medicine and Clinical Nursing at Vanderbilt University Medical Center.
According to the paper, no minor of any age can independently provide consent for immunization in 31 states, for HIV testing in 18 states, and, unless married, for contraceptive care in seven states. Meanwhile, many states simply lack explicit laws regarding the ability of minors to independently consent to mental health services, sexual assault evaluation or prenatal care.
“States that restrict health care consent and privacy for adolescents are letting these patients down, potentially in clinically significant ways,” Rosenbloom said. “It’s well established in the research literature that adolescents are more likely to seek care for sensitive issues if they can keep it to themselves.
“Despite clear evidence and expert consensus, variability in state laws precludes medical societies from issuing clear guidelines to physicians in the matter,” he said.
The authors also highlight how variability in state laws complicates patients’ federally prescribed access to their electronic health information.
The authors found that 20 states permit health care providers to divulge to a parent or guardian an adolescent’s use of services for sexually transmitted infections; eight states allow disclosure of contraceptive services; 14 allow disclosure of prenatal care; 19 allow disclosure of substance abuse treatment; nine allow disclosure of mental health treatment.
“This is a call to action,” the authors write. “State laws need to be aligned with best policies and brought closer in line with recommendations for best care. We must band together, determine the best policies, and promote them for the best interests of our patients.”
Others on the paper from VUMC include Rachael Jameson and Jessica Ancker, PhD, MPH. They were joined by authors from Weill Cornell Medicine/NewYork-Presbyterian Hospital in New York City, the American Academy of Pediatrics in Itasca, Illinois, and Riley Hospital for Children and Indiana University in Indianapolis.
