Minor's Rights Versus Parental Rights: Review of Legal Issues in Adolescent Health Care

Ann Maradiegue, C-FNP, MSN

Disclosures

J Midwifery Womens Health. 2003;48(3) 

In This Article

Abstract and Background

Abstract

The right of adolescents to access confidential health care is sensitive and controversial. Recent challenges in the court system to adolescents' right to access abortion and contraception are eroding current law, including the Roe v Wade decision. The prospect of more than a million pregnancies in individuals under the age of 20 years in the United States with increasingly fewer alternatives to pregnancy is concerning. New regulations under the Health Insurance Portability and Accountability Act are adding yet another layer of complexity to the care of adolescents. Understanding legal issues surrounding adolescent rights to care can help the health care provider make appropriate care available to this age group. Keywords previously identified in CINAHL and MEDLINE were used to perform the literature search. LexisNexis was the search engine used to identify the laws and statutes.

Background

Adolescence is a relatively new term that has more to do with the way society deals with its young people than an individual's biophysical structure; moreover, adolescents are not a homogeneous group and maturation rates vary.[1] The American Academy of Pediatrics identifies adolescents as youth between the ages of 11 and 21 years.

Healthy People 2010 identified 40 health promotion and prevention goals for adolescents and young adults. Among the identified behaviors that cause major health problems is sexual behavior that results in pregnancy and sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV).[2] The National Institute of Medicine states that STDs cost tax payers at least $10 billion dollars annually, not including costs associated with care of persons with HIV. Of the new STD cases that occur each year, 12 million occur in adolescents who are at greater risk for developing HIV because they are more likely to engage in risky behavior and adolescent girls are more susceptible to cervical infections. By the 12th grade, nearly 70% of all adolescents have had sexual intercourse.[2,3]

Developing appropriate interventions relies on an increased understanding of adolescents and the laws that pertain to the provision of health care services to this population.[4] Decisions made during adolescence have implications that last throughout a lifetime and affect both the individual and public health.[5] Moreover, adolescents have the expanded capacity for critical thought, including the questioning of self and others, as well as for reproduction.[6] So although adolescents display more self-reliance than children, they lack the status and resources of adults.

Yet adolescent sexuality evokes visceral responses from health care providers, parents, and politicians. Although biologically adolescents are fully capable of sexual activity and bearing children, adolescent experts agree pregnancy is generally not in their best interest.[7] Teen mothers have more difficulty completing their education and are more likely to have complications during pregnancy.[2] These issues pose significant burdens for the adolescent and society in terms of personal and financial consequences.[8]

Adolescent health care providers have a duty to be aware of the laws within their jurisdiction of practice. Frequently, because of economic realities regarding medical remuneration, physicians will put the interest of the parents ahead of the interest of the minor.[9] Generally, adolescents requiring medical services of this nature do not have the financial resources to pay for care and are covered under their parents' health insurance. A major concern among advocates for adolescents is that adolescents will not seek the care they need because they do not trust an adult that they can approach for sensitive issues.[10] There are few clinicians who specialize in adolescent health and fewer health care providers who are trained to recognize and care for adolescent health problems.[8]

The development of birth control drugs and devices plus the availability of legal abortions has further fueled the contentious discussion over control of reproductive rights. In particular, the rights of adolescents to access health care without parental consent and the legal system's role in determining these rights and issues are at stake today.[11]

The argument over control of one's children is an antediluvian debate. Most parents feel comfortable asserting their rights as parents to make decisions for their children.[12] Adolescents, however, are at a unique intersection in their growth and development and are beginning to assert their independence and make their own decisions.[7] Adolescents do not view themselves as children, and developmentally they have the ability to make informed choices. In addition, there are occasions when adolescents have justified concerns about sharing information with parents who are abusive.[4] In an effort to clarify the laws regarding adolescent health care, this article examines certain laws and the effects these laws can have on adolescent health. When considering minors' rights, the state, the parent, and the federal government all play a role.

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