The nature and scope of mature adolescents’ legal authority to consent to general medical treatment without parental involvement is often misrepresented by commentators. This state of affairs is further complicated by the law itself, which has developed a broad “mature minor exception” to the general requirement of parental consent in abortion cases and which has additionally carved out numerous specific status-based and condition-based exceptions to that requirement. In these circumstances, it is not always a simple matter for physicians and other medical professionals who treat adolescents to ascertain the applicable law. In this article, we discuss the underlying differences between medical ethics and law, which have caused some of the confusion in this area, and we set out the most current legal rules governing adolescent decision-making authority in general medical settings. A comprehensive analysis of both statutory and common law demonstrates that in such settings, parental consent continues to be required by most jurisdictions, even when the minor can be considered cognitively “mature.”
Comments
Mature minors, consent and confidentiality
Dorianne Lambelet Coleman and Philip M Rosoff have presented a thoughtful and erudite account on the legal understanding of the mature minor doctrine (1). However they operate under a wrong assumption, namely that clinician's may think that a mature minor can give consent for any " general medical treatment". By doing so they have raised a " strawman argument": there is no practicing pediatrician holding such belief.
In pediatric practice and specially in the field of Adolescent Medicine, the phrase " the mature minor doctrine " is understood by everybody to simply be short-hand for: " In those jurisdictions that allow it, mature minors ( a clinician's decision that should be documented ) can consent for treatment under special circumstances (emancipated), and otherwise solely for predetermined situations (by legislation), such as seeking treatment for a sexually transmitted disease, a mental illness, substance abuse and reproductive health care".
There is an additional important "general application" of the mature minor doctrine, which is separate from the consent issue: it relates to adolescent confidentiality. Confidentiality merits being respected with very few exceptions. Moreover it is only limited by law to circumstances that require mandatory reporting, such as physical and sexual abuse.
1) Lambelet Coleman D, Rosoff PM. The Legal Authority of Mature Minors to Consent to General Mediucal treatment. Pediatrics 2013;131:786- 793.
Conflict of Interest:
None declared