Legal Issues : Consent by Mature or Emancipated Minors
For situations in which an adolescent presents for care without a parent or other caregiver, the healthcare professional will need to consider if the patient possesses the ability to understand the nature and consequences of the medical evaluation, including testing and prophylaxis for sexually transmitted infections, contraception, pregnancy, and collection of forensic evidence.
Emancipated Minors
Emancipated minors are defined as those who are younger than the legal age of majority (18 years old) who are no longer dependent on their parents and are self-supporting. Emancipation laws in the United States vary by state. The Legal Information Institute provides information about the age of majority and relevant statutes by state: https://www.law.cornell.edu/wex/table_emancipation.
Mature Minors
Mature minor laws and guidance recognize the ability of the non-emancipated minor to make medical decisions, even though they may still be under the guardianship and care of their parents or other adults. Healthcare providers should be aware of their state’s mature minor healthcare exceptions, including age, parental availability, and definition of sensitive clinical situations. States have criteria for which an unemancipated minor patient may decide to choose or reject healthcare specific treatment without parental knowledge or consent. Of note, mature minors are usually older than 12 years of age. The designation is made by the professional responsible for their healthcare during a particular visit.
In many states (but not all), minors may consent to care if presenting with one or more of the following medical issues:
- Abortion
- Contraception services
- Immunizations
- Mental health treatment
- Pediatric care for children of minors
- Prenatal care
- Rape or sexual assault services
- Sexually transmitted infections, including HIV
- Substance use disorder treatment
The SchoolHouse Connection has collated information on state laws and minor consent for routine medical care: https://schoolhouseconnection.org/article/state-laws-on-minor-consent-for-routine-medical-care.
Adolescent concerns about billing and confidentiality must be considered. For more information regarding the unique needs of the adolescent patient, see: Alderman et al. The Unique Needs of the Adolescent in Pediatrics https://doi.org/10.1542/peds.2019-3150.
Emergency Situations
Emergency situations often permit healthcare providers to provide care in good faith. For example, in New York State, Public Health Law §2504 codifies and expands the common law emancipation rules and was updated in 2023. This law outlines consent regarding emergency situations and enables consent to care provided in good faith. It also outlines specific consent details regarding pelvic examinations.
If intrafamilial abuse has occurred, child protective services should be notified and the case reported to child welfare authorities. Adolescents who have been sexually assaulted often request that their parent is not notified. Healthcare professionals must respect this if the assault does not involve a close family or household member such as in intrafamilial child abuse. This ethical issue highlights the conflict between the parent's constitutional right to raise a child without undue interference and the adolescent's constitutional right to privacy.
Considerations affecting whether a parent is notified of an adolescent's medical needs after an assault
- The treatment constitutes an emergency and no notification is required
- Determination that the adolescent understands the nature and consequences of treatment decisions (i.e., is a mature minor)
- Determination that the adolescent capable of following through with necessary medical recommendations if parents are not notified
- The physician has an ethical responsibility to allow the adolescent to refuse treatment
- Possibility of imminent danger to the adolescent if the parents are notified
- The assault was the result of intrafamilial abuse and protection of the adolescent requires that no information be given to the parents until law enforcement can investigate
- Notification may prevent the adolescent's suicide or other harmful acts
