Underage and Patient Autonomy

[aaronrodgers]

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If an underage teen comes asking for birth control w/o telling parents, shouldn't you deny her/him based on the fact that they are not legally of age to decide their own medication? or should I respect patient autonomy by giving the pills while also giving proper education. I think the right decision is the former and one should only give birth control with a legal guardian/parent

 

[wholeheartedly]

It's a pretty common ethics type question.

 

[Red Lobster Actual]

The professional opinion from pediatricians and family practice says the right answer is the latter. In this matter the underage teen is to be given full capacity and autonomy.

See referenced article (from Peds but their opinion is echoed across the board):

Ott MA, Sucato GS; Committee on Adolescence. Contraception for adolescents. Pediatrics. 2014;134(4):e1257–e1281

 

[aaronrodgers]

The professional opinion from pediatricians and family practice says the right answer is the latter. In this matter the underage teen is to be given full capacity and autonomy.

See referenced article (from Peds but their opinion is echoed across the board):

Ott MA, Sucato GS; Committee on Adolescence. Contraception for adolescents. Pediatrics. 2014;134(4):e1257–e1281

In the setting of contraception and sexual health care, the American Academy of Pediatrics (AAP) believes that policies supporting adolescent consent and protecting adolescent confidentiality are in the best interests of adolescents. Most states have specific laws regarding minor consent to contraception (see “State Minor Consent Laws: A Summary”8 and the Guttmacher Institute’s State Center9 for regularly updated state-by-state summaries). For states without specific laws, best-practices guidelines, federal statutes, and federal case law may support minor confidentiality and consent

The answer!

 

[MCATISEZ]

In the setting of contraception and sexual health care, the American Academy of Pediatrics (AAP) believes that policies supporting adolescent consent and protecting adolescent confidentiality are in the best interests of adolescents. Most states have specific laws regarding minor consent to contraception (see “State Minor Consent Laws: A Summary”8 and the Guttmacher Institute’s State Center9 for regularly updated state-by-state summaries). For states without specific laws, best-practices guidelines, federal statutes, and federal case law may support minor confidentiality and consent

The answer!

This. The law will be the ruling matter. From what I know 46 states have a clear cut law as to which minors can and cannot have autonomous consent. For the 4 that don't, I feel as if there is a straightforward tradition within communities of physicians as to how they act. I enjoy the ethics questions and debates, but ultimately I feel like the clinician may typically have their hands tied.

I always have wondered if I can answer an interview question such as this by saying "in the end, I would have to abide by the laws set forth by the state, and keep in mind the traditions of more senior physicians in my municipality if state laws are ambiguous" Then again, physicians should be leaders not followers. But to what extent?

 

[FindMeOnTheLinks]

Varies by state, but parental consent is not required for care related to pregnancy (pregnant patient is considered an emancipated minor), contraception, STIs, substance abuse disorders, and maybe others that I can't remember at the moment.