Minors

1. When minor patients request confidential services, physicians should encourage them to involve their parents. This includes making efforts to obtain the minor's reasons for not involving their parents and correcting misconceptions that may be motivating their objections. The determination of the minor's need for confidentiality must consider the risk of parental abuse and be consistent with facilitating the timely utilization of needed health care.
2. Physicians who treat minor patients have an ethical duty to promote the autonomy of such patients by involving them in the medical decision-making process to a degree commensurate with their maturity, experience and judgment.
3. Where the law does not require otherwise:
   1. Physicians should permit competent minor patients to consent to medical care and should not notify parents without the patients' consent. Depending on the seriousness of the decision, competence may be evaluated by physicians for most minors. When necessary, experts in adolescent medicine or child psychological development should be consulted. Use of the courts for competence determinations should be made only as a last resort.
   2. When a minor patient requests contraceptive services, pregnancy-related care (including pregnancy testing, prenatal and postnatal care, and delivery services), or treatment for sexually transmitted disease, drug and alcohol abuse or mental illness, physicians must recognize that requiring parental involvement may be counterproductive to the health of the patient. Physicians should encourage parental involvement in these situations. However, if the minor continues to object, his or her wishes ordinarily should be respected. If the physician is uncomfortable with providing services without parental involvement, and alternative confidential services are available, the minor should be referred to those services. In cases when the physician believes that without parental involvement and guidance, the minor will face a serious health threat, and there is reason to believe that the parents will be helpful and understanding, disclosing the problem to the parents is ethically justified. When the physician does breach confidentiality to the parents, he or she must discuss the reasons for the breach with the minor prior to the disclosure.
   3. For minor patients who are mature enough to be unaccompanied by their parents for their examinations, confidentiality of information disclosed during an exam, interview, or in counseling should be maintained. Such information may be disclosed to parents when the patient consents to disclosure. Confidentiality may be justifiably breached in situations for which confidentiality for adults may be breached. In addition, confidentiality for immature minors may be ethically breached, after discussing reasons for the breach with the minor, when necessary to enable the parent to make a mature and informed decision about treatment for the minor or when such a breach is necessary to avert serious harm to the minor.
   4. Physicians should not feel, or be, compelled to require minors to obtain consent of their parents before deciding whether to undergo an abortion. The patient – even an adolescent – generally must decide whether, on balance, parental involvement is advisable. Accordingly, minors should ultimately be allowed to decide whether parental involvement is appropriate. Physicians should explain under what circumstances (e.g., life-threatening emergency) the minor's confidentiality will need to be abrogated.
   5. Physicians should ensure that minor patients have made an informed decision after giving careful consideration to the issues involved. They should encourage their minor patients to consult alternative sources if parents are not going to be involved in the abortion decision. Minors should be helped to seek the advice and counsel of those adults in whom they have confidence, including professional counselors, relatives, friends, teachers or the clergy.
4. When laws violate these ethical standards, physicians should fulfill their legal requirements. However, such laws should be altered to conform with these guidelines. Physicians should play an active role in changing laws that are not in conformity with these standards.
5. Physicians should consider the possibility of inadvertent breach of confidentiality when a minor is receiving care under their parent's insurance, resulting in specific billing statements to the parents. (JC Rpt A, A-93) (Reaffirmed A-17)

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Abbreviations for House of Delegates report origination:

EC – Executive Committee; BT – Board of Trustees; CPA – Council on Professional Affairs; JC – Judicial Council; CHS – Community and Health Services