Minor's and the Right to Consent to Health Care

Special An a l y s i s result, Title X–supported clinics provide contraceptive services and other reproductive health care to minors Minors and the Right to on a confidential basis, although they encourage minors to involve their parents in their decision to seek ser- Consent to Health Care vices. Over the years, the provision of confidential con- traceptive services to minors has come under attack from conservatives in Congress, who have repeatedly The notion that many minors have the mounted efforts to require that a parent give consent or capacity and, indeed, the right to make be notified before a minor receives these services in a important decisions about health care has Title X clinic. In 1998, the House of Representatives passed a parental notification requirement, but the been well established in federal and state Senate did not, and the provision was never enacted. policy. Many states specifically authorize minors to consent to contraceptive services, Similar debates have occurred at the state level. In testing and treatment for HIV and other Texas, for example, the legislature in 1997 voted to pro- hibit the use of state family planning funds to provide sexually transmitted diseases, prenatal prescription drugs, such as birth control pills and med- care and delivery services, treatment for ication for treating STDs, to minors without parental alcohol and drug abuse, and outpatient consent. The law was allowed to go into effect in 1998, mental health care. With the exception of after the Texas Supreme Court concluded that striking down the provision without evidence of harm would be abortion, lawmakers have generally resist - premature. In fact, the law does not interfere with ed attempts to impose a parental consent or minors’ ability to obtain confidential services from notification requirement on minors’ access Title X–supported clinics and other providers who serve to reproductive health care and other sensi - minors with federal funds. tive services. Nevertheless, the movement to In 2000, the South Carolina legislature considered a bill “restore” parental rights and to legislate to prohibit the use of state funds to distribute condoms parental control over minors’ reproductive and other types of contraceptives to minors younger health care decisions remains active. than age 16 whose parents had registered an objection with the state health department to their child’s receiv- By Heather Boonstra and Elizabeth Nash ing such services. The measure was passed by the House of Representatives but dropped during committee consideration in the Senate. Similar measures in other Establishing rules for minors’ consent for medical care states did not receive serious consideration, even at the has been one of the more difficult issues to face policy- committee level, and none were enacted. makers. On the one hand, it seems eminently reason- able that parents should have the right and responsibil- ity to make health care decisions for their minor child. The States and Medical Care for Minors On the other hand, it may be more important for a States have traditionally recognized the right of parents young person to have access to confidential medical to make health care decisions on their children’s behalf, services than it is to require that parents be informed of on the presumption that before reaching the age of their child’s condition. Minors who are sexually active, majority (18 in all but four states), young people lack pregnant, or infected with a sexually transmitted dis- the experience and judgment to make fully informed ease (STD) and those who abuse drugs or alcohol or suf- decisions. There have long been exceptions to this rule, fer from emotional or psychological problems may avoid however, such as medical emergencies when there is no seeking care if they must involve their parents. time to obtain parental consent and in cases where a Recognizing this reality, many states explicitly autho- minor is “emancipated” by marriage or other circum- rize a minor to make decisions about their own medical stances and thus legally able to make decisions on his care, but balancing the rights of parents and the rights or her own behalf. of minors remains a topic of debate. In addition, courts in some states have adopted the so- At the federal level, the focal point of debate over called mature minor rule, which allows a minor who is minors’ access to confidential services has been the sufficiently intelligent and mature to understand the Title X family planning program. Since its inception in nature and consequences of a proposed treatment to 1970, services supported by Title X have been available consent to medical treatment without consulting his or to anyone who needs them without regard to age. As a her parents or obtaining their permission.

The Guttmacher Report on Public Po l i c y A u g u s t 2 0 0 0 4 Moreover, over the last 30 years, states have passed In addition to laws and policies that permit minors to laws explicitly authorizing minors to consent to health consent to specific services, 21 states have statutes that care related to sexual activity, substance abuse and authorize minors to consent to general medical and sur- mental health care. Although some states give doctors gical care, at least under some circumstances, such as the option of informing parents that their minor son or having a child, being pregnant or having reached a cer- daughter has received or is seeking these services, these tain age. In Alabama, for example, minors aged 14 and laws leave the decision of whether to inform the parents older may consent to general medical care; in South entirely to the discretion of the physician as to the best Carolina, they may do so at 16. interests of the minor. The States and Abortion This expansion of minors’ authority over health care decisions was spurred in part by U.S. Supreme Court The one notable exception to the expansion of minors’ rulings extending the constitutional right to privacy to a decision-making authority on health care matters is minor’s decision to obtain contraceptives or to termi- abortion. Only two states—Connecticut and Maine—and nate an unwanted pregnancy. It also reflects a recogni- the District of Columbia have laws that affirm a minor’s tion on the part of lawmakers that while parental ability to obtain an abortion on her own. By contrast, involvement is desirable, many minors will not seek ser- 31 states have laws in effect that require the involve- vices they need if they have to tell their parents. ment of at least one parent in their daughter’s abortion decision: In 16 of these states, a minor must have the The Alan Guttmacher Institute has periodically consent of one or both parents; in the other 15 states, reviewed state laws pertaining to minors’ authority to one or both parents must be notified prior to the consent to medical care and to make other important ab o r t i o n . decisions without their parents’ knowledge or permis- sion. This year its review was expanded to also take All but one of these statutes provides a confidential into account state court decisions and attorneys general alternative to parental involvement, in the form of opinions that affect young people’s access to confiden- either a judicial bypass, in which a minor may obtain tial services (see table, page 6). The review, conducted authorization for an abortion from a judge without in July 2000, found the following: informing her parents, or, in the case of Maryland, a “physician bypass” that permits a doctor to waive • Twenty-five states and the District of Columbia have parental notice if the minor is capable of giving laws or policies that explicitly give minors the author- informed consent or if notice would lead to abuse of the ity to consent to contraceptive services. minor. The Supreme Court has said that a confidential • Twenty-seven states and the District of Columbia have alternative is required to protect a minor’s constitu- laws or policies that specifically authorize a pregnant tional right to privacy. Utah is the only state whose minor to obtain prenatal care and delivery services statute does not meet this requirement. without parental consent or notification. Efforts to enact new parental involvement laws in the • All 50 states and the District of Columbia specifically context of abortion have slowed in recent years. allow minors to consent to testing and treatment for Between 1991 and 1997, the number of states with laws STDs, including HIV. (With respect to HIV, three in effect mandating parental consent or notification states limit this authorization to testing only.) rose from 18 to 30, but between 1997 and 2000, that • Forty-four states and the District of Columbia have number increased by only one. In large part, this drop- laws or policies that authorize a minor who abuses off reflects the fact that 10 other states have enacted drugs or alcohol to consent to confidential counseling laws that are currently blocked by courts from going and medical care. into effect, leaving only seven states that have no parental involvement requirement on the books. • Laws in 20 states and the District of Columbia give minors the explicit authority to consent to outpatient Some proponents of mandatory parental involvement mental health services. justify the differential treatment of abortion and other reproductive health services on the ground that the No state explicitly requires parental consent or notifica- decision to terminate a pregnancy is less a medical tion for any of these services. However, two states— choice than a major life decision. Because terminating Texas and Utah—prohibit the use of state funds to pro- an unplanned pregnancy can have a significant long- vide contraceptive services to minors without parental term impact on a woman’s psychological and emotional consent. And one state—Iowa—requires that parents be well-being, they say, parental guidance is especially notified if their child receives a positive HIV test. important. However, states allow minors to make other decisions that can have a lasting effect on their lives.

The Guttmacher Report on Public Po l i c y A u g u s t 2 0 0 0 5 Minors’ Right to Consent to Health Care and to Make Other Importan

STATE CONTRA-PRENATAL STD/HIV TREATMENT FOR OUTPATIENT GENERAL ABORTION CEPTIVE CARESERVICES ALCOHOL AND/ORMENTAL HEALTH MEDICAL SERVICES SERVICES DRUG ABUSESERVICESHEALTH SERVICES

ALABAMA NL MC MC2,3,4 MC MC MC5 PC ALASKA MC MC MC NL NL MC7 NL8 ARIZONA MC NL MC MC2 NL NL NL8 ARKANSAS MC MC10,11 MC4,11 NL NL MC12 PN13 CALIFORNIA MC MC10 MC2,16,17 MC2,4 MC2,4 NL NL8 COLORADO MC7,18 NL MC16 MC MC4,19 NL NL8 CONNECTICUT NL NL MC16 MC MC NL MC DELAWARE MC2,4 MC2,4,10,11 MC2,4,11,16 MC2 NL MC7 PN20,21 DIST.COLUMBIA MC MC MC MC MC NL MC FLORIDA MC7,18 MC11 MC3 MC MC23 NL NL8 GEORGIA MC MC10 MC3,4,11 MC4 NL NL PN HAWAII MC4,24,25 MC4,10,24,25 MC4,24,25 MC4 NL NL NL IDAHO MC NL MC3,24 MC NL MC28 PN13,29 ILLINOIS MC7,18 MC11,18 MC2,3,4 MC2,4 MC2,4 MC7,11 NL8 INDIANA NL NL MC MC NL NL PC IOWA NL NL MC16,31 MC NL NL PN21 KANSAS NL12 MC11,33 MC4 MC NL MC11,33 PN KENTUCKY MC4 MC4,10 MC3,4 MC4 MC4,6 MC4,7 PC LOUISIANA NL NL MC4 MC4 NL MC4,11 PC MAINE MC7,18 NL MC4 MC4 NL NL MC MARYLAND MC4 MC4 MC4 MC4 MC4,6 MC4,7 PN21 MASSACHUSETTS NL36 MC10 MC MC2,37 MC6 MC7 PC MICHIGAN NL MC4 MC4,16 MC4 MC24 NL PC MINNESOTA MC4 MC4 MC4 MC4 NL MC4,7 PN13 MISSISSIPPI MC7,18 MC11 MC3 MC4,19 NL PC PC13 MISSOURI NL MC4,10,11 MC4,11 MC4,11 NL MC7,11 PC MONTANA MC4 MC4,11 MC4,11,16 MC4,11 MC6 MC4,7,11 NL8 NEBRASKA NL NL MC MC NL NL PN NEVADA NL NL MC3 MC NL MC7,12,18 NL8 NEW HAMPSHIRE NL NL MC24 MC2 NL MC12 NL NEW JERSEY NL MC4,11 MC4,11 MC4 NL MC7 NL8 NEW MEXICO MC NL42 MC16,17 NL MC NL NL8 NEW YORK NL36 MC MC16 MC4 MC4 MC7 NL NORTH CAROLINA MC MC10 MC3 MC MC NL43 PC21 NORTH DAKOTA NL NL MC24,44 MC24 NL NL PC13 OHIO NL NL MC16,17 MC MC24 NL PN21,29 OKLAHOMA MC4,45 MC4,10 MC3,4 MC4 NL MC4,7 NL OREGON MC4 NL MC3,11 MC4,24 MC4,24 MC4,11,19 NL PENNSYLVANIA NL MC MC3 MC4 NL MC5 PC RHODE ISLAND NL NL MC16 MC NL NL PC SOUTH CAROLINA MC47 NL47 MC47 NL47 NL47 MC6,47 PC21,48 SOUTH DAKOTA NL NL MC MC NL NL33 PN TENNESSEE MC MC MC3 MC4 MC6 NL PC TEXAS NL50 MC4,10,11 MC3,4,11 MC4 MC NL PN UTAH NL50 MC MC NL NL PC PN52

VERMONT NL NL MC2,3 MC2 NL NL NL VIRGINIA MC MC MC3 MC MC NL33 PN21 WASHINGTON NL54 NL54 MC3,11,24 MC23 MC23 NL NL WEST VIRGINIA NL NL MC MC NL NL PN21 WISCONSIN NL NL MC MC2 NL NL PC21 WYOMING MC NL MC3 NL NL NL PC TOTAL MC/MD 26 28 51 45 21 22 3 TOTAL PC/PN 0 0 0 0 0 2 31 TOTAL NL/NA 25 23 0 6 30 27 17

The Guttmacher Report on Public Po l i c y A u g u s t 2 0 0 0 6 MC = Minor explicitly authorized to consent. (R. HARDIN, DEPUTY ATTORNEY GENERAL, PERSONAL tant Decisions MD = Minor allowed to decide. COMMUNICATION TO P. DONOVAN, AGI, OCT. 22, PC = Parental consent explicitly required. 1990, RECONFIRMEDTO E. NASH, AGI, BY R. HARDIN, JULY 19, 2000.) DROPOUT MARRIAGE MEDICAL PLACING PN = Parental notice explicitly required. OF SCHOOL1 CARE FOR CHILD FOR NL = No law or policy found. 29. A REVISED LAW THAT REQUIRES PARENTAL CON- CHILD ADOPTION SENT IS CURRENTLY NOT IN EFFECT; MEANWHILE, THE PAR E N TA L NO T I F I C AT I O N R E Q U I R E M E N T S R E M A I N I N NOTES: IN ALL BUT FOUR STATES, THE AGE OF MAJOR- EFFECT. ITYIS 18. IN AL AND NE, ITIS 19, ANDIN PA AND MS, 6 MD PC MC MC ITIS 21; HOWEVER, IN MS 18 ISTHEAGEOFCONSENT 30. MINORMAY DROP OUTOFSCHOOLBEFOREREACH - MD6 PC MC NL9 FOR HEALTH CARE. ING AGE 16 IF EMPLOYED. MD6 PC NL MC 1. ALL STATES REQUIRE MINORS TO ATTEND SCHOOL 31. PARENT MUST BE NOTIFIED IF HIV TEST IS POSI- UNTIL A CERTAINAGE, BEYONDWHICH THEYOUNGPER - TIVE. 14 11 15 NA PC MC MC SON OR, IN A FEW STATES, THE PARENTS MAY DECIDE 32. A COURT MAY ALLOW A MINOR TODROP OUT. 14 WHETHER THE MINORWILL STAY IN SCHOOL NA PC NL MC 33. MINOR MAY CONSENT IF PARENT IS NOT “AVAIL- MD6 MD6 MC11 MC 2. MINORMUST BE AT LEAST 12. ABLE” OR IN THE CASE OF GENERAL MEDICAL CARE 3. STATE OFFICIALLY CLASSIFIES HIV/AIDS AS AN “NOT IMMEDIATELY AVAILABLE.” PC PC MC MC15 STD OR INFECTIOUS DISEASE, FOR WHICHMINORS MAY 34. MINOR MUSTBE AT LEAST 17. 6 22 11 MD MD MC MC CONSENT TOTESTING AND TREATMENT. 35. COURT MAYWAIVE PARENTAL CONSENT IF THE 14 NA PC MC MC 4. DOCTOR MAY NOTIFY PARENTS. MINORIS “SUFFICIENTLY MATURE ANDWELL INFORMED” PC MD22 MC11 NL9 5. MINOR MUST BE A HIGH SCHOOL GRADUATE, MAR- OR THE ADOPTION IS IN THECHILD’S BEST INTEREST. RIED, PREGNANTOR APARENT, OR, IN AL, AT LEAST 14. MD6 MD22 MC11 MC 36. THE STATE FUNDS A STATEWIDE PROGRAM THAT 6. MINOR MUST BE AT LEAST 16. GIVES MINORS ACCESS TO CONFIDENTIAL CONTRACEP- 26 19,27 TIVE CARE. MD MD NL MC 7. MINORMAY CONSENTIF APARENT; ALSOIFMARRIED 6 11 MD PC MC MC IN DE, KY, ME, MD, MN, MS, MO AND NV; ALSO IF 37. MINOR MAY CONSENT IF FOUND DRUG-DEPENDENT MD30 PC MC11 MC MARRIED OR PREGNANT IN CO, FL, IL, MA, MT, NJ, BY TWO DOCTORS; BARS CONSENT TO METHADONE NY AND OK. MAINTENANCE THERAPY. PC MD22 NL MC 8. LAW HAS BEEN BLOCKEDBY COURT ACTION. 38. PARENTS MUST BE NOTIFIED IF EITHER PARTY IS 32 9 YOUNGER THAN AGE 21; HOWEVER, FEMALEMINORS AT MD PC NL NL 9. LAW DOES NOT DISTINGUISH BETWEEN MINOR AND LEAST 15 AND MALE MINORS AT LEAST 17 MAY MARRY MD32 PC MC11 MC ADULTPARENTS. WITHOUT PARENTAL CONSENT. 6 22 11 15 10. EXCLUDESABORTION . PN MD MC MC 39. MINOR MUST BE AT LEAST 16 OR HAVE COMPLET- 34 11 35 MD PC MC PC 11. INCLUDES SURGERY. ED 8THGRADE, WHICHEVER OCCURS LATER. 34 9 12. ANY MINOR WHO IS MATURE ENOUGH TO UNDER- MD PC NL NL 4 0 . AF T E R E I G H T H G R A D E, C O U R T D E T E R M I N E S STAND THE NATURE AND CONSEQUENCES OF THE PRO- 6 22 15 WHETHER THE MINOR OR THE PARENTS CAN MAKE THE MD MD MC MC POSED MEDICAL OR SURGICAL TREATMENT MAY CON- DECISION. 26 9 SENT. MD PC MC NL 41. COURT MAY REQUIRE THE CONSENT OF A MINOR 13. INVOLVEMENT OFBOTH PARENTS IS REQUIRED. MD PC MC PC PARENT’SPARENT. 14. MINOR MAY NOT DROP OUT. PC PC MC PC 42. MINORMAY CONSENTTOPREGNANCYTESTINGAND MD34 PN38 MC11 MC 15. MINOR PARENT MUST HAVE A COURT-APPOINTED DIAGNOSIS. GUARDIAN. 43. LAW ALLOWS MINORS TO CONSENT WHEN PARENT 26 11 PN PC MC MC 16. LAW EXPLICITLY AUTHORIZES MINOR TO CONSENT OR GUARDIAN IS NOT “IMMEDIATELY AVAILABLE.” 39 11 15 TO HIV TESTING AND/OR TREATMENT. MD PC MC MC 44. PARENT MUSTBE SHOWN THEINFORMED CONSENT MD26 MD34 NL NL9 17. LAW DOES NOTAPPLY TO HIV TREATMENT. FORM FOR AN HIV TEST BEFORE THE MINORSIGNS IT. MD40 PC MC MC 18. MINOR MAY CONSENT IF HAS A CHILDOR DOCTOR 45. MINORMAY CONSENTIFSHEHASEVERBEENPREG - BELIEVES MINOR WOULD SUFFER “PROBABLE” HEALTH NANT. PC PC NL MC41 HAZARD IF SERVICES NOT PROVIDED; IN IL ALSO IF 46. MINOR MUSTPROVE TOTHESCHOOL BOARD THAT M I N O R I S R E F E R R E D B Y D O C T O R, C L E R G Y M A N O R MD6 PC MC11 MC THE MINOR HAS ACQUIRED “EQUIVALENT KNOWLEDGE” PLANNED PARENTHOODCLINIC; IN CO AND MS ALSOIF OF THE HIGH SCHOOL COURSES, OR CONSENT MAY BE PC PC NL MC MINORIS REFERREDBY A DOCTOR, CLERGYMAN, FAMILY GRANTEDBYTHEST ATESCHOOLBOARDFORMINORS 16 6 MD PC MC MC PLANNING CLINIC, SCHOOL OF HIGHER EDUCATION OR AND 17 WHO ARE EMPLOYED. 6 9 STATEAGENCY. MD PC NL NL 47. ANY MINOR 16 AND OLDER MAY CONSENT TO ANY 19. MINOR MUSTBE AT LEAST 15. MD6,26 PC NL MC HEALTH SERVICE OTHER THAN OPERATIONS. HEALTH 20. APPLIES TOMINORS YOUNGERTHAN AGE 16. SERVICES MAY BE RENDERED TO MINORS OF ANY AGE 14 NA PC NL MC 21. INCLUDESANALTERNATIVETO PARENTALINVOLVE - WITHOUT PARENTAL CONSENT WHEN THE PROVIDER BELIEVES THE SERVICES ARE NECESSARY. PC MD22 MC MC6 MENT OR JUDICIAL BYPASS. IN MD THE LAW PROVIDES MD46 PC NL NL9 FOR A PHYSICIAN BYPASS BUT DOES NOT HAVE A JUDI- 48. APPLIES TOMINORS YOUNGERTHAN AGE 17. CIAL BYPASS. 34 49. MINOR WHO HAS COMPLETED 8TH GRADE MAY MD PC MC PN 22. A MINOR WHO IS PREGNANT OR, IN DE, FL, GA, SEEK COURT AUTHORIZATION TODROP OUT TOWORK. 6 MD PC MC PC IN, MD AND OK, HAS A CHILD MAY MARRY WITHOUT 50. STATE FUNDS MAY NOT BE USED TO PROVIDE 49 PARENTAL CONSENT; IN FL, KY AND OK, THE MAR- M I N O R S W I T H C O N F I D E N T I A L C O N T R A C E P T I V E S E R- MD PC MC MC RIAGE MUST BE AUTHORIZED BY A COURT; IN IN AND 6 9 VICES. MD PC NL NL MD A MINORMUST BE AT LEAST 15. 51. MINORS 14–18 MAY PETITIONCOURTFORPERMIS - 34 MD PC NL MC 23. MINOR MUST BE AT LEAST 13. SION TO MARRY. 14 51 9 NA MD NL NL 24. MINOR MUST BE AT LEAST 14. 52. LAW DOES NOT INCLUDE A JUDICIALBYPASS. 14 NA PC MC MC 25. EXCLUDES SURGERY. 53. MINOR MUST BE AT LEAST 16, HAVE COMPLETED 26. MINOR MAY DROP OUT IF EMPLOYED AND IN MA, 10THGRADE ORBE EXCUSEDBY THESUPERINTENDENT. MD53 PC NL MC MO AND NE IS 14, IN HI IS 15, IN MA ALSO IF HAS 54. PROVIDERS RELY ON STATE V. KOOME, WHICH 14 11 NA PC MC MC COMPLETED THE 6THGRADE; IN NE ALSO IF HASCOM- HELD THAT MINORS HAVE THE SAME CONSTITUTIONAL PLETED THE 8TH GRADE. OTHERWISE A MINOR MAY MD6 PC NL MC15 RIGHTS AS ADULTS, TO PROVIDE CONFIDENTIAL CON- DROP OUT AT 16 IN THESE STATES. MD30 PC NL MC TRACEPTIVE SERVICES ANDPRENATALCARETOMINORS . 27. MINORS NEED JUDICIAL AUTHORIZATION. 14 9 55. MINOR MUST BE AT LEAST 16 AND HAVE COM- NA PC NL NL 28. THE STATE’S MEDICAL CONSENT STATUTES ALLOW PLETED 10TH GRADE. 55 MD PC NL MC “ANY PERSON OF ORDINARY INTELLIGENCE AND AWARE- 34 11 30 35 NESS” TO CONSENT TO HOSPITAL, MEDICAL, SURGICAL ORDENTALCARE . ALTHOUGH A LATERSECTIONAUTHO- 9 40 0 5 RIZES PARENTS TO CONSENT FOR A MINOR CHILD, THE 8 0 21 11 ATTORNEY GENERAL’S OFFICE “FREQUENTLY” INTER- PRETS THE LAW AS AUTHORIZING MINORS TOCONSENT.

The Guttmacher Report on Public Po l i c y A u g u s t 2 0 0 0 7 Most states, for example, permit teenagers to drop out care if they have to inform a parent or have their parent’s high school without their parents’ approval, despite the consent. “Minors’ consent laws are extremely important,” documented adverse effects associated with the lack of argues Abigail English, director of the Center for a diploma. Although all states require young people to Adolescent Health and the Law. “They encourage young stay in school at least to age 16 or 17, except in very people to seek the health care services they need and limited circumstances, once that age threshold has been enable them to talk candidly with their providers.” reached, the states generally impose no barriers to minors’ deciding to leave. A few states permit a minor Advocates of parental involvement laws, which include to marry without parental consent under certain cir- organizations such as Focus on the Family and the cumstances, usually pregnancy. Family Research Council, maintain that minors’ consent laws reflect “an increasing nonchalance about the sanc- Notably, more than half of the states that require tity of the family unit on the part of the government.” parental involvement for abortion permit a pregnant Government policies, they contend, undermine parental minor to make the decision to continue her pregnancy authority and family autonomy. Conservative activists and to consent to prenatal care and delivery without also argue that granting minors access to confidential consulting a parent. In addition, states appear to con- services is tantamount to condoning sexual activity. sider a minor who is a parent to be fully competent to Despite access to contraceptives, they say, pregnancy make major decisions affecting the health and future of rates among teens remain high. “The current prescrip- his or her child, even though many of these same states tion for preventing pregnancy and STDs among adoles- require a minor to involve her parents if she decides to cents has failed miserably in solving the problem,” terminate her pregnancy. according to Focus on the Family. “Parental involvement and the transmitting of the parent’s values are the most • Twenty-nine states and the District of Columbia cur- effective deterrent in preventing early sexual activity.” rently have laws that authorize a minor parent to con- sent to medical care for his or her child. Providers who serve young people agree that parental • Most striking, 34 states and the District of Columbia involvement is desirable but point out that in some explicitly permit a minor mother to place her child for instances, it is not to a minor’s benefit. “In the best of adoption without her own parents’ permission or all worlds, teens and parents would work in partnership knowledge. In addition, 11 states make no distinction on decisions that could have a lifelong impact,” says between minor and adult parents; in these states, it Leslie Tarr Laurie, president and chief executive officer appears, the decision to relinquish her child for adop- of Tapestry Health Systems, a health services provider tion rests with the young mother. in western Massachusetts. “But we see teens all the time whose parents are not their best advocates. In our In practice, it is likely that some adoption agencies and state, where the greatest growth in HIV cases is among judges (all adoptions, regardless of the mother’s age, adolescents, access to reproductive health care is a mat- have to be approved by a court) require that a young ter of life and death. Confidentiality is the cornerstone woman’s parents be involved in the adoption decision. of our services,” Laurie reports. “We help teenagers In principle, however, virtually all states consider a avoid not only the costly and often tragic consequences minor mother capable of making an independent deci- of unintended pregnancy and childbearing, but also an sion about whether or not to place her child for adop- early death from AIDS. The bottom line is, if we don’t tion (although a few states require that the minor have assure access to confidential health care, teenagers sim- a court-appointed guardian). ply will stop seeking the care they desire and need.”

The research on which this article is based was supported in part by Ensuring Minors’ Access to Health Care the U.S. Department of Health and Human Services under grant FPR000072-01. The conclusions and opinions expressed in this arti- Most youth-serving agencies and medical professionals cle, however, are those of the authors and The Alan Guttmacher believe that access to confidential services is essential, Institute. because many sexually active adolescents will not seek

The Guttmacher Report on Public Po l i c y A u g u s t 2 0 0 0 8