“Do you have to tell my mom?” Minors, Health Care & the Law

Adolescence is a complicated period of emotional, physical and psychological maturation. Teens struggle to develop a sense of self and understand the world around oneself and must make important choices related to sex, alcohol and drugs. But minors are generally unaware of their rights to consult with or seek treatment from medical professionals on a confidential basis. Lacking information, places teens at risk. In a regional survey of suburban adolescents only 45% of teens said they would seek care for depression if their parents would be notified, and less than 20% would seek care related to birth control, STDs or drug use. We have developed a reference card, available in English and Spanish outlining the rights to minors to consent to various health care services. Limited numbers are hard copies are available by contacting us: duvall@aclupa.org

Likewise, physicians and health professionals are under-educated about when they may provide services to teens absent parental knowledge and/or consent. To address this problem among Pennsylvania medical professionals, the Duvall Project developed a comprehensive training program called, “Do you have to tell my mom? Minors, Health Care & the Law.” The training manual and supporting material includes 14 case histories covering reproductive health, mental health, substance abuse and treatment following sexual assault.

For each case, we provide a comprehensive legal analysis of the issues and address practical concerns about insurance, privacy, and so on. Since its inception 15 years ago, the program has been delivered across the state in a variety of fields from obstetrics and gynecology, emergency medicine, adolescent medicine, pediatrics, AIDS advocates, school guidance counselors, teachers and nurses, sexual assault advocates, etc.

Duvall staff members and volunteers are available to give presentations for grand rounds, in-service trainings and so on. If you would be interested in such a presentation, please contact us at: duvall@aclupa.org

Excerpt from a manual for trainers

Case 1

Katherine Ryan (KR) is a 15-year old who comes to the clinic and wants to know whether she can see a doctor and receive treatment without parental consent.

  • Can the clinician treat KR as she is requesting?

Maybe. Generally, parental consent is required before medical care can be rendered to someone under the age of 18 (a “minor”). However, there are several exceptions to this rule. First, there are four categories of minors who can consent to all health care services except abortion: (1) those who have graduated from high school; or (2) those who have been married; or (3) those who have been pregnant. Additionally, an emancipated minor may consent to all health services including abortion. See 35 P.S. § 10101. The clinician should determine whether KR falls into one of these categories. If not, the clinician should ask KR very generally what her area of concern is to determine whether it is an area in which all persons under the age of 18 are entitled to receive health services upon their own consent.

KR explains that she is concerned she is pregnant. She would like a pregnancy test

  • Can the clinician give KR a pregnancy test without parental consent?

Yes, the clinician can give KR a pregnancy test without parental consent. Pennsylvania law provides “[a]ny minor may give effective consent for medical and health services to determine the presence of or to treat pregnancy…and the consent of no other person shall be necessary.” 35 P.S. § 10103 (emphasis added).

  • Will the clinician have to report the results to KR’s parents?

No. Generally, under Pennsylvania law, the right to consent entitles the minor to confidentiality. Pennsylvania law is explicit when clinicians are required or even permitted to inform a parent of a minor’s treatment despite the minor’s ability to consent. See, e.g., 71 P.S. § 1690.112(a).

The test result is negative; KR is not pregnant. The clinician discusses her sexual practices and discovers that KR has recently begun having unprotected intercourse with her boyfriend. The clinician wants to discuss birth control options with KR

  • Can the clinician discuss the birth control options with KR without parental consent?

Yes, a federal court in Pennsylvania has interpreted the Minor’s Consent Act to include a right of minors’ to receive contraception on their own consent. See Parents United for a Better Sch. V. Sch. Dist. Of Philadelphia, 978 F, Supp. 197, 208 (E.D. Pa. 1997), aff’d on other grounds, 148 F. 3d 260 (3d Cir. 1998). The same federal district court also observed that conditioning the receipt of contraception on parental consent would violate the U.S. Constitution. See id. at 209(“[T]he Constitution forecloses an interpretation of Pennsylvania law that would compel parental consent whenever a minor seeks contraceptives.”) (citing Carey v. Population Servs. Int’l, 431 U.S. 678, 693 (1977)). Therefore, the clinician may provide KR with birth control pills without informing or obtaining the consent of her parents.

Finally, it is noteworthy that a clinician working in a facility that receives Title X funding is explicitly prohibited under federal law from requiring a minor to get parental consent before providing the minor with contraception. See 42 U.S.C. § 300, et seq. Additionally, the Social Security Act guarantees patients who participate in the Medicaid program confidential access to contraception without parental consent. See 42 U.S.C. § 1396 (a)(4)(C).

KR is receptive to the idea of birth control but stresses that her parents cannot find out she has received it. She tells the clinician that her parents are staunchly opposed to premarital sex; they have repeatedly refused to put her on birth control, even after her family clinician said he believed it would help control the regularity and severity of her periods.

  • Does knowing about the opposition of KR’s parents to KR receiving birth control change the clinician’s obligations?

No. The purpose of laws permitting minors to make certain decisions is that they permit the mirror to make the decision he or she chooses even when the parents disagree.

After discussing all of the options with the clinician, KR asks to receive a Depo-Provera shot. She believes this form of birth control suits her best because her parents are unlikely to find out.

  • Can the clinician administer the shot without the consent of KR’s parents?

Yes. There is no distinction in the law between orally administered contraceptives, i.e. birth control pills, and other kinds of contraception requiring medical prescriptions, including Depo-Provera, which is administered as a shot, or a diaphragm, which is inserted.

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