Reproductive Health

Sexually Transmitted Diseases

Under the statutes of some jurisdictions, parental consent is not required for treatment of sexually transmitted diseases in minors. Similarly, minors may be able to give consent for HIV testing without notification of their parents or legal guardians.

Table 4-1. Considerations in assessment of children and adolescents for emergency medication treatment

1. Benefits of treatment and risks of withholding treatment

2. Benefits and potential risks of proposed medication

3. Necessity of physical restraint to administer medication

4. Route of medication administration: Is oral administration possible? If not, is alternative route already in place (e.g., intravenous access or gastric tube), or would medication have to be administered rectally or intramuscularly and potentially be more traumatic?

5. Patient age: A mature minor may be able to consent to treatment. Efforts should be made to document that physician has communicated with patient before giving medication. The younger the child, the less input he or she would have regarding treatment.

6. Level of anxiety: Mild panic attack episodes characterized by hyperventilation and tremors may not require any immediate intervention, whereas severe attacks associated with acute agitation (e.g., pulling out intravenous or nasogastric tubes or removal of oxygen mask) would constitute a higher level of urgency.

7. Level of agitation: Mild episodes characterized by restlessness may not require immediate intervention, whereas severe agitation associated with significant threat of harm to self or others would constitute a higher level of urgency.

Pregnancy Prevention and Treatment

Minors can generally consent to medical care related to the prevention (contraceptives) or treatment of pregnancy, including prenatal care.

The ages of the patient and partner, and the nature of the activity and relationship, may trigger other clinical and legal obligations. In certain jurisdictions, minors ages 16 and older can legally consent to sex. Some contraceptives require surgical procedure (e.g., subdermal implants), in which case consent of the parent or guardian is generally recommended. Minors cannot consent to sterilization, nor can parents on their behalf, without involvement of the courts.

Pregnancy Termination

Consent issues regarding abortion are complex, with individual jurisdictions having different laws governing the authorization for an abortion without parental consent. Emancipated (married, widowed, or divorced) minors under age 18 may generally consent to an abortion. In some states, an unmarried minor younger than age 18 cannot have an abortion unless the physician first gets written consent of the pregnant woman and a parent or guardian or a court order authorizing the procedure. If the minor does not want to tell her parent or guardian that she is pregnant or if the parent or guardian does not consent to an abortion, the minor can apply to a court to ask permission for an abortion. Parents cannot provide consent for an abortion if the minor does not want to go through with the procedure.

Sexual Abuse

Victims of sexual assault can be evaluated and treated without parental consent, but local statutes may require the physician to inform the parent or legal guardian unless the parent or legal guardian is suspected of having committed the assault. The younger the age of the minor, the more caution clinicians should exercise before deciding not to notify the parent of a child who has been sexually molested.

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