A rational policy toward consent and confidentiality in adolescent health care

Abstract

In this paper I explore and seek to reconcile current conflicts surrounding consent and confidentiality in adolescent health care. Based on an analysis of pragmatic need, cognitive maturation, and determinants of parent-minor relationships, it is proposed that ethical and legal systems for adolescents must be different from those suitable for children and that traditional minority concepts improperly embrace both groups under the same dependency umbrella. Rules governing consent and confidentiality must respond to the unique developmental status of young people as individuals who are increasingly capable of exercising rational choice and giving informed consent, yet still need flexibly proffered guidance and support by parents and/or other adults. This approach will afford adolescents better health protection and better preparation for assuming responsible, self-directed health care practices as an adult than will the application of standard minority-majority precepts. Specific policy recommendations include: (a) the provision of options for adolescents to obtain confidential health services as necessary for health protection and/or as suitable for their level of maturity; (b) the establishment of counseling standards that require confidential services to adolescents to include developmentally appropriate guidance and support rendered by professionals trained in adolescent health; (c) the encouragement of adolescents receiving confidential care to consider whether or not they should involve their parents, recognizing that most young people are advantaged thereby; and (d) when confidentiality is not at issue, the active participation of adolescents in their health care decisions are affirmed by obtaining their informed consent.