Commentary: consensual adolescent sexual activity with adult partners--conflict between confidentiality and physician reporting requirements under child abuse laws.

Abstract

Over the past several decades, sexual activity between unmarried adolescents and adult partners has received increased public scrutiny, especially as it relates to teenage pregnancy.1 Although the total adolescent birth rate has declined over the past decade, the birth rate for teenagers younger than 15 years has remained stable.2 Adult fathers are responsible for one quarter of births to adolescents <15 years of age, and they typically are nearly 9 years older than the mothers.3 Because this sexual behavior is associated with an increase in teenage pregnancy, with all of its associated social consequences, public policy has dictated better enforcement of laws that prohibit such activity. This is one reason for the revision and increased enforcement of many state statutory rape laws that criminalize certain sexual activity between adolescents and adult partners. Individuals, however, generally do not have a legal duty to report a crime. Thus, physician reporting of such sexual behavior under these criminal statutory rape laws is premised on ethical and other considerations. Physicians encountering teenagers involved in sexual relationships with adults may, however, be mandated to report such activity because of reporting requirements of child protection laws (ie, abuse and neglect), if the sexual activity is construed as abuse or neglect. A physician who becomes aware of sexual activity between an adolescent and an adult partner must then decide between confidentiality and disclosure. Physicians may be ethically troubled about maintaining confidentiality when parents are unaware of such activity, particularly if reporting to child protection agencies is also needed. Conversely, confidentiality between adolescents and their physicians is essential for their continued participation in medical care.4,5 In fact, physicians who specialize in treating adolescents prefer to maintain confidentiality about most consensual sexual situations between adolescents and adult partners, except for those relationships with a …