Legal, Ethical, Confidentiality, and Health Systems Issues in Adolescent Care
Consent and confidentiality
Minors' consent laws vary by state. Many allow confidential consent for STI testing and treatment, contraception, pregnancy care, and some mental health care. Confidentiality is not absolute: disclose for imminent danger to self or others, suspected abuse or neglect, and court orders. Explain limits at the start. HIPAA permits disclosure with consent and in limited exceptions, but state law may be stricter.
Ethics and systems
Use assent for minors and respect developing autonomy. Mandatory reporting laws require reporting reasonable suspicion of abuse. Research with minors generally requires parental permission and minor assent, with exceptions. Insurance explanation-of-benefits statements can inadvertently disclose confidential care; discuss billing privacy. School-based health centers and Title X clinics can offer confidential services.
Traps
Do not promise absolute confidentiality. Do not tell a parent everything without the adolescent's consent unless an exception applies. Do not assume the age of consent is the same as the age of majority. Do not ignore guardianship and foster care issues.
Worked example
A 16-year-old requests confidential STI testing. Explain confidentiality and its limits, obtain history, test using NAAT, treat if positive, and discuss partner notification. Disclose to parents only if required by law or with consent, unless abuse or imminent danger is present.