Professional Practice, Ethics, and Legal Issues
Professional practice items test consent, confidentiality, reporting duties, and scope. Many answers are decided by state law, and the exam wants you to know that and to act on it.
Consent
- Parents or legal guardians consent for minors.
- Emancipated minors (married, military, court-declared) consent for themselves.
- Many states allow minors to consent to STI testing and treatment, contraception, prenatal care, and some mental health and substance use care without a parent.
- Emergency treatment may proceed under implied consent when delay would risk life or limb.
Assent and research
- Assent is the child's developmental agreement, required for research under an IRB-approved protocol. It is not legally binding and does not replace parental permission.
Confidentiality and reporting
- Explain the limits of confidentiality up front: danger to self or others, and suspected abuse.
- Mandated reporters must report reasonable suspicion of abuse or neglect to child protective services; good-faith reports carry immunity. You need not prove anything, and you do not investigate.
- HIPAA permits disclosure for treatment, payment, operations, and as required by law.
Documentation and end of life
- Chart objective findings, who consented, what was taught, and the response - contemporaneously and factually.
- DNR orders in children require informed parent permission and a physician order; honor family wishes within policy.
Worked example
A 16-year-old asks for confidential chlamydia testing. Verify your state's minor consent law, tell her what will and will not be shared and why, provide confidential testing and treatment, and document the encounter per policy. Do not notify parents against state law.
Traps
- Promising absolute confidentiality.
- Demanding parental permission when state law allows minor consent.
- Investigating suspected abuse yourself instead of reporting.
- Treating a signature as proof of understanding.