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March 17, 1993, Vol 269, No. 11 >
ARTICLE | March 17, 1993

Confidential Health Services for Adolescents FREE

Yank D. Coble, Jr, MD; E. Harvey Estes, Jr, MD; C. Alvin Head, MD; Mitchell S. Karlan, MD; William R. Kennedy, MD; Patricia Joy Numann, MD; William C. Scott, MD; W. Douglas Skelton, MD; Richard M. Steinhilber, MD; Jack P. Strong, MD; Christine C. Toevs; Henry N. Wagner, Jr, MD; Jerod M. Loeb, PhD; Robert C. Rinaldi, PhD; Janet E. Gans, PhD
[+] Author Affiliations

This report was presented at the 1992 House of Delegates Annual Meeting as Report A of the Council on Scientific Affairs. The recommendations were adopted as amended, and the remainder of the report was filed.

This report is not intended to be construed or to serve as a standard of medical care. Standards of medical care are determined on the basis of all the facts and circumstances involved in an individual case and are subject to change as scientific knowledge and technology advance and patterns of practice evolve. This report reflects the scientific literature as of June 1992.

Reprint requests to the Group on Science and Technology, American Medical Association, 515 N State St, Chicago, IL 60610 (Janet E. Gans, PhD).


JAMA. 1993;269(11):1420-1424. doi:10.1001/jama.1993.03500110088042
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References

DURING the past 20 years rates of suicide,1 illicit drug use,2 sexually transmissible diseases (STDs),3 and births to single mothers4 have increased dramatically among adolescents. The changing nature of adolescent morbidity and mortality makes it critical that they receive medical care on a timely basis, and that barriers to care are removed.5 One such barrier for many adolescents is their concern about whether sensitive information shared in private with their physician will remain confidential.

See also p 1404.

This report reviews adolescents' need for confidential health services and support by physicians and organized medicine for confidential care. Examined are two major barriers to confidential medical care: the prerogative to provide informed consent for medical treatment and payment for health services. The report describes how physicians can balance parental involvement and adolescents' needs for privacy in health care decisions and strategies to allay parental concerns and

REFERENCES

1 +
Fingerhut LA, Kleinman JC.  Trends and current status in childhood mortality: United States, 1900-85. Vital Health Stat 3 . 1989;;No. (26) .
2 +
Johnston LD, O'Malley PM, Bachman JG. Illicit Drug Use, Smoking, and Drinking by America's High School Students, College Students, and Young Adults: 1975-1987 . Washington, DC: US Dept of Health and Human Services; 1988;. Publication ADM 89-1602.
3 +
Shafer MA, Irwin CE Jr, Sweet RL.  Acute salpingitis in the adolescent female. J Pediatr . 1982;; 100:339-350.
4 +
Pittman K, Adams G. Teenage Pregnancy: An Advocate's Guide to the Numbers . Washington, DC: Children's Defense Fund; 1988;.
5 +
Gans JE, McManus MA, Newacheck PW. Adolescent Health Care: Use, Costs, and Problems of Access . Chicago, Ill: American Medical Association; 1991;.
6 +
National Conference of Commissioners on Uniform State Laws. Uniform Health Care Information Act, Uniform Laws Annotated, Part I . St Paul, Minn: West Publishing Co; 1988;;9:475-520.
7 +
Council on Ethical and Judicial Affairs. Current Opinions—1989 . Chicago, Ill: American Medical Association; 1989;:section 5.05.
8 +
Council on Long Range Planning and Development. AMA Policy Compendium . Chicago, Ill: American Medical Association; 1990;.
9 +
Hofmann AD.  A rational policy toward consent and confidentiality in adolescent health care. J Adolesc Health Care . 1980;;1:9-17.
10 +
Marks A, Malizio J, Hoch J, Brody R, Fisher M.  Assessment of health needs and willingness to utilize health care resources of adolescents in a suburban population. J Pediatr . 1983;;102:456-460.
11 +
Chamie M, Eisman S, Forrest JD, Orr MT, Torres A.  Factors affecting adolescents' use of family planning clinics. Fam Plann Perspect . 1982;;14: 126-139.
12 +
Mosher WD. Use of Family Planning Services in the United States: 1982 and 1988 . Hyattsville, Md: National Center for Health Statistics; 1990;. Publication PHS 90-1250.
13 +
Lovett J, Wald M.  Physicians' attitudes toward confidential care for adolescents. J Pediatr. 1985;; 106:517-521.
14 +
Harvey LK, Shubat SC. Physician Opinion on Health Care Issues: 1987 . Chicago, Ill: American Medical Association; 1987;.
15 +
Novack D, Detering B, Arnold R, Forrow L, Ladinsky M, Pezzullo JC.  Physicians' attitudes toward using deception to resolve difficult ethical problems. JAMA . 1989;;261:2980-2985.
16 +
Resnick MD, Litman TJ, Blum WR.  Physician attitudes toward confidentiality of treatment for adolescence: findings from the Upper Midwest Regional Physician Survey. J Adolesc Health . 1992;; 13;616-622.
17 +
House of Delegates. Family Planning . Chicago, Ill: American Medical Association; June 1971;. Report 82.
18 +
House of Delegates. Opposition to HHS Regulations on Contraceptive Services to Minors . Chicago, Ill: American Medical Association; December 1983;. Resolution 65.
19 +
Council on Ethical and Judicial Affairs, American Medical Association.  Mandatory parental consent to abortion. JAMA . 1993;;269:82-86.
20 +
American College of Obstetricians and Gynecologisis. ACOG Statement of Policy: Confidentiality in Adolescent Health Care . Washington, DC: American College of Obstetricians and Gynecologists; 1988;.
21 +
American Medical Association National Coalition on Adolescent Health; Gans J, ed. Policy Compendium on Confidential Health Services for Adolescents . Chicago, Ill: American Medical Association; 1993;.
22 +
English A.  Legal and ethical concerns.  In: Mc-Anarney ER, Kreipe R, Orr DP, Comerci GD, eds. Textbook of Adolescent Medicine . Philadelphia, Pa: WB Saunders Co; 1992;.
23 +
Neinstein LS. Adolescent Health Care: A Practical Guide . 2nd ed. Baltimore, Md: Urban & Schwarzenberg; 1991;.
24 +
English A.  Ensuring access to health care for teenagers: legal and ethical issues concerning consent and confidentiality. Youth Law News . 1985;;45:22-24.
25 +
Morrissey JM, Hofmann AD, Thrope JC. Consent and Confidentiality in the Health Care of Children and Adolescents: A Legal Guide . New York, NY: Free Press; 1986;.
26 +
Gittler J, Quigley-Rick M, Saks MJ. Adolescent Health Care Decision-Making: The Law and Public Policy . New York, NY: Carnegie Corp; 1990;.
27 +
English A.  Treating adolescents: legal and ethical consideration. Med Clin North Am . 1990;;74: 1097-1112.
28 +
Center for Substance Abuse Prevention. Legal Issues for Alcohol and Other Drug Use Prevention and Treatment Programs Serving High-Risk Youth . Washington, DC: Center for Substance Abuse Prevention; 1990;. Publication ADM 90-1674.
29 +
Holder AR.  Disclosure and consent problems in pediatrics. Law Med Health Care . 1988;;16:219-228.
30 +
Holder AR.  Minors' rights to consent to medical care. JAMA . 1987;;257:3400-3402.
31 +
Crosby MC, English A.  Mandatory parental involvement/judicial bypass laws: do they promote adolescents' health? J Adolesc Health Care . 1991;; 12:143-147.
32 +
Donovan P. Our Daughters' Decisions: The Conflict in State Law on Abortion and Other Issues . New York, NY: The Alan Guttmacher Institute; 1992;.
33 +
Henshaw SK, Kost K.  Parental involvement in minors' abortion decisions. Fam Plann Perspect . 1992;;24:197-207, 213.
34 +
Blum RW, Resnick MD, Stark TA.  The impact of parental notification law on adolescent abortion decision-making. Am J Public Health . 1987;;77:619-620.
35 +
Yates S, Pliner AJ.  Judging maturity in the courts: the Massachusetts consent statute. Am J Public Health . 1988;;78:646-649.
36 +
Cartoof VG, Klerman LV.  Parental consent for abortion: impact of the Massachusetts law. Am J Public Health . 1986;;76:397-440.
37 +
Gold RB. Abortion and Women's Health: A Turning Point for America? New York, NY: The Alan Guttmacher Institute; 1990;.
38 +
Greenberger MD, Connor K.  Parental notice and consent for abortion: out of step with family law principles and policies. Fam Plann Perspect . 1991;; 23:31-35.
39 +
Rogers JL, Boruch RF, Stoms GB, DeMoya D.  Impact of the Minnesota parental notification law on abortion and birth. Am J Public Health . 1991;; 81:294-298.
40 +
The Alan Guttmacher Institute.  Teenage abortions fell after Minnesota imposed parental notification law. Fam Plann Perspect . 1991;;23:240.
41 +
Torres A.  Does your mother know? Fam Plann Perspect . 1978;;10:280-282.
42 +
Zabin LS, Hirsch MB, Emerson MR, Raymond E.  To whom do inner-city minors talk about their pregnancies? adolescents' communication with parents and parent surrogates. Fam Plann Perspect . 1992;;24:148-154, 173.
43 +
English A, Tereszkiewicz L. School-Based Health Clinics: Legal Issues . San Francisco, Calif: National Center for Youth Law; 1988;.
44 +
Fisher M, Marks A, Trieller K, et al.  Are adolescents able and willing to pay the fee for confidential health care? J Pediatr . 1985;;107:480-483.
45 +
King N, Cross AW.  Children as decision-makers: guidelines for pediatricians. J Pediatr . 1989;; 115:10-16.
46 +
Silber TJ.  Justified paternalism in adolescent health care: cases of anorexia nervosa and substance abuse. J Adolesc Health . 1989;;10:449-453.

Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Fingerhut LA, Kleinman JC.  Trends and current status in childhood mortality: United States, 1900-85. Vital Health Stat 3 . 1989;;No. (26) .
2 +
Johnston LD, O'Malley PM, Bachman JG. Illicit Drug Use, Smoking, and Drinking by America's High School Students, College Students, and Young Adults: 1975-1987 . Washington, DC: US Dept of Health and Human Services; 1988;. Publication ADM 89-1602.
3 +
Shafer MA, Irwin CE Jr, Sweet RL.  Acute salpingitis in the adolescent female. J Pediatr . 1982;; 100:339-350.
4 +
Pittman K, Adams G. Teenage Pregnancy: An Advocate's Guide to the Numbers . Washington, DC: Children's Defense Fund; 1988;.
5 +
Gans JE, McManus MA, Newacheck PW. Adolescent Health Care: Use, Costs, and Problems of Access . Chicago, Ill: American Medical Association; 1991;.
6 +
National Conference of Commissioners on Uniform State Laws. Uniform Health Care Information Act, Uniform Laws Annotated, Part I . St Paul, Minn: West Publishing Co; 1988;;9:475-520.
7 +
Council on Ethical and Judicial Affairs. Current Opinions—1989 . Chicago, Ill: American Medical Association; 1989;:section 5.05.
8 +
Council on Long Range Planning and Development. AMA Policy Compendium . Chicago, Ill: American Medical Association; 1990;.
9 +
Hofmann AD.  A rational policy toward consent and confidentiality in adolescent health care. J Adolesc Health Care . 1980;;1:9-17.
10 +
Marks A, Malizio J, Hoch J, Brody R, Fisher M.  Assessment of health needs and willingness to utilize health care resources of adolescents in a suburban population. J Pediatr . 1983;;102:456-460.
11 +
Chamie M, Eisman S, Forrest JD, Orr MT, Torres A.  Factors affecting adolescents' use of family planning clinics. Fam Plann Perspect . 1982;;14: 126-139.
12 +
Mosher WD. Use of Family Planning Services in the United States: 1982 and 1988 . Hyattsville, Md: National Center for Health Statistics; 1990;. Publication PHS 90-1250.
13 +
Lovett J, Wald M.  Physicians' attitudes toward confidential care for adolescents. J Pediatr. 1985;; 106:517-521.
14 +
Harvey LK, Shubat SC. Physician Opinion on Health Care Issues: 1987 . Chicago, Ill: American Medical Association; 1987;.
15 +
Novack D, Detering B, Arnold R, Forrow L, Ladinsky M, Pezzullo JC.  Physicians' attitudes toward using deception to resolve difficult ethical problems. JAMA . 1989;;261:2980-2985.
16 +
Resnick MD, Litman TJ, Blum WR.  Physician attitudes toward confidentiality of treatment for adolescence: findings from the Upper Midwest Regional Physician Survey. J Adolesc Health . 1992;; 13;616-622.
17 +
House of Delegates. Family Planning . Chicago, Ill: American Medical Association; June 1971;. Report 82.
18 +
House of Delegates. Opposition to HHS Regulations on Contraceptive Services to Minors . Chicago, Ill: American Medical Association; December 1983;. Resolution 65.
19 +
Council on Ethical and Judicial Affairs, American Medical Association.  Mandatory parental consent to abortion. JAMA . 1993;;269:82-86.
20 +
American College of Obstetricians and Gynecologisis. ACOG Statement of Policy: Confidentiality in Adolescent Health Care . Washington, DC: American College of Obstetricians and Gynecologists; 1988;.
21 +
American Medical Association National Coalition on Adolescent Health; Gans J, ed. Policy Compendium on Confidential Health Services for Adolescents . Chicago, Ill: American Medical Association; 1993;.
22 +
English A.  Legal and ethical concerns.  In: Mc-Anarney ER, Kreipe R, Orr DP, Comerci GD, eds. Textbook of Adolescent Medicine . Philadelphia, Pa: WB Saunders Co; 1992;.
23 +
Neinstein LS. Adolescent Health Care: A Practical Guide . 2nd ed. Baltimore, Md: Urban & Schwarzenberg; 1991;.
24 +
English A.  Ensuring access to health care for teenagers: legal and ethical issues concerning consent and confidentiality. Youth Law News . 1985;;45:22-24.
25 +
Morrissey JM, Hofmann AD, Thrope JC. Consent and Confidentiality in the Health Care of Children and Adolescents: A Legal Guide . New York, NY: Free Press; 1986;.
26 +
Gittler J, Quigley-Rick M, Saks MJ. Adolescent Health Care Decision-Making: The Law and Public Policy . New York, NY: Carnegie Corp; 1990;.
27 +
English A.  Treating adolescents: legal and ethical consideration. Med Clin North Am . 1990;;74: 1097-1112.
28 +
Center for Substance Abuse Prevention. Legal Issues for Alcohol and Other Drug Use Prevention and Treatment Programs Serving High-Risk Youth . Washington, DC: Center for Substance Abuse Prevention; 1990;. Publication ADM 90-1674.
29 +
Holder AR.  Disclosure and consent problems in pediatrics. Law Med Health Care . 1988;;16:219-228.
30 +
Holder AR.  Minors' rights to consent to medical care. JAMA . 1987;;257:3400-3402.
31 +
Crosby MC, English A.  Mandatory parental involvement/judicial bypass laws: do they promote adolescents' health? J Adolesc Health Care . 1991;; 12:143-147.
32 +
Donovan P. Our Daughters' Decisions: The Conflict in State Law on Abortion and Other Issues . New York, NY: The Alan Guttmacher Institute; 1992;.
33 +
Henshaw SK, Kost K.  Parental involvement in minors' abortion decisions. Fam Plann Perspect . 1992;;24:197-207, 213.
34 +
Blum RW, Resnick MD, Stark TA.  The impact of parental notification law on adolescent abortion decision-making. Am J Public Health . 1987;;77:619-620.
35 +
Yates S, Pliner AJ.  Judging maturity in the courts: the Massachusetts consent statute. Am J Public Health . 1988;;78:646-649.
36 +
Cartoof VG, Klerman LV.  Parental consent for abortion: impact of the Massachusetts law. Am J Public Health . 1986;;76:397-440.
37 +
Gold RB. Abortion and Women's Health: A Turning Point for America? New York, NY: The Alan Guttmacher Institute; 1990;.
38 +
Greenberger MD, Connor K.  Parental notice and consent for abortion: out of step with family law principles and policies. Fam Plann Perspect . 1991;; 23:31-35.
39 +
Rogers JL, Boruch RF, Stoms GB, DeMoya D.  Impact of the Minnesota parental notification law on abortion and birth. Am J Public Health . 1991;; 81:294-298.
40 +
The Alan Guttmacher Institute.  Teenage abortions fell after Minnesota imposed parental notification law. Fam Plann Perspect . 1991;;23:240.
41 +
Torres A.  Does your mother know? Fam Plann Perspect . 1978;;10:280-282.
42 +
Zabin LS, Hirsch MB, Emerson MR, Raymond E.  To whom do inner-city minors talk about their pregnancies? adolescents' communication with parents and parent surrogates. Fam Plann Perspect . 1992;;24:148-154, 173.
43 +
English A, Tereszkiewicz L. School-Based Health Clinics: Legal Issues . San Francisco, Calif: National Center for Youth Law; 1988;.
44 +
Fisher M, Marks A, Trieller K, et al.  Are adolescents able and willing to pay the fee for confidential health care? J Pediatr . 1985;;107:480-483.
45 +
King N, Cross AW.  Children as decision-makers: guidelines for pediatricians. J Pediatr . 1989;; 115:10-16.
46 +
Silber TJ.  Justified paternalism in adolescent health care: cases of anorexia nervosa and substance abuse. J Adolesc Health . 1989;;10:449-453.

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