In most cases, the law grants people autonomy over their own bodies, including a constitutional right to consent to or refuse medical treatment; however, for teenagers, that right is curbed by their parents, who have the right to control medical procedures in most cases until that child turns eighteen. There has been a lot of news lately where teens are fighting back against their parents over medical treatments, procedures, and even appointments. Read on to learn more about this issue, including mental health, substance abuse, and physical problems.

Parent – Child Medical Care

Traditionally when a teenager, child, or infant goes for medical treatment, including routine check-ups, parents are welcome in the room. Many doctors’ offices allow the parent in, while some do so only if the child says the parent can come in. This is especially true in more sensitive appointments. In most cases, a child’s parents or guardians are the ones who know the most about the child.

According to the University of Washington School of Medicine:

Parents have the responsibility and authority to make medical decisions on behalf of their children. This includes the right to refuse or discontinue treatments, even those that may be life-sustaining. However, parental decision-making should be guided by the best interests of the child. Decisions that are clearly not in a child’s best interest can and should be challenged.

The concern that a parent could make a decision that isn’t in their child’s best interest has led to some cases where children and teenagers start to fight back against their parents when it comes to medical care.

What are age of consent laws?

Doctors of all kinds, from dentists to ophthalmologists, have grappled for years with age of consent when it comes to mature adolescents. In a 2013 Pediatrics article, the authors stated:

It is well understood in the medical community that adolescents’ aptitude to make rational, responsible decisions changes over time and that older teenagers and young adults have substantially similar cognitive capacities.

According to Doctor Will See You Now, this question of maturity, and the automatic assumption of parent’s rights, endures as the general background rule that will apply in the majority of court cases regarding treatment of teens. The site points out that most frequently, parents are “free to sort among alternatives and elect the course of treatment based on his or her assessment of the child’s best interests.” This rule applies to any patient below the age of majority, 18 in most states, although in a small number of states, such as Delaware (19), Mississippi (21), and Nebraska (19),  it is higher. In Arkansas, Nevada, Ohio, Utah, and Wisconsin the age of majority varies due to high school graduation dates. Some health insurance plans also have rules associated with their policies.

Those who are evaluated to have a maturity over their physical age, however, have been deemed “mature minors” in some court cases. That concept, as psychologically valid as it is, is cloudier when it comes to state laws, which vary widely in their “mature minor” stances, including the ages at which one becomes a “mature minor.” SeverFew U.S. courts have already defined the term, and a few more will be tasked to evaluate it in coming months. Seventeen states do have some form of concession to the standard parental consent requirement, ranging from written exceptions from psychologists to emancipation rights. Most often, the exceptions are requested by minors seeking an abortion without parental consent or knowledge.

These rules have become increasingly open to exceptions aiming to protect minors’ privacy and bodily integrity, safeguard the public health, and respect older minors’ adult-like autonomy and decision making ability.

Sensitive Categories of Treatment: Exceptions to the Rule

All states have some exceptions to parental consent when it comes to medical care for minors. It can become public health issue if young people are scared to get medical treatment because they have to tell their parents about them. These include procedures like testing for STDs–something that all 50 states and D.C. allow minors to do without having parental permission.

In many states, but not all, minors can also give their personal consent without their parents’ input regarding reproductive health services, with regard to contraceptive services and prenatal care, as well as drug and alcohol abuse treatment and outpatient mental health services. However, there usually is a minimum age for this kind of care without parental consent–usually early teens. These laws also don’t preclude parents from being able to require them to submit to treatment.

Abortion

One specific area of concern when it comes to minor medical care is abortion. Most states require parental consent for a minor to receive an abortion, although Supreme Court precedent allows a pregnant minor to receive an abortion under certain circumstances, such as “if she is sufficiently mature or if it would be in her best interests mentally and physically.” “Tests of maturity can include questions about good grades or extracurricular activities, as well as other less-defined queries that would allow judges to see a young person’s thinking process and understanding of the procedure,” said Doriane Coleman, a law professor at Duke University. The law is pretty inconsistent state-by-state, however, in some states, another relative could be allowed to be present at the abortion, in others a young woman could go to court to fight for her right to have the medical procedure.

Substance Abuse

When it comes to substance abuse, some states allow minors to consent to treatment. However, the laws usually also require that minors have to receive treatment if their parents consent to it on their behalf. Allowing minors the option to consent is is an attempt to make sure the treatment sticks–after all, a person who consents to treatment or requests treatment is more likely to follow through and at least stay in the program until the end.

According to the Doctor Will See You Now:

For doctors, the issue is that even if a minor is empowered by state law to give consent, they still need to ensure that the minor is intellectually and emotionally capable of giving informed consent. Thus, even if there is no age limit under state law or the age limit is very low, at times doctors may find it is inappropriate to allow a minor to consent to his own care if he is too immature or otherwise incapable of understanding the procedure’s risks, benefits and alternatives.

Payment, Confidentiality, and HIPAA

Additionally, the Doctor Will See you Now points out:

The fact that some minors can consent to their own health care and treatments in certain areas does not always mean that they actually have a right to confidentiality with respect to that care. Under the Health Insurance Portability and Accountability Act (HIPAA), practitioners are basically required to follow state law regarding confidentiality for minors, and they are given discretion over parental notification when state law is silent on the issue. Most parents will find out eventually, whether it is from HIPAA or the patient’s own volition.

Particular federally funded programs also have certain confidentiality laws. For example, services subsidized by Title X, the federal family planning funding program, have to be provided confidentially, per federal law.

Case Study: Cassandra C.

The Connecticut Supreme Court ruled recently that the state was well within its rights to require a young woman named Cassandra C. to continue undergoing chemotherapy treatments even though it wasn’t what she wanted. Her mother wanted her to do whatever she thought was best.

Because of the nature of the case, and concerns about Cassandra’s wellbeing, the case has been featured in the national news. Unfortunately, Cassandra spent every day in isolation from other patients and was under constant supervision. “She hasn’t been convicted of a crime, but it’s kind of like she’s in jail,” said Joshua Michtom, an assistant public defender and Cassandra’s lawyer. “It’s an especially lousy way to go through chemo.”

Court Orders

There are very rare situations in which the court becomes involved, because parents aren’t acting in the best interests of their children. In addition, there are cases like those outlined in the novel My Sister’s Keeper, where parents seek to have a minor child donate an organ to a sibling, or to undergo any other significantly invasive medical procedure for the benefit of another child.

Conclusion

Medical decision making by and on behalf of children and teens is a subject that is ethically, mentally, physically, and legally complex. State laws vary considerably, and they often have vague standards and language. Children should generally be involved in medical decision making to the extent of their abilities. It is not only a teaching moment, but it is also a way to create autonomy. In the case of a conflict between a minor’s wishes and a parent’s wishes, however, everyone needs to proceed with caution, especially in life or death cases. As such, it is usually wise for them to seek the advice of legal counsel and, in some cases, to proceed to court for a judicial order authorizing the proposed course of treatment.

Resources

Primary

District Court of Appeal of Florida, First District: DEPT. OF HEALTH v. STRAIGHT, INC.

Eastern District Court of Pennsylvania: Parents United for Better Schools v School District of Philadelphia

Additional

The Doctor Will See You Now: Doctor-Patient Confidentiality: How Do We Define It and When Should We Waive It?

Journal of Health Care Law and Policies: Medical Decision Making by and on Behalf of Adolescents

Journal of Pediatric Psychology: Involving Children and Adolescents in Medical Decision Making: Developmental and Clinical Considerations

Guttmacher Institute: Minors and the Right to Consent to Health Care

Philly: Should Teens Get to Say “No” to Life-Saving Medical Treatment?

Pediatrics: The Legal Authority of Mature Minors to Consent to General Medical Treatment

Editor’s Note: This article has been edited to credit select information to the Doctor Will See you Now, and some portions have been edited for clarity. 

Noel Diem

Law Street contributor Noel Diem is an editor and aspiring author based in Reading, Pennsylvania. She is an alum of Albright College where she studied English and Secondary Education. In her spare time she enjoys traveling, theater, fashion, and literature. Contact Noel at staff@LawStreetMedia.com.

The post Medical Care for Minors: Who Calls the Shots? appeared first on Law Street.

Let us examine a scenario; parents go to a hospital to treat their child’s cancer and after seeing the debilitating effects of chemotherapy, opt to end the treatment. The hospital, however, sees the child’s cancer as curable and uses the court system to attempt to force their patient to continue treatment. Which party has the law on their side, the parents of the child or the hospital?

This seemingly hypothetical situation has become a real debate between an Amish couple in Ohio and the Akron Children’s Hospital. Parents, Andy and Anna Hershberger, have decided to stop the chemotherapy treatments of their 10 year old daughter, Sarah, who is battling Leukemia. The couple originally consented to the chemotherapy of Sarah in May 2013 but put an end to the treatment in June 2013. The parents saw the effects of the treatment as more harmful than helpful and opted to use natural herbs and vitamins rather than radiation to rid the girl’s body of the cancer.

While it is the belief of Mr. and Mrs. Hershberger that chemotherapy was actually killing their daughter, it is the moral and legal obligation of the hospital to make sure that the young girl received proper care. As explained by Robert McGregor, Akron’s chief medical officer, the hospital believes that the girl will die without the chemotherapy treatment. “We really have to advocate for what we believe is in the best interest of the child,” explained McGregor.

This is where the law stepped in, as the hospital went to court in order to force Sarah’s continued chemotherapy treatment. Judges appointed an unaffiliated third party, or “court guardian” to the case, Maria Schimer who is an attorney as well as registered nurse. Along with guardianship came Maria’s power to make all medical decisions regarding Sarah’s continued treatment. With this decision, the Amish family went into hiding about four months ago and has refused to reappear until the guardian is removed. Maria Schimer recently requested to be dropped from this case as she can no longer reach Sarah and her family.

The Hershbergers are currently fighting to obtain the right to make health care decisions for Sarah after the legal guardian is formally removed from the case. These parents are appealing the decision that allowed Maria Schimer to step in and make medical decisions for their daughter in the first place. The couple feels that assigning this guardian has infringed upon their constitutional rights and are appealing under the Ohio Health Care Freedom Amendment, approved in 2011. This amendment prohibits laws that force Ohioans to, “participate in a health care system.” This appeal is the first time that the court has been forced to determine the scope of this amendment, which has previously been seen as a symbol against President Obama’s health care overhaul.

The representing attorney to the Hershberger’s, Maurice Thompson of the libertarian 1851 Center for Constitutional Law in Ohio also helped draft the Ohio Health Care Freedom Amendment. Thompson feels that this case is a significant issue under said amendment because the Ohio Health Care Freedom Amendment is in place to preserve the rights of parents and children to choose their health care free of compulsion and prevent forced health care. “Allowing an uninterested third-party, one that has never even met the family or the child, to assert an interest in an exceedingly important parental decision will completely undermine the parent-child relationship,” argues Thompson.

Though the case of the Hershberger family has not yet been decided, it is most likely going to face multiple challenges. This stems from the fact that though the Ohio Health Care Freedom Ammendment was approved, it did not prevent the implementation of the Obama’s new federal health care law. This is because a state amendment does not have the ability to nullify a law. This situation could harm Ohio’s ability to enforce its specific laws and amendments to a case such as this. It is also questionable as to whether this amendment can extend to the point of protecting the Hershberger family’s case, which will be up to the court system as they decide on the full scope of the amendment.

The bigger picture of this case becomes, is it the right of the parents or the right of the hospital to determine the medical future of a child? While the Akron Hospital, versus the Hershberger family case is one of the most recent, there are other similar situations in which parents have lost the custody of their ill children to decisions made by the hospitals treating them. Fifteen year old Justina Pelletier was taken from her parents and placed into the custody of Boston Children’s Hospital in February 2013. This event occurred due to a dispute between Justina’s parents and the hospital, when her diagnosis changed from a mitochondrial disorder to a mental illness. After the change in diagnosis, the Pelletier family threatened to withdraw their daughter from the hospital in order to seek a second medical opinion. Once a child is labeled with a mental disorder, it is within the hospital’s power to call child protective services. In this case DCF labeled the parents behavior as insolent and abusive. The parents were stripped of their custody and the state of Massachusetts forcibly been treating as well as detaining Justina since that time. Based on the current ruling, it looks as if Justina will not be fully released until she is 18 years old.These two extreme cases can seem terrifying in the eyes of parents, and rightfully so. It seems that the hospitals often have the final say in the treatment of child patients rather than the parents.

While both sides of this scenario, the hospitals and the parents, seem to be looking to protect the child’s best interests, it becomes hard to draw a line between who is correct in their judgements. If parents are fully informed about treatment options as well as their risks and decide that the risks do outweigh the benefits, it should be within their ability to opt out of treatment as the child’s legal guardians from birth. However, this becomes complicated with the consideration of some parental religious beliefs that could bar the child from receiving potentially life saving treatment. On one hand, due to custody under the hospital or a third party guardian, a life can be saved, but on the other religious beliefs may be compromised. This medical debate does not have an all encompassing answer.

At what point, does it become ok to take over the custody of a child without the consent of their parents, or is it ever ok? To each his own, what is your opinion?

[The News- Herald] [Fox News] [Police State USA]

—

Taylor Garre (@TaylorLynn013)

Featured image courtesy of [Randall Pugh via Flickr]

Taylor Garre

Taylor Garre is a student at Fordham University and formerly an intern at Law Street Media. Contact Taylor at staff@LawStreetMedia.com.

The post Parents vs Hospitals: is Forced Treatment Legal? appeared first on Law Street.

Don’t get pregnant in Nebraska, ladies. Back in January 2011, Republican State Senator Lydia Brasch introduced legislative bill 690. The bill mandated that if a woman under the age of 18 wanted to abort a pregnancy, she must receive written permission from a parent or guardian. Otherwise, no abortion procedure for you, sweetheart. Good luck with that!

LB 690 was a wild success in the Nebraska legislature. It passed by a landslide in May 2011, and was signed into law the very same day. These kinds of bills are called “parental consent” bills by the anti-abortion lobby. But for those of us who believe in Roe v. Wade and a woman’s right to choose?

This is just a straight-up, anti-abortion bill.

Why? After all, abortion is still legal in Nebraska, even after LB 690’s passage. No big deal, right? Wrong. Anonymous 5, a 16-year-old Nebraskan ward of the state who was denied her right to an abortion this week, can personally tell you that it’s a very, very big deal.

At a hearing back in July, Anonymous 5’s parents were stripped of their parental rights because they had been abusive and neglectful of their three children. Anonymous 5 and her two younger siblings were placed in foster care, under the legal protection of the state. At this same hearing, Anonymous 5 informed the judge that she was 10 weeks pregnant, and wanted to get an abortion.

She was, to put it lightly, in a pickle. She needed written parental consent, but legally, she no longer had any parents. What to do? Her only option was to ask a judge for permission to circumvent LB 690—something young girls are supposed to be allowed to do, in cases of medical emergency or abuse.

But that really didn’t work out for her. This week, the Nebraska court made a final decision on her abortion request, ruling that she had not sufficiently proved that she had been a victim of abuse, and—most importantly—she had not proved herself to be mature enough to decide that she wanted an abortion.

That’s right, folks. The Nebraska court ruled that a 16-year-old girl was not mature enough to have an abortion. But, she’s mature enough to become a mother!

Because that makes a lot of sense.

Especially considering that Anonymous 5 had some really good reasons for not wanting to give birth to a child. Besides the obvious factors—she’s a high school student without the financial or emotional resources to be, in her words, the kind of “mom [she] would like to be right now”—a very religious foster family is currently housing her and her two young siblings. Anonymous 5 expressed concern that she would lose her foster placement if her foster parents found out about the pregnancy.

Meaning that, in this case, adoption is not a viable option. The mere act of carrying this child to term could cause Anonymous 5 and her siblings to wind up homeless. And haven’t they already been through enough, after growing up in an abusive, neglectful household?

You’d think so, but the Nebraska judge didn’t agree. He denied Anonymous 5 the right to make this deeply personal choice by herself, and instead, decided for her, ruling that she would not be allowed to receive an abortion in the state of Nebraska.

So, what does this mean for LB 690, and other parental consent bills like it?

It means that they have the power to deny young women access to abortions. That’s a really big problem. But perhaps more importantly, these bills take the right of bodily decision-making away from young women, and hand it over to someone else.

And that’s just not OK. Every person, regardless of gender, needs to be able to choose what happens to his or her (or zir!) body. How would you like it if someone else had the power to decide what hairstyle you should wear, or how provocative your clothes should be, or what you could eat, or when you could sleep?

You’d hate it. You’d get angry and frustrated. You’d feel powerless. And these feelings would be in response to relatively trivial kinds of control.

I mean, seriously, everyone freaked out when Mayor Bloomberg tried to control how big our sodas could be.

So, can you imagine how powerless you’d feel if someone else forced you to grow a child inside your abdomen for nine months, after which, you’d have to literally tear your body apart trying to expel it? And then, you’d either have to raise it for the next 18 years, or make the heart wrenching decision to hand that responsibility off to someone else?

That’s not trivial. That’s a life-altering kind of control. It’s too important to be placed in someone else’s hands.

Walter White, for the win.

Only the person who’s pregnant can make that call. It’s a deeply personal decision, and one that she’ll have to live with forever. Simply put, women need to be in control of their own bodies.

And the fact that, in 2013, this concept still hasn’t sunken in is horrifying. How far have we really come from the days when women’s bodies were bought and sold by men through marriage—when women were nothing more than property?

Not far, apparently, when a man in Nebraska has the power to decide what’s going to happen inside of Anonymous 5’s body.

So, whaddya say, folks? Can we stop controlling and policing women’s bodies, so that no one else ever has to go through what Anonymous 5 did this week?

I really hope so.

—

Featured image courtesy of [Rudy Eng via Flickr]

Hannah R. Winsten

Hannah R. Winsten is a freelance copywriter, marketing consultant, and blogger living in New York’s sixth borough. She hates tweeting but does it anyway. She aspires to be the next Rachel Maddow. Contact Hannah at staff@LawStreetMedia.com.

The post If You Got Mad About the Big Gulp Ban, Get Mad About This appeared first on Law Street.