Substance Abuse – Law Street https://legacy.lawstreetmedia.com Law and Policy for Our Generation Wed, 13 Nov 2019 21:46:22 +0000 en-US hourly 1 https://wordpress.org/?v=4.9.8 100397344 NFL Bans Seantrel Henderson for Using Medical Marijuana to Treat Crohn’s Disease https://legacy.lawstreetmedia.com/blogs/cannabis-in-america/nfl-bans-seantrel-henderson-using-medical-marijuana-use-treat-crohns-disease/ https://legacy.lawstreetmedia.com/blogs/cannabis-in-america/nfl-bans-seantrel-henderson-using-medical-marijuana-use-treat-crohns-disease/#respond Thu, 01 Dec 2016 15:36:12 +0000 http://lawstreetmedia.com/?p=57283

Seantrel Henderson could pursue a lawsuit against the NFL

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The National Football League suspended a Buffalo Bills player Tuesday for violating the NFL’s substance abuse policy. Offensive tackle Seantrel Henderson was suspended for 10 games. According to what Henderson’s agent Brian Fettner said to the Associated Press, this suspension comes from the player’s use of medical marijuana to treat his Crohn’s disease

The Bills announced the league had notified them on Tuesday of their player’s suspension.

“The league has notified us of the suspension and we are moving forward with our preparations to play the Oakland Raiders this Sunday,” the Bills said in their statement.

This is Henderson’s second suspension of this year; he began the season with a four-game suspension.

Henderson was diagnosed with Crohn’s a year ago, and underwent multiple surgeries on his intestines in the previous offseason.

“The reality is, the NFL’s position has been if you need medical marijuana then you’re too sick to play,” Fettner also said. “But that’s just not the case for Seantrel Henderson.”

The NFL’s substance policy does not allow medical exemptions for marijuana use, although it does for some other banned substances.

According to Yahoo, “If he were to fail a third drug test, Henderson would be banned for life, with the ability to apply for reinstatement after a year.”

Henderson has spoken in defense of the drug previously.

“I’ve got doctors telling me this is the No. 1 medicine that would help your disease,” Henderson told The Buffalo News. “You try to tell that to the league and it seems like they didn’t care too much.”

If Henderson chooses to, he could pursue a lawsuit against the NFL.

Julia Bryant
Julia Bryant is an Editorial Senior Fellow at Law Street from Howard County, Maryland. She is a junior at the University of Maryland, College Park, pursuing a Bachelor’s degree in Journalism and Economics. You can contact Julia at JBryant@LawStreetMedia.com.

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The U.S. Has a Massive Substance Abuse Problem: How Can We Combat it? https://legacy.lawstreetmedia.com/blogs/politics-blog/u-s-massive-substance-abuse-problem-can-combat/ https://legacy.lawstreetmedia.com/blogs/politics-blog/u-s-massive-substance-abuse-problem-can-combat/#respond Thu, 17 Nov 2016 19:38:04 +0000 http://lawstreetmedia.com/?p=57039

Will President-elect Trump's plans work?

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Addiction has become a gigantic problem in the United States. According a recent report by the Surgeon General, one in seven Americans will suffer from sort of addiction disorder over their lifetimes, and only 10 percent will receive any sort of treatment for their addiction. Surgeon General Vivek Murthy released the “Surgeon General’s Report on Alcohol, Drugs, and Health” for the first time ever yesterday. The report outlines the issues with substance abuse in the United States, and provides guidelines for how to remedy them. But will President-elect Donald Trump actually follow them?

The numbers are shocking: 74 Americans die from prescription painkillers and heroin overdoses every single day; drug abuse is now the leading cause of accidental death. That’s one American dying from an overdose every 19 minutes. And according to USA Today:

Nearly 21 million Americans struggle with substance addictions, according to the report. That’s more than the number of people who have all cancers combined.

And while those numbers are shocking, they shouldn’t necessarily be surprising. Coverage, particularly of the heroin crisis, has gotten more intense than ever. Photos and videos of individuals overdosing have become almost the norm on social media and in the news, in an attempt to shed real light on the epidemic.

Murthy’s suggestions include treating addiction–particularly opioid addiction–as a public health issue, by veering away from the abstinence-only solutions that became popular during the War on Drugs. Murthy points out that addiction is a “disease of the brain, not a character flaw,” and advocates for implementing preventative measures early, like addressing children still in school. The Surgeon General also pointed out the need to invest in life-saving measures like suboxone, which can counter overdoses.

President-elect Trump talked a lot about substance abuse–particularly opioid addiction–on the campaign trail. He obviously talked a lot about stopping the drug trade from South America, which wasn’t on Murthy’s list of recommendations. But he also spoke about drug courts, treatment, and prevention, which could be steps in the right direction, if he is able to pay for them.

The substance abuse addiction crisis is a real problem in the United States. We’ll have to see if Donald Trump is able to follow through on his promise to fix it.

Anneliese Mahoney
Anneliese Mahoney is Managing Editor at Law Street and a Connecticut transplant to Washington D.C. She has a Bachelor’s degree in International Affairs from the George Washington University, and a passion for law, politics, and social issues. Contact Anneliese at amahoney@LawStreetMedia.com.

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Allison Janney Speaks About Substance Abuse at WH, Fulfills Our “West Wing” Dreams https://legacy.lawstreetmedia.com/blogs/politics-blog/allison-janney-speaks-about-substance-abuse-at-wh-fulfills-our-west-wing-dreams/ https://legacy.lawstreetmedia.com/blogs/politics-blog/allison-janney-speaks-about-substance-abuse-at-wh-fulfills-our-west-wing-dreams/#respond Fri, 29 Apr 2016 20:25:48 +0000 http://lawstreetmedia.com/?p=52187

She made us all miss CJ Cregg.

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"Actor Allison Janney" courtesy of [Sarah Burris via Flickr]

Allison Janney fulfilled a lot of “The West Wing” fan fantasies today when she went to the White House and briefed the press corps as C.J. Cregg. For those of you who haven’t watched “The West Wing,” Cregg was Janney’s Emmy-winning portrayal of the White House Press Secretary. Also those of you who haven’t watched “The West Wing” should do so immediately, but that’s a whole different point. But Janney’s appearance in the White House briefing room wasn’t just intended to cause nostalgic revelry for fans of the Aaron Sorkin classic. While borrowing current White House Press Secretary John Earnest’s podium, Janney talked about combatting the incredibly serious opioid epidemic in the United States.

While Janney’s reason for visiting was serious and apt, it didn’t stop her from making some delightful references to the show. She began by telling the assembled press that she was filling in for Earnest because he had a root canal–a favorite funny moment from the show. She also promised that she would perform the “Jackal,” another one of C.J. Cregg’s trademark scenes.

But after just a few good-hearted jokes, Janney told the press why she was really there. She discussed the show she now stars on, called “Mom,” which features recovery from substance abuse as a consistent theme. Janney also has a personal history with substance abuse recovery–her brother committed suicide after a long struggle with addiction. While at the podium, Janney explained that the White House is honoring 10 individuals as “Champions of Change” for their work to fight substance abuse and to help those who are now in recovery. Janney stated:

This is a disease that can touch anybody, and all of us can help reduce drug abuse through evidence-based treatment, prevention and recovery. Research shows it works, and courageous Americans show it works every day.

On her way out, one of the reporters asked Janney who President Jed Bartlett (played by Martin Sheen) would hypothetically support in the Democratic primary. Janney replied with all the grace and poise of her press secretary character, retorting: “I think you know the answer to that question.” That quip could be a reference to the fact that her fellow “The West Wing” star, Bradley Whitford, has said that the fictional president would vote for Hillary Clinton. Whitford stated: “There’s no doubt in my mind that Hillary would be President Bartlet’s choice. Nobody is more prepared to take that position on day one.”

Cregg’s appearance, while certainly unexpected, was very welcome and entertaining–and supported a great cause. As the 2016 primaries drag on and just get more depressing, sometimes it’s fun to be reminded of one of the best fictional presidents of all time.

Anneliese Mahoney
Anneliese Mahoney is Managing Editor at Law Street and a Connecticut transplant to Washington D.C. She has a Bachelor’s degree in International Affairs from the George Washington University, and a passion for law, politics, and social issues. Contact Anneliese at amahoney@LawStreetMedia.com.

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Are American Prisons Becoming Psychiatric Hospitals? https://legacy.lawstreetmedia.com/issues/law-and-politics/american-prisons-becoming-de-facto-psychiatric-hospitals/ https://legacy.lawstreetmedia.com/issues/law-and-politics/american-prisons-becoming-de-facto-psychiatric-hospitals/#comments Fri, 22 May 2015 20:32:43 +0000 http://lawstreetmedia.wpengine.com/?p=40071

The United States houses more mentally ill people in prisons than hospitals. Is it helping anyone?

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A Human Rights Watch report released this month titled “Callous and Cruel: Use of Force Against Inmates With Mental Disabilities in U.S. Jails and Prisons,” reported on the treatment of mentally ill inmates in prisons. The report documented major abuses in the prison system and major flaws in the availability of mental health services, and indicates that mentally ill do not do well in the American prison system. But why do they end up in correctional facilities in the first place? Read on to learn about mental health care in the United States and how it intersects with criminal justice.


How many mentally ill people are in correctional facilities?

People with mental illnesses are heavily represented in correctional facilities across the United States. In 2006, mentally ill inmates numbered 705,600 in state prisons, 78,800 in federal prisons, and 479,900 in local jails. In 2009, mentally ill individuals were on parole and probation at rates two to four times the general population. As of 2012, there were 356,368 mentally ill inmates in American jails and prisons. At the same time, psychiatric facilities hosted only 35,000 mentally ill patients, ten times less than the number of mentally ill inmates housed in correction facilities.

By various estimations, 20 percent of jail inmates and 15 percent of state prisoners, including violent and non-violent offenders, have some sort of mental ailment. Some of them were born with mental illnesses, while many acquired mental disabilities as the result of various circumstances. 


Why are so many mentally ill Americans in the prison system?

In order to understand why so many mentally ill Americans end up in correctional facilities instead of psychiatric hospitals, it’s important to look at the history and the changing dynamics of mental health care in the United States.

Using prisons and jails to house mentally ill people is not a new phenomenon. In fact, from 1770 to 1820, individuals with mental disabilities were routinely confined to correctional facilities. This practice was condemned as cruel and inhumane. As a result, the government asserted its obligation to care for and treat mentally ill people in a more suitable environment, creating a wide net of mental health hospitals across the country. Before the 1940s, the majority of mentally ill individuals, especially those with severe mental ailments, were housed in public mental institutions.

This situation changed in the beginning of 1950s. The government was again criticized for the inhumane treatment of mentally ill patients, now housed in psychiatric facilities, resulting in the inception of the deinstitutionalization movement. From this point on, instead of providing treatment and care in public mental hospitals, the government shifted the policies toward community-based treatment centers. The deal was sealed by the Mental Health Centers Act of 1963 that pushed mental health care away from state-run psychiatric hospitals and toward community-based centers. These changes allowed those with mental ailments to live in the community while receiving treatment at nearby mental facilities.

But in practice, this shift in policies created a disconnect between the care and treatment of mentally ill people, especially those with severe and chronic mental ailments. After deinstitutionalization, many were left without needed care as the government’s focus shifted toward outpatient mental services.

Shifting mental health policies toward outpatient services and breaking the link between treatment and care resulted in the decline of inpatient care and depreciation of state mental hospitals. In 1959, public psychiatric hospitals housed 559,000 mentally ill patients, by the late 1990s there were only 70,000 patients in such facilities. Now, there are only 35,000 patients in psychiatric hospitals, the lowest number in decades. Most states don’t even have enough psychiatric beds. From 2009-2012, the government disposed of 4,500 beds in public psychiatric hospitals. For example, Connecticut has only 20 beds per 100,000 people, while the nationally recommended standard is 50 beds per 100,000 people.

Thus, the deinstitutionalization of mental health services shifted public spending toward prescription drugs and outpatient treatment, largely ignoring the needs of those mentally ill people who required inpatient treatment. At the same time, access to outpatient mental health services proved to be worse than access to any other health services. In 2010, there were 156,300 mental health counselors in the United States. It’s estimated that 89.3 million Americans are living in areas that lack mental health professionals.

Mental health care is very expensive. In fact, 45 percent of people who suffer from some sort of mental illness fail to receive appropriate treatment due to the high costs associated with mental health services. A quarter of those who are mentally ill and have sought outpatient mental health services end up largely paying for treatment themselves, with out-of-pocket costs ranging from $100 to $5,000.

From 2009 to 2012, state governments, who pay most of the mental health care costs, also cut $5 billion from their funding overall, negatively influencing the availability and price of outpatient mental health services. 

The failure of the current mental health system to treat and care for people with severe and chronic mental illnesses paired with the lack of access to outpatient services is what has brought so many mentally ill people into the prison system. Those who have severe and/or chronic mental illnesses and cannot get access to outpatient mental health treatment, often end up in the criminal justice system. Before deinstitutionalization mentally ill people with severe and chronic illnesses were hospitalized, reducing their chances to break the law and come in contact with law enforcement. Some experts argue that beginning in the 1970s the United States has turned back toward incarceration practices resembling the 1800s paradigm of confining mentally ill people instead of treating and caring for them.


How do people with mental illnesses end up in the prison system?

Often, mentally ill people are arrested for crimes that could be avoided with proper mental health treatment or inpatient services. Those crimes are more bothersome than dangerous, and can include disorderly conduct, trespassing, disturbing the peace, and public intoxication. 

As 25-50 percent of mentally ill people in American prisons also suffer from substance abuse disorders, and 60 percent reported using drugs, alcohol, or both a month prior to their arrest, substance abuse issues can increase the likelihood of people with mental illnesses ending up in jail or prison. 

After initial contact with law enforcement, mentally ill individuals go through the court system. Due to harsh drug sentencing policies, such as “zero tolerance” and mandatory sentencing for certain drug offenses, mentally ill people are often sentenced to jail or prison terms.

All in all, those with mental disorders have a higher chance of coming into contact with law enforcement, mostly due to their mental condition. If they are regularly using drugs or alcohol, the chances are even higher. But, instead of offering treatment and support services to those with mental illnesses, the American justice system often uses the most punitive approach: incarceration.


What are the issues with incarcerating mentally ill individuals? 

Inadequate Staff Training

Inadequate staff training is one of the most important issues when talking about mentally ill people in the prison system. Many correction officers and jail deputies receive no guidance in how to interact with mentally ill inmates. Prison staff often don’t recognize symptoms of mental illness, nor do they use appropriate techniques, such as verbal de-escalation, when communicating with such inmates. Even when mental health professionals are available in the vicinity of the prison, guards rarely call for their intervention.

Physical Abuse

According to the recent Human Rights Watch Report, mentally ill inmates in American prisons and jails are regularly abused, including physically, by prison staff. The study cites the use of chemical sprays and stun guns as well as strapping mentally ill inmates to chairs and beds for prolonged periods of time. 

Solitary Confinement

Besides the fact that mentally ill inmates often suffer from physical abuse from prison or jail staff, they are also more often held in isolation, sometimes for months. According to a 2010 audit of three state prisons in Wisconsin, 55-75 percent of inmates in solitary confinement were mentally ill. Prolonged isolation of such inmates can exacerbate their conditions and increase symptoms of mental illness, often resulting in more misconduct instead of compliance.

Management Problems

As life in correctional facilities is heavily regulated and supervised, mentally impaired individuals can experience issues following rules, creating additional problems for prison guards. In many cases, their behavior is symptomatic, meaning that it’s conditioned by mental illness. They can  refuse to follow orders, and sometimes injure themselves, all things that can disrupt the daily routines of correction officers and other inmates. In some cases mentally ill inmates are provocative and can pose a danger to themselves or others.

Lack of Treatment

As prisons are not psychiatric hospitals, they often lack  mental health services as well as mental health professionals. Inmates are often not properly diagnosed, don’t have timely access to mental health services, and are often treated with medications only. Correctional facilities cannot usually aid mentally ill inmates in their recovery or even alleviate symptoms of their mental illnesses. In fact, the most helpful procedures for mentally ill patients are often not used in correctional facilities. Mentally ill inmates rarely receive therapeutic mental health interventions or participate in psychiatric rehabilitation programs.

Longer Stay

Mentally ill inmates usually stay in the prison system longer than those who have no mental issues. There are two primary reasons for this. First, mentally ill inmates can be less obedient due to their mental disorder, leading to additional charges and prolonged sentences. The other reason centers on the long waiting periods for beds in psychiatric hospitals. For example, in Florida’s Orange County Jail the average stay for mentally ill inmates is twice as long than for those without mental illnesses. In New York’s Riker’s Island Jail, the average stay for a mentally ill inmate is even longer215 days–compared with 42 days for inmates without mental ailments. 

It’s Expensive

The cost of holding mentally ill inmates in prisons and jails is higher than average. This is due to the higher spendings on mental health services, including medications and staffing. It’s estimated that mentally ill inmates cost $130 a day, $50 more than average. The overall cost of incarcerating mentally ill inmates can be two to three times higher than average. 

Suicide & Rape

Mentally ill inmates are more likely to commit suicide than inmates who do not have mental illnesses. Multiple studies confirmed that the harsh prison conditions and the lack of proper treatment can increase the odds of suicide for this population. For example, a 2002 study of a Washington county jail noted that 77 percent of all suicides were committed by inmates with a mental illness. Sexual assault is another danger for mentally ill inmates. Many are are sexually assaulted, and their likelihood of being raped is higher than the general population in American prisons and jails. 

Watch the video below to get a full picture of mental health behind bars:


Conclusion

It’s evident that there are many issues with incarceration of mentally ill people, as there are many shortcomings and flaws in American mental health care, especially in prisons and jails. Such a system creates a cycle of incarceration for mentally ill people, by providing no remedies after the initial release. States should invest in more beds in public mental hospitals and provide better access to outpatient community treatment programs. It’s time to start treating and caring for the mentally ill, not just incarcerating them. 


Resources

Primary

National Institute of Corrections: Mentally Ill Persons in Corrections

Additional

Health Affairs: Mental Health Policy in America: Myths and Realities

The New York Times: Mentally Ill Inmates Are Routinely Physically Abused, Study Says

Human Rights Watch: Callous and Cruel: Use of Force against Inmates with Mental Disabilities in US Jails and Prisons

Washington Post: A Shocking Number of Mentally ill Americans End up in Prison Instead of Treatment

West Hartford News: Lawyers: Mentally Ill Need Services, not Prison

Treatment Advocacy Center: How Many Individuals with Serious Mental Illness are in Jails and Prisons? – Backgrounder

Mother Jones: There Are 10 Times More Mentally Ill People Behind Bars Than in State Hospitals

Stanford Law School: Three Strikes Project: When did Prisons Become Acceptable Mental Healthcare Facilities?

Washington Post: Seven facts about America’s Mental Health-care System

USA Today: Cost of Not Caring: Nowhere to Go

HNGN: Human Rights Watch: Mentally Ill Prisoners Are Abused In U.S. Correctional Facilities

The Sentencing Project: Mentally Ill Offenders in the Criminal Justice System: An Analysis and Prescription

Valeriya Metla
Valeriya Metla is a young professional, passionate about international relations, immigration issues, and social and criminal justice. She holds two Bachelor Degrees in regional studies and international criminal justice. Contact Valeriya at staff@LawStreetMedia.com.

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Medical Care for Minors: Who Calls the Shots? https://legacy.lawstreetmedia.com/issues/health-science/medical-care-for-minors-calls-shots/ https://legacy.lawstreetmedia.com/issues/health-science/medical-care-for-minors-calls-shots/#comments Thu, 29 Jan 2015 11:30:43 +0000 http://lawstreetmedia.wpengine.com/?p=32773

Medical care for minors sometimes pits teens against their parents.

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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.

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