Minors and the right to consent to health care.

The notion that many minors have the capacity and, indeed, the right to make important decisions about health care has been well established in federal and state policy. Many states specifically authorize minors to consent to contraceptive services, testing and treatment for HIV and other sexually transmitted diseases, prenatal care and delivery services, treatment for alcohol and drug abuse, and outpatient mental health care. With the exception of abortion, lawmakers have generally resisted attempts to impose a parental consent or notification requirement on minors' access to reproductive health care and other sensitive services. Nevertheless, the movement to "restore" parental rights and to legislate parental control over minors' reproductive health care decisions remains active.

Establishing rules for minors' consent for medical care has been one of the more difficult issues to face policymakers. On the one hand, it seems eminently reasonable that parents should have the right and responsibility to make health care decisions for their minor child. On the other hand, it may be more important for a young person to have access to confidential medical services than it is to require that parents be informed of their child's condition. Minors who are sexually active, pregnant, or infected with a sexually transmitted disease (STD) and those who abuse drugs or alcohol or suffer from emotional or psychological problems may avoid seeking care if they must involve their parents. Recognizing this reality, many states explicitly authorize minors to make decisions about their own medical care, but balancing the rights of parents and the rights of minors remains a topic of debate.

At the federal level, the focal point of debate over minors' access to confidential services has been the Title X family planning program. Since its inception in 1970, services supported by Title X have been available to anyone who needs them without regard to age. As a result, Title X--supported clinics provide contraceptive services and other reproductive health care to minors on a confidential basis, although they encourage minors to involve their parents in their decision to seek services. Over the years, the provision of confidential contraceptive services to minors has come under attack from conservatives in Congress, who have repeatedly mounted efforts to require that a parent give consent or be notified before a minor receives these services in a Title X clinic. In 1998, the House of Representatives passed a parental notification requirement, but the Senate did not, and the provision was never enacted.

Similar debates have occurred at the state level. In Texas, for example, the legislature in 1997 voted to prohibit the use of state family planning funds to provide prescription drugs, such as birth control pills and medication for treating STDs, to minors without parental consent. The law was allowed to go into effect in 1998, after the Texas Supreme Court concluded that striking down the provision without evidence of harm would be premature. In fact, the law does not interfere with minors' ability to obtain confidential services from Title X--supported clinics and other providers who serve minors with federal funds.

In 2000, the South Carolina legislature considered a bill to prohibit the use of state funds to distribute condoms and other types of contraceptives to minors younger than age 16 whose parents had registered an objection with the state health department to their children receiving such services. The measure was passed by the House of Representatives but dropped during committee consideration in the Senate. Similar measures in other states did not receive serious consideration, even at the committee level, and none were enacted.

The States and Medical Care for Minors

States have traditionally recognized the right of parents to make health care decisions on their children's behalf, on the presumption that before reaching the age of majority (18 in all but four states), young people lack the experience and judgment to make fully informed decisions. There have long been exceptions to this rule, however, such as medical emergencies when there is no time to obtain parental consent and in cases where a minor is "emancipated" by marriage or other circumstances and thus legally able to make decisions on his or her own behalf.