Limits of Informed Consent in United States Secondary Schools

By Nicholas Spangler & Zachary Winkelmann.

The law for most US states require that individuals under the age of 18 must provide parental consent for medical services. For healthcare providers who work in secondary school settings, this would mean that every patient who walks in the door requesting services would need parental consent and child assent to provide care. Especially in secondary school settings, patients typically seek out sports medicine services on their own, sometimes without the knowledge or consent of a parent or guardian. This is where consent to treat forms play a huge role in secondary school athletics. Every patient needs to have such paperwork filled out by their parent or guardian in order to ensure the athletic trainers have parental consent for medical treatment. However, despite their use, it could be argued that due to the broad nature of a consent to treat form, it does not fulfill the requirements of giving informed consent. So this begs the question, “Should clinicians provide medical care to unaccompanied minors?” In order to further discuss this, we must first explore consent by proxy (consent to treat forms), and consider if they indeed contain the elements of informed consent.

When working with minors, a practitioner must gain assent from the patient. This is defined as “child’s agreement for medical procedures in circumstances where he or she is not legally authorized or has insufficient understanding to be competent to give full consent.” Experts state that informed consent is comprised of at least the following elements: provision of information, assessment of the patient’s understanding of the nature of their ailment, assessment of the capacity of the patient to make necessary decisions, and assurance that the patient as the freedom to choose among the medical alternatives without coercion or manipulation. However, when working with an unaccompanied minor, informed consent cannot take place. The general consensus being that minors do not have the capacity to understand the information they are presented about their health, and should not be treated as rational adults. Consent to treat forms are the typical means of overcoming that legal barrier. However, one could argue that consent to treat forms fail to include all of the elements of informed consent. When we consider the elements of informed consent, a person who consents will make a decision based on unique personal beliefs, values, and goals. In the case of an unaccompanied minor, our duty as a healthcare provider is to provide medical care that is based on the patient’s needs, not parental desires. The problem being that while a parent has provided written consent through the consent to treat form, this form is broad in nature. There could be specific medical/clinical tests and interventions that the parent/legal guardian would not consent being used on their child, but the parent may not be present to make the healthcare provider aware of such specific desires.

When we consider the legality of this problem, there are some important facts to highlight. Many courts have started to adopt the mature minor rule. This rule allows a young person to validly consent to a physician’s treatment. Based on this rule, unaccompanied patients in the secondary school setting would have the legal ability to seek out medical treatment without parental consent. In total, 13 states as of 2013 have mature minor rules that allow minors to seek general medical care without consent of a parent. However, even in states that have a mature minority rule, the age to meet such statutes varies (as low as 14 while other have to be at least 16 years of age).

Healthcare providers who work in secondary school settings should be aware of the patient’s age prior to providing medical care, and should be aware of the laws in their state regarding minors’ consent authority. The use of parental consent waivers should be used in order to provide proxy consent especially in states that do not have mature minority rules. Practitioners should be aware that in cases of disagreements between patient and parents regarding healthcare, that athletic trainers have a responsibility to the needs of their patient that are independent of parental responsibility or values. Individuals who do not meet the statute for minor consent authority in their state and/or do not have proxy consent for medical treatment from a parent should be refused medical treatment except in cases of life threatening conditions.

 

Authors: Nicholas Spangler1 & Zachary Winkelmann1

Affiliations:

  1. Department of Applied Medicine and Rehabilitation, Indiana State University, Terre Haute, Indiana, USA

Competing interests: None

Social media accounts of post author(s): Dr. Nicholas Spangler: Twitter; Dr. Zachary Winkelmann: Twitter

 

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