Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, New York.
Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee.
Pediatrics. 2022 Jun 1;149(6). doi: 10.1542/peds.2021-053458.
Health care providers managing the complex health needs of adolescents must comply with state laws governing adolescent consent and right to privacy. However, these laws vary. Our objectives were to summarize consent and privacy laws state-by-state and assess the implications of variation for compliance with the 21st Century Cures Act and with evidence-based guidance on adolescent care.
We summarized state laws and regulations on minor consent for the following: health services, substance abuse treatment, prenatal care, mental health care, contraceptive management, immunizations, sexually transmitted infection management, human immunodeficiency viruses testing and treatment, dental care, and sexual assault evaluation. We compared state laws and regulations with American Academy of Pediatrics' evidence-based guidelines to assess consistencies in guidance.
We observed notable state-by-state variability in laws governing consent for adolescent patients. No states had identical policies for all services studied. For example, although all states had provisions for consent to management of sexually transmitted infections, there were variable specifications in the age and type of minor, whether this includes human immunodeficiency viruses, and whether confidentiality is protected. Providing confidential care to the adolescent patient has been set as a priority by medical societies; however, guidelines are limited by the need to comply with state laws and regulations.
State laws on consent and privacy for adolescents are highly variable, and many do not reflect pediatric professional standards of care. This inconsistency is a barrier to operationalizing a consistent and equitable experience providing evidence-based medical care and ensuring adolescent privacy protection.
管理青少年复杂健康需求的医疗保健提供者必须遵守有关青少年同意和隐私权的州法律。然而，这些法律各不相同。我们的目标是总结各州关于未成年人同意的法律和法规，并评估其对遵守 21 世纪治愈法案和基于证据的青少年护理指南的影响。
我们总结了有关未成年人同意的州法律和法规，包括以下方面：医疗服务、药物滥用治疗、产前护理、心理健康护理、避孕管理、免疫接种、性传播感染管理、人类免疫缺陷病毒检测和治疗、牙科保健和性侵犯评估。我们将州法律和法规与儿科学会的循证指南进行了比较，以评估指导意见的一致性。
我们观察到，关于青少年患者同意的法律在各州之间存在显著差异。没有一个州对所有研究的服务都有相同的政策。例如，尽管所有州都有关于管理性传播感染的同意规定，但在未成年人的年龄和类型、是否包括人类免疫缺陷病毒以及保密性是否受到保护等方面存在差异。为青少年患者提供保密护理已被医疗协会列为优先事项；然而，指南受到遵守州法律和法规的限制。
关于青少年同意和隐私的州法律差异很大，许多法律都没有反映儿科护理的专业标准。这种不一致性是实施一致和公平的提供循证医疗服务和确保青少年隐私保护的经验的障碍。
