According to the 2014 SAMHSA survey, 26,500,000 individuals, aged 12 or older, experienced substance abuse or dependence. As cited in Kerwin et al. (2015), the 2010 SAMSHA reports indicate that about 1.8 million 12 to 17-year-olds in the United States needed treatment for an alcohol or illicit drug use problem. However, only a small number receive treatment. To increase the treatment rate, Kerwin et al. (2015) describes how some states decided to give minors more control over their health care decisions as a way of improving their response to treatment. To do this, states have provided minors the opportunity to consent for treatment for several medical issues. These include pregnancy, sexually transmitted diseases, psychiatric disorders, and drug and alcohol issues.
One very controversial issue is abortion, which was legalized by the U.S. Supreme Court in January 1973. However, that decision did not establish a procedure that minors could use to obtain an abortion without parental consent. In 1979, the court ruled that it was up to the states to determine whether minors were required to obtain consent of a parent before terminating their pregnancy. However, even in those states that required parental consent, minors could petition the court for permission to bypass parental consent or notification (Altindag & Joyce, 2017). In the U.S., this has been interpreted as providing physicians the right to treat ‘mature minors’: young people who have left home or who have drug, alcohol, or sexual problems and who want to be treated without their parents’ knowledge (Alderson, 2007).
The mature minor exception was developed to meet the problem of obtaining consent in medical emergencies and semi-emergencies. This approach enabled physicians to provide treatment when the parents or guardians could not be immediately contacted. Sometime later, the mature minor exception was expanded to allow consent by minors for abortion and/or for general medical interventions (Partridge, 2013).
In California, a minor who is 12 years of age or older may consent to mental health and drug treatment (Kerwin et al., 2015). However, can a 12-year-old make an informed decision to terminate a pregnancy? The American Academy of Pediatrics (AAP) has concluded, based on its research, that most 14-17-year-old adolescents are as competent as adults to provide consent to abortion. They are considered capable enough to weigh the risks and benefits and review options, allowing them to make decisions independently.
Alderson, P. (2007). Competent children? Minors’ consent to health care treatment and research. Social Science & Medicine, 65(11), 2272-2283.
Altindag, O., & Joyce, T. (2017). Judicial bypass for minors seeking abortions in Arkansas versus other states. American Journal of Public Health, 107(8), 1266-1271.
Dickens, B., & Cook, R. (2005). Ethical and legal issues in reproductive health: Adolescents and consent to treatment. International Journal of Gynecology and Obstetrics Is, 89(2), 179-184.
Kerwin, M. E., Kirby, K. C., Speziali, D., Duggan, M., Mellitz, C., Versek, B., & McNamara, A. (2015). What can parents do? A review of state laws regarding decision making for adolescent drug abuse and mental health treatment. Journal of Child & Adolescent Substance Abuse, 24(3), 166-176.
National Center for Youth Law. (n.d.). https://youthlaw.org/
American College of Pediatricians. (2015). Parental notification/consent for treatment of the adolescent. Issues in Law & Medicine, 30(1), 99-105.
Partridge, B. C. (2013). The mature minor: Some critical psychological reflections on the empirical bases. Journal of Medicine & Philosophy, 38(3), 283-299.
SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2013 and 2014. https://www.samhsa.gov/
Age of Consent
Internationally, the legal age of consent to treatment varies considerably between countries from 12 to 19 years. According to a summary by Alderson (2007), Anglo-American law recognizes that ‘Every human being of adult years and sound mind has the right to determine what shall be done with his own body.’ For children, this was adapted to a child who ‘achieves a sufficient understanding and intelligence to enable him or her to understand fully what is proposed’ and has ‘sufficient discretion to enable him or her to make a wise choice on his or her own.
Lallemont, Mastroianni, and Wickizer, (2009) conducted a survey of statutes, regulations, and legal cases in the 50 states and the District of Columbia. They surveyed the comparative authority of parents and minors to make substance abuse treatment decisions. They found some states deferred to the minor while others to the parent, while some did not provide the necessary clarification. Kerwin et al. (2015) concluded that many states have provided minors the opportunity to consent for treatment for several medical issues. Included are pregnancy, sexually transmitted diseases, psychiatric disorders, and drug and alcohol issues. For your protection and that of youth with whom you are involved with in your role as a parent, teacher, or anyone working in the helping professions, it is important for you to know and understand the laws and regulations of your state.
In this assignment, compare the age of consent laws for drug treatment in your state (you can use NY) and four of the following states: Alabama, California, Utah, South Carolina, and North Carolina. Then, review the following scenario:
Jomeka is 15 years old. She has been smoking marijuana since she was 12, but now her friends are pressuring her to try cocaine. She is frightened. She does not feel she can tell her mother, since her mother has no idea that she has been using marijuana for the past three years. One of her friends has been attending a drug and alcohol outpatient program. You are the director of that program.
Prepare an analysis that addresses the following:
Self-Admission: Explain whether Jomeka could admit herself into the program. Include a response for each of the states listed above for a total of five results.
Enrollment Steps: Determine which steps you might take to enroll her into the program if she cannot enroll herself.
Ethical Considerations: Discuss the ethics of allowing a minor to enroll herself into a drug program without parental consent, which is allowed in some states. In your discussion, review and cite relevant literature on brain development and the mature minor exemption. Be sure to consider aspects such as autonomy, parental rights, the best interests of the child, and confidentiality.