Source: http://jlgh.org/Past-Issues/Volume-10---Issue-4/Parents--Rights-vs--Children-s-Rights-to-Make-Heal.aspx
Timestamp: 2019-04-24 08:22:44+00:00

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Parents’ rights are thus limited and must give way to countervailing interests and rights of the minor-child, whether as a result of statutorily defined circumstances, the minors’ constitutional rights, or compelling governmental interests. This article will discuss those circumstances.
The Pennsylvania General Assembly has articulated a limited number of circumstances in which, contrary to the general rule of parental consent, minors have the right to make their own health care decisions. Though this can create tension between a minor’s choice and a parent’s preference, if the minor has the power to make the decision, a health care provider must defer to the minor regardless of the parent’s wishes. This situation can be difficult for parents to accept, especially if they believe their child, regardless of age, lacks the maturity to make an informed decision. Nevertheless, minors in Pennsylvania have the decision-making power under circumstances specified by the state legislature, which seems to have implicitly indicated that, in specified circumstances, minors generally have the necessary maturity level.
The Minors’ Consent Act8 provides that parental consent for any minor is not required for medical, dental, and health services if doing so “would result in delay of treatment which would increase the risk to the minor’s life or health.”9 This is similar to the rule that consent is not required in an emergency but is more general.
Venereal Diseases: The Disease Prevention and Control Law of 1955 allows a physician to provide treatment to anyone under 21 years of age who has a venereal disease and provides that, if the minor consents to the treatment, parental consent is not needed.13 Under the Minors’ Consent Act, a minor can consent to medical and health services to determine the presence of and to treat venereal disease and other diseases that are reportable under the Disease Prevention and Control Law of 1955.14 Consequently, under both laws combined, a minor can consent, without parental consent, to services needed to determine the presence of a venereal disease as well as to treatment.
Thus, before admitting a minor who can give effective consent for voluntary inpatient treatment, healthcare providers should satisfy themselves that the minor has the requisite level of understanding and document that opinion and the underlying conversation.
For voluntary outpatient treatment, a parent can consent for a minor younger than 14 years old.27 For a minor who is 14 years or older, the Minors’ Consent Act allows either the minor alone or a parent alone to consent to examination and treatment.28 This provides finality and allows providers to rely upon the consent.
The Minors’ Consent Act also identifies who has the power to consent to the release of mental health records of minors who are at least 14 years old, subject to the provisions of the MHPA.31 Generally stated, but subject to exceptions, the person who consented to the mental health treatment holds the power to consent to the release of the treatment records.
The Pennsylvania Drug and Alcohol Abuse Control Act37 states that if a minor “suffers from the use of a controlled or harmful substance[,]” the minor can consent to “medical care or counseling related to diagnosis or treatment” without parental consent is not needed, and the minor’s consent is valid, binding, non-voidable, and cannot be disaffirmed based on the age of minority. However, if a physician or “agency or organization operating a drug abuse program” provides counseling to the minor, they are allowed, but not required, to notify the minors’ parents about the treatment provided or the treatment needed.38 The statute does not articulate factors to consider when making that decision, but the focus should be on the minor’s best interests. Factors to consider should be fact specific, and the provider might want to consider the minor’s opinions on the subject and description of the family relationship and situation, including whether the parents would be supportive of or hurtful to the treatment. In any event, even if parents are notified, the statute expressly prohibits the minor’s consent from being invalidated. Similarly, it can be inferred from the power granted to the minor to consent that a parent cannot withdraw the minor from treatment in which the minor chose to engage.
This provision of seeking judicial relief in the absence of parental consent, and perhaps even of parental notification, is commonly referred to as “judicial bypass.” Even though this maturity exception is embodied in the abortion law by the state legislature, the legislature has not adopted a similar maturity analysis in other statutes, with the exception of the MHPA’s quasi-maturity analysis previously mentioned. Instead, the statutes authorizing minors to consent, as previously described, imply that minors who fall within the delineated categories are of sufficient maturity by status or circumstance but without regard to any fact inquiry. Their age combined with the specified status or circumstance is sufficient.
In 2011, the Supreme Court of Pennsylvania rendered a decision involving an unemancipated minor’s request for judicial bypass.48 The minor was 17 years old and ten weeks pregnant with her boyfriend’s baby. She was a high school senior, planned on attending college immediately after graduation, and wanted to be a lawyer. She was unemployed, had seen her siblings struggle financially to care for children from unplanned pregnancies, and had been informed by a physician about abortion and its risks, complications, and alternatives. She believed that she was unable and unprepared to care for a child and that her future plans would be jeopardized if she had to do so. She chose not to ask for parental consent because she believed that her mother would throw her out of the home if she learned about the pregnancy.
The trial court ultimately denied the request for judicial bypass, thereby not allowing the abortion based on its finding that, because the minor chose not to seek parental consent, she lacked the maturity and capability of giving informed consent independent of a parent. The Superior Court of Pennsylvania affirmed. On appeal before the Supreme Court of Pennsylvania, the appellate court initially held that an appeal from a court’s denial of a petition for judicial bypass must be reviewed under the abuse-of-discretion standard, meaning that the decision would not be overturned unless the trial court abused its discretion when it rendered the decision under appeal. It also held that “a trial court lacks statutory authority to deny a minor’s petition for judicial authorization for an abortion based on her failure to obtain parental consent.” Simply put, it did not allow the trial court to impose, in a circuitous manner, a requirement of parental consent when the legislature specifically did not require it and expressly designed the procedure at issue to allow a pregnant minor to obtain an abortion even if she chose not to seek a parent’s consent. Therefore, it vacated the trial court’s order even though the trial court also specifically considered the statutory factors for its analysis and, further, found the minor to lack credibility.49 In fact, the appellate decision turned on the legal issue and specifically offered no opinion on the trial court’s conclusion that the minor lacked maturity and capacity to consent.
As a general matter, parents continue to enjoy many rights, privileges, and duties associated with child-rearing and protecting their children. However, those rights are not absolute, particularly once a child reaches the age of 14 years old, or once the child begins making decisions relating to his or her own reproductive health. Parents’ rights and minors’ rights can come into tension with each other. Therefore, it is important that health care providers understand who has the legal right to make decisions about health services for minors.
iThe emergency exception is reflected in Pennsylvania regulations. See 28 Pa. Code § 103.22(b)(9) (“Except for emergencies, the physician must obtain the necessary informed consent prior to the start of any procedure or treatment, or both.”); 55 Pa. Code § 6000.1012 (“Consent is implied by law for emergencies and there is no need to seek a surrogate health care decision maker before providing emergency medical treatment.”); cf. 28 Pa. Code § 119.23(b)(2) (“If trainees in patient care, reflecting the concept of team care, the patient shall be so informed, and his consent shall be obtained, unless an emergency precludes such consent, which emergency shall be documented by the treating physician.”).
iiIf a child has a legal guardian, the guardian generally has the same duties to the child as a parent, and, for the purposes of this article, would have the same rights.
iii“Mental health treatment” is defined as “a course of treatment, including evaluation, diagnosis, therapy and rehabilitation, designed and administered to alleviate an individual’s pain and distress and to maximize the probability of recovery from mental illness. The term also includes care and other services which supplement treatment and aid or promote recovery.” 35 P.S. § 10101.1(d).
iv“Inpatient treatment” is defined as “all mental health treatment that requires full-time or part-time residence in a facility that provides mental health treatment.” 35 P.S. § 10101.1(d).
1. Commonwealth of Pa. v. Nixon, 761 A.2d 1151, 1157 (Pa. 2000) (citing In re Fiori, 673 A.2d 905, 909 (Pa. 1996)) (Cappy, J., concurring).
3. See, e.g., Parents United for Betters Schools v. Sch. Dist. of Phila., 978 F. Supp. 197, 206 (E.D. Pa. 1997).
4. Nixon, 761 A.2d at 1153.
5. Commonwealth of Pa. v. Foster, 764 A.2d 1076, 1082 (Pa. Super. Ct. 2000). In Foster, a 2-year-old was terminally ill with renal carcinoma because his parents failed to seek medical care. They believed instead that “God would raise Patrick up and restore him to perfect health.” The Department of Human Services intervened with a restraining order, and the child survived after medical treatment. Id. at 1078-80.
6. This Latin phrase means parent of the nation.
7. Prince v. Commonwealth of Massachusetts, 321 U.S. 158, 166-67 (1944) (citations and footnotes omitted), quoted in Nixon, 761 A.2d at 1153; see also Parents United, 978 F. Supp. at 206 (“Parental consent may be waived when the parent’s refusal of consent likely would compromise the minor’s long-term prospects for health and well-being.”).
8. 35 P.S. §§ 10101 – 10105.
10. Id. §§ 10101; 10101.1(c).
14. Id. § 10103 (referencing 35 P.S. §§ 521.1 – 521.21).
15. 50 P.S. §§ 7101 – 7503.
16. Id. § 7201; 35 P.S. § 10101.1(a)(2).
17. 35 P.S. § 10101.1(b)(11).
20. 50 P.S. § 7201.
24. 35 P.S. § 10101.1(b)(8).
29. Id. § 10101.1(a)(3), (b)(4).
34. Id. § 10002 (emphasis added).
35. 28 Pa. Code § 30.30(2).
36. 35 P.S. § 10002.
37. 71 P.S. §§ 1690.101 – 1690.113.
39. Id. § 1690.112a(a); id. § 1690.112a(b)(2); id. § 1690.112a(c).
40. 18 Pa. C.S.A. §§ 3201 – 3220.
42. Id. § 3206(a), (g).
44. H.L. v. Matheson, 450 U.S. 398, 408 (1981) (describing Bellotti v. Baird, 443 U.S. 662, 651 (1979)).
45. 18 Pa. C.S.A. § 3206(d).
48. See generally In re Doe, 33 A.3d 615 (Pa. 2011).
49. Id. at 618-21, 629.

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