A Review of State Laws.To clarify the issues surrounding parental involvement for abortion, the AGI (Artificial General Intelligence) A machine intelligence that resembles that of a human being. Considered impossible by many, most artificial intelligence (AI) research, projects and products deal with specific applications such as industrial robots, playing chess, examined the state statutes that affect the right of an unmarried or otherwise unemancipated minor to obtain certain types of medical care. These are contraceptive services; prenatal care prenatal care,
n the health care provided the mother and fetus before childbirth. and delivery services; the diagnosis of and treatment for an STD (Subscriber Trunk Dialing) Long distance dialing outside of the U.S. that does not require operator intervention. STD prefix codes are required and billing is based on call units, which are a fixed amount of money in the currency of that country. , or venereal disease venereal disease (vənēr`ēəl): see sexually transmitted disease. (VD), and human immunodeficiency virus human immunodeficiency virus
Human immunodeficiency virus (HIV)
A transmissible retrovirus that causes AIDS in humans. (HIV HIV (Human Immunodeficiency Virus), either of two closely related retroviruses that invade T-helper lymphocytes and are responsible for AIDS. There are two types of HIV: HIV-1 and HIV-2. HIV-1 is responsible for the vast majority of AIDS in the United States. ) infection; treatment for drug and alcohol abuse; treatment for emotional problems; general medical and surgical care in nonemergency situations; and abortion services. The AGI also reviewed laws dealing with other areas in which a young person might have to make important or life-changing decisions--namely, dropping out of school, getting married, consenting to any medical care that a child might need and placing a child for adoption. The review involved analysis of two types of laws: statutes that might authorize a minor to make independent decisions in any of these areas, and statutes requiring parental involvement. Th e laws that were examined generally affect both boys and girls boys and girls
mercurialisannua. ; the exceptions are those dealing with reproductive health services (in which states have traditionally been more restrictive than they have in other aspects of health care for minors) and those applying to a minor parent's decisions on behalf of a child. In these two areas, a teenage girl is probably more affected than a teenage boy.
Where the state has no law, there may have been relevant federal or state court decisions (or opinions of state attorneys general) that affect whether or not a minor can make confidential decisions without consulting or gaining permission from his or her parents. For example, under the Supreme Court rulings recognizing that minors have a fundamental constitutional right to privacy, (36) there is a presumption that a minor may make her own decision about abortion, unless the state has enacted a law that specifically requires parental consent or notification (and provides for a confidential alternative to parental involvement). Even when there are no relevant statutes or case law, physicians may commonly provide medical care to a mature minor without parental consent, particularly if state law authorizes a minor to consent to related services.
We summarize the major findings of the review of state laws in the next sections. More detailed information about the specific laws of each state and of the District of Columbia District of Columbia, federal district (2000 pop. 572,059, a 5.7% decrease in population since the 1990 census), 69 sq mi (179 sq km), on the east bank of the Potomac River, coextensive with the city of Washington, D.C. (the capital of the United States). is presented in Appendix Table 1; the text of the appendix contains a description of the methodology used to collect this information.
The findings of the AGI review suggest that states understand that confidentiality is a critical factor if young people are to be encouraged to seek treatment for sensitive health problems. As Table 1 indicates, most states have laws authorizing a teenager to consent to medical treatment for STDs and substance abuse. About half have authorized a minor to consent to contraceptive services and prenatal care and delivery services. Moreover, no state mandates parental involvement for any of these services. In addition, more than one-third of the states have statutes that authorize a minor to consent to general medical and surgical care, at least under some circumstances.
By law, a minor in 24 states and the District of Columbia may give informed consent to contraceptive services. These services might include the provision of birth control pills, the insertion of an IUD IUD Definition
An IUD is an intrauterine device made of plastic and/or copper that is inserted into the womb (uterus) by way of the vaginal canal. One type releases a hormone (progesterone), and is replaced each year. , the prescription of a diaphragm, and the insertion of Norplant, the new long-acting contraceptive method. (*) In three of these states, the law specifies that a doctor may provide contraceptive services if he or she believes that without them, a teenager is likely to suffer a serious health problem. This condition is unlikely to constitute a barrier to the provision of services to a sexually active minor, in view of the well-documented health benefits that are associated with the use of contraceptives. (37)
Prenatal Care and Delivery Services
A pregnant minor in 27 states and the District of Columbia may obtain prenatal care and delivery services without parental consent or notification. (+) The laws in these jurisdictions authorize regular medical visits during pregnancy and the routine services needed during normal labor and delivery. They also appear to permit a minor to consent to prenatal genetic screening (including amniocentesis amniocentesis (ăm'nēō'sĕntē`sĭs), diagnostic procedure in which a sample of the amniotic fluid surrounding a fetus is removed from the uterus by means of a fine needle inserted through the abdomen of the pregnant woman (see and chorionic villus sampling chorionic villus sampling (CVS) or chorionic villus biopsy (CVB) (kōr'ē-ŏn`ĭk, kôr'–), diagnostic procedure in which a sample of chorionic villi from the developing placenta is removed from the , which involve a small risk to the fetus) and, except in Hawaii (where the law specifically excludes surgery), delivery by cesarean section cesarean section (sĭzâr`ēən), delivery of an infant by surgical removal from the uterus through an abdominal incision. The operation is of ancient origin: indeed, the name derives from the legend that Julius Caesar was born in this and in utero procedures to treat a life-threatening condition of the fetus.
Treatment for STDs and HIV
The District of Columbia and every state except South Carolina South Carolina, state of the SE United States. It is bordered by North Carolina (N), the Atlantic Ocean (SE), and Georgia (SW). Facts and Figures
Area, 31,055 sq mi (80,432 sq km). Pop. (2000) 4,012,012, a 15. (++) authorize a minor to consent to the diagnosis and treatment of STDs.[section] These diseases (syphilis, gonorrhea gonorrhea (gŏnərē`ə), common infectious disease caused by a bacterium (Neisseria gonorrhoeae), involving chiefly the mucous membranes of the genitourinary tract. , chlamydia chlamydia (kləmĭd`ēə), genus of microorganisms that cause a variety of diseases in humans and other animals. Psittacosis, or parrot fever, caused by the species Chlamydia psittaci, , and genital herpes Genital Herpes Definition
Genital herpes is a sexually transmitted disease caused by a herpes virus. The disease is characterized by the formation of fluid-filled, painful blisters in the genital area. , among others) afflict an estimated three million teenagers every year. (38) If untreated, STDs can lead to cancer, infertility pelvic inflammatory disease pelvic inflammatory disease (PID), infection of the female reproductive organs, usually resulting from infection with the bacteria that cause chlamydia or gonorrhea. , ectopic pregnancy ectopic pregnancy
or extrauterine pregnancy
Condition in which a fertilized egg is imbedded outside the uterus (see fertilization). Early on, it may resemble a normal pregnancy, with hormonal changes, amenorrhea, and development of a placenta. and death. (39) The states that have enacted these statutes generally impose no restrictions on a minor's authority to consent to hospitalization, to the use of antibiotics and other prescription medications or to any other medical care needed to treat infection; the exceptions are a prohibition against consent to surgery in Hawaii and a parental notification requirement if a minor needs emergency hospitalization in Vermont.
Because HIV, the virus that causes AIDS, can be transmitted through sexual contact, laws permitting a minor to consent to STD services would appear to cover diagnosis of and treatment for HIV infection as well. (**) To avoid any ambiguity in this area, 11 states have explicitly authorized a minor to consent to HIV-related services, but in seven of these states, the statute covers only testing for the virus. In the remaining four, the law also applies to medical care for HIV infection. In these states, a teenager who is HIV-positive presumably pre·sum·a·ble
That can be presumed or taken for granted; reasonable as a supposition: presumable causes of the disaster. may consent to the continuous testing that is needed to monitor the status of the infection, as well as to drug therapies such as AZT AZT or zidovudine (zīdō`vydēn'), drug used to treat patients infected with the human immunodeficiency virus (HIV), which causes AIDS; also called that are believed to slow the onset of AIDS.
(*.) The law in one state-Oregon-permits a minor to consent to surgical sterilization surgical sterilization Mechanical sterilization Gynecology Sterilization that prevents passage of a fertilized egg to the uterus, or of sperm meeting egg; the more common form of SS is tubal ligation, but vasectomy is not uncommon. See Tubal ligation, Vasectomy. if all other methods of contraception have proved unsuccessful or are not appropriate for some reason. Four other states-Florida, Maryland, North Carolina North Carolina, state in the SE United States. It is bordered by the Atlantic Ocean (E), South Carolina and Georgia (S), Tennessee (W), and Virginia (N). Facts and Figures
Area, 52,586 sq mi (136,198 sq km). Pop. and Virginia--specifically exclude sterilization from the contraceptive services to which a minor may consent. However, it is extreme]y unlikely that any state statute authorizing a minor to consent to contraceptive services would be interpreted as including sterilization. Unlike other methods, tubal Tubal (t`bəl), in the Bible, son of Japheth. occlusion is usually irreversible, and it has been linked to the abuse of minors and of the mentally incompetent. For these reasons, federal regulations impose a number of restrictions on sterilizations carried out with federal funds Federal Funds
Funds deposited to regional Federal Reserve Banks by commercial banks, including funds in excess of reserve requirements.
These non-interest bearing deposits are lent out at the Fed funds rate to other banks unable to meet overnight reserve , including a prohibition against sterilization performed on anyone under the age of 21, a 30-day waiting period and a detailed informed consent procedure. (See: Federal Register, 43:52146 .)
(+.) New York New York, state, United States
New York, Middle Atlantic state of the United States. It is bordered by Vermont, Massachusetts, Connecticut, and the Atlantic Ocean (E), New Jersey and Pennsylvania (S), Lakes Erie and Ontario and the Canadian province of law authorizes a minor to consent to "medical, dental, health and hospital services relating to prenatal care." (See: N.Y. Public Health Law, sect. 2504(3) [McKinney 1985].) We have assumed that the law allows a minor to consent to child-birth services.
(++.) However, South Carolina law permits a minor 16 or older to consent to general medical care, which would include treatment for an STD.
([section].) Some state statutes use the term "venereal disease" rather than "sexually transmitted disease sexually transmitted disease (STD) or venereal disease, term for infections acquired mainly through sexual contact. Five diseases were traditionally known as venereal diseases: gonorrhea, syphilis, and the less common granuloma inguinale, ." Idaho does not have a statute pertaining expressly to STD or VD services, but does have a law authorizing minors to consent to treatment for infectious, contagious or communicable diseases.
(**.) In addition to STD laws, 10 states (including Idaho) have statutes that authorize a minor to consent to diagnosis of and treatment for contagious, infectious or reportable diseases (not shown in Table 1). These laws also presumably allow a minor to consent to treatment for HIV infection.
Services for Substance Abuse
The District of Columbia and all but four states--Alaska, Arkansas, Utah and Wyoming--have laws that authorize a minor who abuses drugs or alcohol to consent to (or obtain) confidential medical care and counseling. In 36 states and the District of Columbia, an adolescent may obtain services in connection with both alcohol and drug abuse; in 10 other states, a teenager may consent to treatment for one of these addictions.
Mental Health Services health services Managed care The benefits covered under a health contract
Laws in 20 states and the District of Columbia authorize a minor to consent to outpatient mental health services; in 18 states and the District of Columbia, a minor may apply for hospitalization to receive treatment for mental health problems. About half of the statutes in the latter group specify that a minor must be at least 16 years old to be admitted for such treatment without parental knowledge or consent. If inpatient and outpatient services are grouped together (not shown in Table 1), 28 states and the District of Columbia authorize a minor to consent to treatment for mental health problems.
In six states, a minor may obtain inpatient services, but parents must be notified upon their child's admission. One state requires parental consent for admission.
General Nonemergency Medical Care
Statutes in 21 states authorize a minor to obtain general medical care in nonemergency situations. (As was pointed out earlier, states commonly permit a doctor to treat a minor in an emergency without obtaining parental consent.) In 10 of these states, the law applies to a minor who has reached a certain age (ranging from 14 to 16) or to a minor of any age who is sufficiently mature to understand the nature and consequences of the proposed treatment. In eight other states, a minor who is a parent may obtain general medical care. In the remaining three states, a minor may consent to general medical care if she is pregnant (Illinois), has ever been pregnant (Pennsylvania), or is either pregnant or a parent (Massachusetts).
These laws appear to authorize a minor to consent to virtually any type of medical and surgical treatment, except in South Carolina, where the law bars consent to operations. In the other states, the only statutory restrictions are a prohibition against consent to sterilization in Massachusetts and Nevada, and to brain surgery to relieve the symptoms of mental problems in Massachusetts. Nevertheless, it bears emphasizing that in states that both authorize a minor to consent to surgical care on her own and require parental involvement in the abortion decision, the laws clearly conflict.
As Table 1 suggests, states make a sharp distinction between abortion and other medical services related to reproduction and other sensitive health concerns. Whereas substantial numbers of states authorize a minor to make her own decisions about these latter services, only three states and the District of Columbia have statutes that permit a minor to obtain an abortion without parental involvement. Moreover, 18 states have laws mandating the involvement of at least one parent in the abortion decision: In 10 of these, a minor must have the consent of one or both parents; in the other eight, one or both parents must be notified prior to the abortion.
Nine states have parental consent or notification laws with a judicial bypass whose enforcement is under injunction (see Appendix Table 1). Some of these statutes, which were enacted within the last few years, are still on appeal and could go into effect in the future; others may never be enforced. We mention them because they reflect the states' view at the time the laws were passed--namely, that where teenagers are concerned, the abortion decision should be treated differently from decisions regarding other medical services needed in connection with pregnancy and its prevention.
Decisions on a Minor's Own Behalf
Some people consider abortion less a medical choice than a major life decision that can have a significant long-term impact on a woman's psychological and emotional well-being. For purposes of comparison, the AGI also examined state laws that affect a minor's authority to make other types of decisions- decisions that in some cases might have a dramatic and long-lasting effect on the course of a young person's life, decisions such as whether to quit school and whether to marry.
Dropping Out of School
Most states allow a teenager to drop out of high school before graduation, despite strong statistical evidence that failure to earn a high school diploma A high school diploma is a diploma awarded for the completion of high school. In the United States and Canada, it is considered the minimum education required for government jobs and higher education. An equivalent is the GED. can have long-range adverse consequences in terms of the ability to earn a living, find employment, maintain a stable marriage and have the number of children couples say they want, when they want them. (*) Although many teenagers probably do not fully understand the negative consequences that are associated with dropping out of school, 34 states and the District of Columbia allow a 16-year-old to leave school without any statutory requirement that the parents be involved in or approve of the decision. In eight other states, a teenager may drop out of school at age 17; in Washington, a minor may leave school at age 15 if he or she has a job.
The District of Columbia and 40 states require parental consent before a minor may marry, and most states establish an age--usually 16--below which a minor generally may not marry even with parental consent. However, although early marriages are often unstable, (+) 10 states have statutes that permit a minor to marry without parental consent, at least under certain circumstances, such as pregnancy or the birth of a child.
(*.) In 1988, for example, 20 percent of families in which the head of household had had on]y 1--3 years of high school had incomes below the federal poverty level--more than twice the proportion of families in which the household head had earned a high school diploma but had not gone on to college. (See: U.S. Bureau of the Census Noun 1. Bureau of the Census - the bureau of the Commerce Department responsible for taking the census; provides demographic information and analyses about the population of the United States
Census Bureau , Statistical Abstract of the United States The Statistical Abstract of the United States is a publication of the United States Census Bureau, an agency of the United States Department of Commerce. Published annually since 1878, the statistics describe social and economic conditions in the United States. , 1990, U.S. Government Printing Office, Washington, D.C., 1990, Table 749.) High school dropouts also are more likely to be unemployed than are individuals whose education ended with high school graduation. (Ibid., Table 654.) And they are more likely to experience marital disruption: Women who fail to finish high school are more likely than those who graduate to divorce or separate within five years of marriage. (See: T.C. Martin and L.L. Bumpass, "Recent Trends in Marital Disruption," Demography 26:37, 1989.) On the other hand, the more years of school a young woman has completed, the more likely she is to delay childbearing and, therefore, to avoid the adverse consequences of adolescent childbearing. Teenage mothers are disproportionately poor and dependent on public assistance. (See: National Research Council, Risking the Future: Adolescent Sexuality, Pregnancy and Childbearing, National Academy Press, Washington, D.C., 1987, pp.126, 129 and 132.)
(+.) The younger a woman is when she marries, the greater the chance that she will divorce or separate within five years of marriage. Women who marry as teenagers are twice as likely to separate as those who marry after the age of 22. (See: T.C. Martin and L.L. Bumpass, "Recent Trends in Marital Disruption," Demography, 26:37, 1989.)
Decisions on Behalf of a Minor's Child
To a remarkable degree, if state laws can be interpreted as anything to go by, most states consider a minor who is a parent to be fully competent to make major decisions affecting the health and future of his or her own child.
Medical Care for a Child
The District of Columbia and 28 states, for example, have laws that authorize a minor parent to consent to medical care for his or her child. Since none of these statutes sets any limit on the type of services that a minor may authorize, a young parent presumably may consent to anything for an infant or child from routine monthly pediatric pediatric /pe·di·at·ric/ (pe?de-at´rik) pertaining to the health of children.
Of or relating to pediatrics. visits to open heart surgery. In principle, no state requires the involvement of the teenager's parents in any of these decisions; in practice, however, it is likely that without consulting or informing some older responsible adult, some physicians might be reluctant, for example, to perform major surgery on an infant whose mother is herself a teenager.
Placing a Child For Adoption
Even more striking is the fact that in 46 states and the District of Columbia, a minor mother may place her child for adoption without her parents' permission or knowledge. (*) Specifically, 33 states and the District of Columbia have enacted laws that allow a teenage mother to make this decision without having to consult or obtain consent from her own parents. Only one of these states--Oklahoma--requires that a mother be a certain age (16) before she can decide by herself to relinquish her parental right to a child. In 13 other states, where the adoption laws make no distinction between minor and adult parents, it appears that the decision to place her child for adoption rests with the young mother.
Only four states--Michigan, Minnesota, Pennsylvania and Rhode Island--mandate that a teenager's parents either consent to the adoption of their grandchild or receive notice of a hearing on their daughter's decision to relinquish her child. (Whether the mother is a minor or an adult, all adoptions must be approved by a court, after the judge is satisfied that the mother's consent has been obtained without duress or fraud and that a home study of the adoptive parents has been properly carried out. (40)
In practice, it is likely that some adoption agencies require that a young woman's parents be involved in the adoption decision. In principle, however, virtually all states consider a teenage mother capable of making an independent decision about whether or not to place her child for adoption.
(*.) The states handle the role of the unmarried father in the adoption process in a variety of ways. Some require the consent of both teenage parents, unless one cannot be located or has not voluntarily supported the child; others require the father's consent only if paternity has been established; some provide that an unmarried father is not entitled to be notified of the adoption hearing; still others specify that the putative father can be notified of a hearing, but that such notification is not required.
(36.) Carey v. Population Services International Population Services International (PSI): PSI is a nonprofit organization based in Washington, D.C. that uses private sector funding to address the health problems of low-income and vulnerable populations in 60 developing countries . , 1977, op. cit. (see reference 16); Planned Parenthood of Central Missouri v. Danforth, 1976, op. cit. (see reference 17); and Bellotti v. Baird Bellotti v. Baird, 443 U.S. 622 (1979) is a United States Supreme Court case that ruled that teenagers do not have to secure parental consent to obtain an abortion. See also
(37.) S. Harlap, K. Kost and J. D. Forrest, Preventing Pregnancy, Protecting Health: A New Look at Birth Control Choices in the United States, AGI, New York, 1991.
(38.) Center for Prevention Services, 1990 Division of STD/HIV Prevention Annual Report, Centers for Disease Control (CDC See Control Data, century date change and Back Orifice.
CDC - Control Data Corporation ), Atlanta, 1991, p.3.
(39.) F. A. Althaus, "An Ounce of Prevention... STDs and Women's Health," Family Planning Perspectives, 23:173, 1991.
(40.) National Committee for Adoption, Adoption Fact book, Washington, D.C., 1989; and M. B. Cedar, National Committee for Adoption, personal communication to P. Donovan, AGI, July 15, 1991.
Table 1 Number of states having laws affecting an unmarried, unemanipated minor's right to make decisions about medical care, abortion and other important issues STATE LAW MEDICAL CARE Contraceptive Prenatal care and STD/VD services delivery services services Minor may consent or decide 25 28 50 Parent must consent 0 0 0 Parent must be notified 0 0 0 No law found or not applicable (6) 26 23 1 Total (7) 51 51 51 STATE LAW MEDICAL CARE HIV testing Treatment for durg Out services (1) and treatment and alcohol abuse Inpatient Minor may consent or decide 11 47 19 Parent must consent 0 0 1 Parent must be notified 0 0 6 No law found or not applicable (6) 40 4 25 Total (7) 51 51 51 STATE LAW MEDICAL CARE ABORTION SERVICES General nonemergency medcical care (2) Minor may consent or decide 21 4 Parent must consent 0 10 (5) Parent must be notified 0 8 (5) No law found or not applicable (6) 30 29 Total (7) 51 51 STATE LAW DECISION ON MINOR'S OWN BEHALF Dropping out Getting of school married Minor may consent or decide 44 10 Parent must consent 0 41 Parent must be notified 0 0 No law found or not applicable (6) 7 0 Total (7) 51 51 STATE LAW DECISION ON BEHALF OF MINOR'S CHILD Medical care Placing child for child for adoption (3) Minor may consent or decide 29 47 (4) Parent must consent 0 3 Parent must be notified 0 1 No law found or not applicable (6) 22 0 Total (7) 51 51 (1)In Alabama, the District of Columbia, Maine, and Maryland, where the law does not distinguish between outpatient and inpatient services, it was assumed that minors may consent to both. (2)States with no law relating specifically to unmarried and unemancipated minors may have a law authorizing married and emancipated minors or teenagers over the age of majority to consent to general medical care that, by implication, requires unmarried and unemancipated minors to have parental consent. (3)In addition to the consent of the minor mother, some states require the consent of the unwed father if he can be located or if paternity has been established, but others do not require the father to be informed of adoption proceedings. (4)Includes the 13 states where the adoption laws make no distinction between adult and minor parents, and where it was therefore assumed that a minor parent may give legally binding consent to the adoption of her child. (5)Includes only parental consent and notification laws that are currently being enforced. (6)"Not applicable" refers to the seven states that have laws requiring young people to be 18 (the age of majority) before they drop out of school. (7)Includes the District of Columbia.