Pregnancy, teenagers and the law, 1976.

A number of significant developments have occurred since June 1974, when the authors last reviewed state laws and policies affecting the right of teenagers to obtain sex-related medical care on their own consent. (1) At that time, liberalization of state laws to affirm the right of young people to consent for their own contraceptive and other medical care, and, in particular, reduction of the age of majority to 18 in most states had established the right of 18-year-old unmarried women to consent for most aspects of their own medical care, including contraception, in at least 45 states and the District of Columbia. In 48 states and the District, they could consent for most pregnancy-related health services and for abortion.

Young people under 18, however, still faced considerable difficulty in obtaining medical contraceptive services, and even greater difficulty in terminating an unwanted pregnancy without parental consent. Only 23 states and the District of Columbia had specifically affirmed the right of these younger teenagers to obtain contraceptive care; 16 states and the District had affirmed their right to consent to abortion; and 11 states had affirmatively established their right to consent to medical care in general.

The past 18 months have seen a continuation of the trend toward liberalization of laws that affirm the right of young people to consent for their own contraceptive care, as well as the trend toward reducing the age of majority from 21 to 18. State legislatures have not looked with equal favor upon the right of minors to consent for their own abortions, and seven states have enacted new legislation requiring parental consent for abortions for unmarried minors. Courts all over the country, however, have (with one exception) invalidated such legislation, holding that a pregnant minor has a constitutional right to make the decision, in consultation with her physician, whether to terminate a pregnancy or carry it to term (see discussion below, p. 19).

Thus, by the end of 1975, it was established that an 18-year-old unmarried woman could consent for all aspects of her own medical care, including contraception, in 46 states and the District of Columbia. (*) In 48 states and the District, she could consent for most pregnancy-related health services and in 49 states and the District, for abortion. (+) (See Table 1.)

Twenty-six states and the District of Columbia explicitly affirm by statute or court decision the right of young people under the age of 18 to consent for contraceptive care; and in 25 states and the District, girls under 18 may obtain abortions without parental consent. With passage of legislation in Wisconsin in 1975, (2) all 50 states and the District now have statutes that establish the right of persons younger than 18 to consent for treatment of venereal disease (see Table 1). Of course, as pointed out in our previous article, the fact that there is no specific affirmative statute or decision in any state does not mean that minors in that state cannot consent to contraception, abortion and other pregnancy-related treatment. Indeed, in many if not most of these states, there is reason to believe that teenagers who have the capacity to give informed consent may consent to all sex-related medical care.

Informed Consent

In our earlier article, we stated that the problem faced by minors seeking medical services stems mainly from physician anxiety concerning the old common law (or judge-made) rule that the consent of a parent or guardian is required before a doctor may provide any kind of medical treatment for a minor. We pointed out that there have always been exceptions to that rule, such as treatment in cases of medical emergency and treatment of minors who are legally emancipated. We discussed the development in recent years of a new exception for the minor who is sufficiently intelligent and mature to understand the nature and consequences of a treatment which is for his or her benefit; and we pointed out that this exception, commonly called the "mature minor doctrine," may be viewed as a logical corollary of the requirement of informed consent for medical care. Before a patient makes a decision about medical treatment, he or she is entitled to a full explanation of the nature of the proposed treatment, its risks, its lim itations and its alternatives. A minor cannot give informed consent unless he or she is sufficiently intelligent and mature to understand the explanation. This may depend in each case on the nature and seriousness of the medical treatment involved. For example, a federal judge recently pointed out that "many girls of childbearing age are undoubtedly sufficiently aware of the relevant considerations to use temporary contraceptives." Such girls, he pointed out, are legally competent to use contraceptives even though they may lack the knowledge, maturity and judgment to consent to a permanent sterilization operation. (3)

Contraception

A milestone was passed in California on September 17, 1975 when Governor Edmund Brown, Jr., signed into law a bill enabling minors to consent to medical and surgical care related to the prevention or treatment of pregnancy (including contraception and abortion, but excluding sterilization). (4) The measure took effect January 1, 1976. A similar bill had been vetoed for three straight years by former Governor Ronald Reagan.

Laws enabling minors to consent for their own contraceptive care were also passed in Alaska and Delaware. (5) The Delaware statute applies to minors 12 years of age and older who "profess to be exposed to the chance of becoming pregnant."

Six other states and the District of Columbia followed the strong nationwide trend toward reducing the age of majority for both sexes to 18. (*)

There have been two judicial decisions of major importance. A federal court in Utah ruled that on grounds of statutory construction as well as of constitutionality, the state could not adopt regulations under federal AFDC and Medicaid programs requiring the written consent of a minor's parents before furnishing family planning services to the minor. (6) In New York, a three-judge federal court declared unconstitutional a state statute which barred pharmacists from selling nonprescription contraceptives to persons younger than 16. (7)

Until the New York decision was handed down on July 2, 1975, New York was the only state in the Union to have on its books a statute that explicitly restricted the sale of nonprescription contraceptives to minors. (+) The court struck down the statute on the ground that it violated the due process guarantees of the Fourteenth Amendment, including the minors' constitutional right of privacy.

The court found no substantial relationship between the statute and the state's purported interest in seeking to deter sexual intercourse on the part of minors younger than 16. The court pointed out that the state of New York "cited no evidence whatever to the Court that sexual activity among young persons under the age of 16 decreases as the availability of contraceptives is restricted." On the other hand, the court found that when sexual intercourse takes place, venereal disease and pregnancy are more likely to occur if contraceptives are not used. The state is seeking review of the decision by the U.S. Supreme Court.

The Utah decision struck down regulations, adopted as part of the state's AFDC and Medicaid plans, providing that family planning services to minors could be furnished only with the written consent of the minor's parents. The three-judge federal court held that these regulations impermissibly added to AFDC and Medicaid eligibility requirements a condition in conflict with the federal Social Security Act. The court also held that the regulations infringed upon the plaintiff minor's right to privacy and were not justified by any compelling state interest.

The court said that the financial, psychological and social problems arising from teenage pregnancy and motherhood argue for the recognition of a right of privacy for sexually active minors equal to that for adults. The court also said that the state's interest in protecting minors from possible physical harm associated with birth control was adequately met by the Utah Planned Parenthood Association, which employs social workers, licensed physicians and other trained personnel to examine and counsel minors seeking contraceptives.

The State of Utah is seeking review of the decision by the U.S. Supreme Court. Should the Court agree to review the case, the outcome will undoubtedly be influenced by what the Court decides in already pending cases involving parental consent for abortion. (++) If the Supreme Court strikes down statutes requiring parental consent for abortion, it would seem to follow that such requirements for contraception would also fall since it is generally acknowledged to be preferable, from the point of view of health as well as of other considerations, to prevent rather than terminate unwanted pregnancies.

The ruling in the Utah case that the language of federal statutes requires that family planning services funded under federal programs must be made available to minors raises questions about the validity of restrictive legislation in at least one other state. In Kansas, a state statute was recently interpreted by the attorney general to permit state family planning centers to treat only individuals over 18 years of age who are either married or referred by a licensed physician (9) even though Kansas courts have held that mature minors may consent for their own medical care. (10) The Governor has indicated that he will seek to amend the Kansas statute; it is believed that if it is not amended, the state may lose federal funding for its family planning service program.

Abortion

At the time the authors' 1974 article appeared, parental consent requirements for abortion had been enacted in 13 states. (*) Despite numerous court rulings (see discussion below) invalidating statutory requirements of parental consent for abortions performed on unmarried minors, seven states have enacted such requirements since June of 1974. (+) Eleven other states have passed laws which authorize minors to consent for their own medical care but which specifically exclude abortion. (++) When duplication is eliminated (some states have both types of law), 26 of the 50 state legislatures have endorsed the principle that unmarried minors should not be able to obtain an abortion without parental consent. Most of these parental consent requirements were enacted in connection with other restrictions on the right to abortion, and generally reflect attempts by states to limit the constitutional right to abortion that was established by the 1973 U.S. Supreme Court abortion decisions in Roe v. Wade" and Doe v. Bolton. (ss) (12) They are not necessarily inconsistent with the trend, so apparent in other areas of the law, toward broadening the rights of minors generally.

In its landmark decisions in Roe and Doe, the U.S. Supreme Court held that states may not restrict the right to abortion unless the restriction can be justified by a "compelling state interest." Although the Supreme Court left open the question of the validity of parental consent requirements, a number of courts have invalidated such requirements on the ground that they are not justified by the necessary "compelling state interest." These courts have followed the recent trend in the U.S. Supreme Court and lower courts as well of extending a variety of constitutional rights to minors. In the first case inaugurating this trend, the U.S. Supreme Court held that minors are constitutionally entitled to procedural safeguards in juvenile court proceedings. (13) Subsequently, the Court upheld the right of public school students to wear black armbands in school as a protest against the Vietnam war, and stated that minors are 'persons" under our Constitution and that they "are possessed of fundamental rights which the State must respect." (14) Most recently, the Court has required constitutional safeguards for students facing disciplinary action by school authorities. (15)

At the time our 1974 article appeared, specific statutory requirements of parental consent for abortion had been held unconstitutional by federal district courts in Florida (16) and Utah. (17) Subsequently, the Florida lower federal court decision was affirmed by the U.S. Court of Appeals for the Fifth Circuit in Poe v. Gerstein. The Court of Appeals for the Eighth Circuit affirmed a holding striking down all the provisions of a St. Louis, Missouri, ordinance regulating abortion, including a parental consent requirement. (18) Federal district courts also held invalid parental consent requirements in abortion statutes in Colorado, (19) Kentucky, (20) Massachusetts (21) and Pennsylvania. (22) In addition, federal district courts issued preliminary injunctions preventing the enforcement of parental consent requirements for abortion in Illinois, (23) Indiana (24) and Nebraska, (25) and a state statute requiring parental consent was held unconstitutional by the Supreme Court of the state of Washington. (26)

Missouri's statute requiring parental consent for abortion for unmarried women younger than 18 was the only such state law to withstand court attack. The Missouri statute, which contained many other provisions restricting abortion, was held constitutional by a three-judge federal court. (27) However, the U.S. Supreme Court stayed enforcement of the entire statute even before it agreed to review the case. (28) The Supreme Court has (+) now agreed to review the constitutionality of the Missouri abortion statute as well as the constitutionality of a Massachusetts law that also requires parental consent for abortion for an unmarried minor. The cases will be argued together this spring and their decision may supply much-needed clarification of the rights of minors to consent for their own sex-related medical care.

Constitutional Issues

An excellent analysis of the constitutional issues raised by parental consent requirements for abortion appears in the court's opinion in Poe v. Gerstein. (29) In that case, the U.S. Court of Appeals for the Fifth Circuit pointed out that the state could possibly rely upon four interests to defend a statute requiring parental consent for abortions: preventing illicit sexual conduct among minors; protecting minors from their own improvidence; fostering parental control; and supporting the family as a social unit. The court held that none of these interests was a sufficient justification for denying the minor's right to have an abortion and accordingly struck down the Florida statute requiring parental consent for minors' abortions. (**)

The court found no evidence to support the state's argument that the availability of contraception and abortion had increased sexual intercourse among adolescents; it pointed out that many Florida minors had become pregnant and sought abortions during the period prior to Roe v. Wade when Florida had a restrictive abortion law. (Studies have shown little if any effect from the increasing availability of contraceptives on the incidence of premarital or extramarital sex relations. Apparently, young people rarely seek contraceptive assistance until long after a pattern of sexual behavior has been established. (30))

The court in the Gerstein case further found that a parental consent requirement does not "protect a minor from her own improvidence." Instead, it gives her parents an absolute veto power which may be exercised for any number of reasons unrelated to the minor's welfare. The court pointed out that in any event the abortion procedure must be performed by a physician who is in a good position to counsel the minor regarding the physical and emotional consequences of abortion.

The appeals court in Gerstein also rejected any contention that a parental consent requirement fosters parental control or supports the family as a social unit. "The fact that the minor became pregnant and sought an abortion contrary to the parents' wishes," the court said, "indicates that whatever control the parent once had over the minor had diminished, if not evaporated entirely." The court added that if a minor's pregnancy fractured the family structure, giving the parents a veto power over the minor's abortion could not repair the damage.

Similar reasoning has been employed by federal and state courts throughout the country that have invalidated statutory parental consent requirements for abortions.

Notification and Consultation Laws

Three states-Hawaii, (*) Montanat (+) and Utah (++) - have enacted statutes requiring that parents be notified when an abortion is performed on their daughter. (31) No court has yet ruled on the constitutionality of these provisions; however, in some of the opinions declaring consent requirements unconstitutional, judges have suggested that a requirement of notice to or consultation with a parent might be upheld. (32)

A recent thoughtful analysis points out that statutes conditioning abortion upon a notification or consultation requirement are just as objectionable on constitutional grounds as parental consent requirements, since the harm to the minor far outweighs any possible benefit to the state. (33)

Voluntary Sterilization of Minors

As pointed out in our earlier article, few adolescents request sterilization except in the unusual cases where any pregnancy would endanger their health or where they are carriers of a serious hereditary disease. The subject of sterilization of minors was, however, widely publicized following the disclosure that federal funds were used for the tubal ligation of two young black adolescents in Montgomery, Alabama, in the summer of 1973.

In a lawsuit brought by the National Welfare Rights Organization, Federal Judge Gerhard Gesell ruled on March 15, 1974, that under the applicable statutory framework, federal funds could not be used at all to sterilize minors or mentally incompetent adults. (34) Pending appeals from this decision, DHEW extended the previously announced moratorium on federal funding of all sterilizations of persons under age 21 and those mentally incompetent under state law. (33) At the same time, DHEW promulgated proposed regulations with respect to sterilization of mentally competent persons older than 21.

On April 18, 1975, the U.S. Court of Appeals for the District of Columbia Circuit remanded the case to Judge Gesell for consideration of modifications proposed by DHEW of Judge Gesell's original order. The modifications were designed to establish a "universal federal standard of voluntariness" which, under stated conditions and procedures, would permit sterilization of persons 18 years of age and older even where such persons were otherwise incompetent under state standards because of age or mental condition.

Judge Gesell rejected the proposed modifications as inappropriate and contrary to the public interest. In a memorandum issued on October 22, 1975, he stated that he was unwilling to enter an order "which would authorize sterilizations contrary to state law and purport to affect the rights of minors and certain adjudicated incompetents to challenge at some later date the intrusion upon their person on the ground it was conducted in a manner inconsistent with applicable state law." (36) Judge Cesell also noted that any regulation establishing a federal standard for voluntary sterilization should be considered through the rule-making process, after publication in the Federal Register.

Meanwhile, a group of physicians and a few of their patients filed suit in a federal district court in New York challenging city, state and federal sterilization regulations, including the ban on sterilization for minors and mentally incompetent persons. (37) The plaintiffs charged that the regulations single out sterilization from all other medical procedures for excessive restrictions and thereby abridge fundamental constitutional rights.

Even when there is no federal funding, the right of minors to consent for sterilization procedures remains unclear. When our 1974 article appeared, statutes in Arkansas, Colorado, North Carolina and Tennessee specifically provided that a person must be 18 or married to consent to sterilization, and Virginia required the consenting person to be 21. Of the state statutes which specifically authorized minors to consent for their own contraceptive care, those of Georgia, Kentucky, Maryland, Montana and the District of Columbia excluded sterilization. Since then, new statutes enabling minors to consent for general medical care or for contraceptive or pregnancy-related care which specifically exclude sterilization have been enacted in California, Louisiana, Massachusetts, Nevada and Oklahoma. Thus, a total of 14 states have enacted statutes specifically providing that minors may not consent for sterilization or they have excluded sterilization from medical services for which minors are specifically authorized to co nsent.

Conclusions

Both legislatures and courts have continued to affirm the right of young people to consent for their own health care in general and for contraceptive services in particular. The right of young people to consent to their own medical care has in part been a by-product of sweeping changes lowering the age of majority. Since mid-1972, (38) 27 states and the District of Columbia have lowered the age of majority, almost all of them to age 18 for both sexes. Only two states, Mississippi and Pennsylvania, still define as minors for all purposes unemancipated individuals under the age of 21; three others, Alabama, Alaska and Nebraska, have established 19 years as the age of majority. Largely as the result of these changes, young people 18 and older may consent to their own medical and surgical care in 46 states and the District of Columbia.

In the past three and one-half years, only Arkansas, Montana and Oklahoma have joined the nine states that affirmed the right of minors younger than 18 to consent to medical and surgical care generally. (*) The number of states and jurisdictions that have affirmed the right of such minors to consent for their own contraceptive care has increased from 12 to 27 in the three and one-half year period; and for pregnancy-related care, from 20 to 31. In mid-1972, prior to the Supreme Court decisions in Roe and Doe, abortion was still illegal in most states, or available under highly restrictive conditions; and minors under 18 could get abortions on their own consent in only two states, New York and California. By the end of 1975, this right had been affirmed in 25 states and the District of Columbia. With respect to abortion, however, there has been marked tension between the courts and the legislatures. Although courts, both federal and state, throughout the country have declared statutory requirements of parental consent for abortion to be unconstitutional, state legislatures have continued to enact such requirements. Further clarification of the law as to minors' rights in this area should result from the decisions of the U.S. Supreme Court in cases now pending before it. It may be hoped that in this context, too, the Court will reaffirm its past holdings that minors are not "second class citizens."

Eve W. Paul is an associate of, and Harriet F. Pilpel and Nancy F. Wechsler are partners in, the law firm of Greenbaum, Wolff and Ernst, which is counsel to Planned Parenthood Federation of America and Planned Parenthood of New York City.

(*.) All but Missouri (21 years), Alaska (19), Nebraska (19) and Wyoming (19).

(+.) All but Wyoming (19). The law in Missouri is unclear (see discussion below, p. 19).

(*.)Arkansas, Colorado, Hawaii, Missouri (for purposes of signing contracts), South Carolina and Utah. Alabama reduced the age of majority to 19. In a number of these jurisdictions, minors of considerably younger ages were already authorized to consent for their own medical care.

(+.)Nebraska and Utah have statutes restricting the sale of prophylactics to minors, however (see reference 8, pp. 234 and 299).

(++.)See discussion, p. 19.

(*.)Colorado, Florida, Indiana, Kentucky, Louisiana, Massachusetts, Missouri, Nebraska, Nevada, Ohio, South Carolina (minors under 16), South Dakota and Utah. (In addition, Alaska and Washington had statutes predating the Supreme Court decisions in Roe v. Wade, 416 U.S. 113 (1973), and Doe v. Bolton, 410 U.S. 179 (1973), which contained parental consent requirements; these statutes, though far more liberal than the ones declared invalid in Roe and Doe, were in some respects unconstitutional.) Many of the parental consent requirements had already been declared unconstitutional as of June 1974.

(+.)Arkansas, Delaware, Illinois, North Dakota, Pennsylvania, Texas and Virginia.

(++.)Arkansas, Georgia, Kentucky, Louisiana, Massachusetts, Missouri, Montana, Oklahoma, Oregon, Texas and Virginia.

(ss.) These include laws: (1) requiring consultation by other physicians, spousal consent and measures to save a viable fetus; (2) prohibiting the use of public funds for abortion and the advertising of abortion services; (3) including 'conscience' clauses for professionals and institutions; and (4) promulgating facility licensing and reporting requirements. (See: "A Review of State Abortion Laws Enacted Since January 1973," Family Planning/ Population Reporter, 4:108, 1975.)

(**.)The decision of the Court of Appeals for the Fifth Circuit is binding also in the other states of that circuit, which include Alabama, Georgia, Louisiana, Mississippi and Texas. (See: Jackson v. Goste, Civ. No. 74-2425 [ED. La., Jan. 26, 1976].)

(*.) Although in June 1972, the Attorney General of Hawaii indicated to the authors that Hawaii's abortion law, together with statutes authorizing minors to consent to pregnancy-related care, enabled minors to consent for abortion, the authors were advised by a letter in 1974 that this interpretation has never been tested and that as a practical matter, young women under 18 cannot get abortions without parental consent. (See: "Teens, Pregnancy and the Law," Family Planning Perspectives, 6:195, 1974.)

(+.) In the same session of the legislature, Montana adopted a statute enabling some minors to consent for all medical care and enabling all minors to consent for the prevention and treatment of pregnancy except for abortion and sterilization. (See: Montana Reg. Session, 1974 New Laws, Ch. 312, p. 603, House Bill No. 999.)

(++.) Enacted after an earlier abortion statute with a parental consent requirement was declared unconstitutional in Doe v. Rampton (see reference 17).

(*.) In Montana and Oklahoma, if health or life of minor would be endangered by delay.

References

(1.) E.W. Paul, H.F. Pilpel and N.F. Wechsler, "Pregnancy, Teenagers and the Law, 1974," Family Planning Perspectives, 6:142, 1974.

(2.) Wisconsin Senate Bill No. 94, Chap. 6(1975).

(3.) Relf v. Weinberger, 372 F. Supp. 1196 at 1202 (D.D.C. 1974).

(4.) California Senate Bill No. 395, Chap. 820 (1975).

(5.) Laws of Alaska, 1974 Chap. 73; Laws of Delaware Chap. 441, Vol. 59(1974).

(6.) T_____ H_____ v. Jones, D. Utah Central Division No. C. 74-276, July 23, 1975. After the state filed a petition for certiorari (44 U.S. Law Week 3265 [Oct. 24, 1975]), the Supreme Court Invited the Solicitor General to file a brief expressing the views of the United States (44 U.S. Law Week 3358 (Dec. 16, 1975]).

(7.) Population Services International v. Wilson, 398 F. Supp. 321 (S.D. N.Y. 1975), appeal filed, 44 U.S. Law Week 3162 (Sept. 20,1975).

(8.) National Center for Family Planning Services, DHEW, Family Planning, Contraception and Voluntary Sterilization: An Analysis of Laws and Policies in the United States, Each State and Jurisdiction (as of September 1971), U.S. Government Printing Office, Washington, D.C., GPO Stock No. 1731-0002, 1974, p. 70.

(9.) Kansas Attorney General Opinion No. 75-450 (Dec. 9, 1975).

(10.) Younts v. St. Francis Hospital and School of Nursing, 205 Kan. 292,469 P. 2d 330 (1970).

(11.) 410 U.S. 113(1973).

(12.) 410 U.S. 179(1973).

(13.) In re Gault, 387 U.S. 1 (1967). See also: In re Winship, 397 U.S. 358(1970).

(14.) Tinker v. Des Moines School District, 393 U.S. 503 at 511 (1969).

(15.) Goss v. Lopez, 419 U.S. 565(1975).

(16.) Coe v. Gerstein, 376 F. Supp. 695 (S.D. Fla. 1973), affirmed, Poe v. Gerstein, 517 F. 2d 787 (5th Cir. 1975), appeal filed, 44 U.S. Law Week 3319 (Nov. 14, 1975).

(17.) Doe v. Rampton, 366 F. Supp. 189 (D. Utah, 1973), vacated, 410 U.S. 950 (1973).

(18.) Word v. Poelker, 495 F. 2d 1349 (8th Cir. 1974).

(19.) Foe v. Vanderhoof, 389 F. Supp. 947 (D. Colo. 1975).

(20.) Wolfe v. Schroering, 388 F. Supp. 631 (W.D. Ky. 1974).

(21.) Baird v. Bellotti, 393 F. Supp. 847 (D. Mass. 1975), prob. jurisd. noted, 44 U.S. Law Week 3304 (Nov. 17,1975).

(22.) Planned Parenthood Association v. Fitzpatrick, Civ. No. 74-2440 (E.D. Pa., Sept. 4, 1975), appeal filed sub. nom. Beal v. Franklin, 44 U.S. Law Week 3306 (Nov. 13,1975).

(23.) Wynn v. Scott, Civ. No. 75-3975 (N. D. Ill., Nov. 22, 1975).

(24.) Gary-Northwest Indiana Women's Services, Inc. v. Bowen, Civ. No. H-74-289 (N. D. Ind., Jan. 31, 1975).

(25.) Doe v. Exon, Civ. No. 75-L-146 (D. Nebr., Nov. 3, 1975).

(26.) State v. Koome, 84 Wash. 2d 901, 530 P. 2d 260(1975).

(27.) Planned Parenthood of Central Missouri v. Danforth, 392 F. Supp. 1362 (E.D. Mo.), prob. jurisd. noted, 44 U.S. Law Week 3200 (Oct. 6, 1975).

(28.) 420 U.S. 918 (1975).

(29.) Poe v. Gerstein, 1975, op. cit.; and R. J. Zuckerman, "Abortion and Contraception: A Minor's Constitutional Right to Privacy," Family Planning/Population Reporter, 4:114, 1975, pp. 115-117.

(30.) D. S. F. Settlage, S. Baroff and D. Cooper, "Sexual Experience of Younger Teenage Girls Seeking Contraceptive Assistance for the First Time," Family Planning Perspectives, 5:223, 1973; B. C. Sorensen, Adolescent Sexuality in Contemporary America, World, New York, 1973, p. 303 ff; M. Schofield, The Sexual Behaviour of Young People, Longmans Green, London, 1965; "Parental Consent Requirements and the Privacy Rights of Minors: The Contraceptive Controversy," 88 Harvard Law Review 1001, 1010-11 (1975); M. A. Stein, "Furnishing Information and Medical Treatment to Minors for Prevention, Termination and Treatment of Pregnancy," 5 Clearinghouse Review 131 (1971).

(31.) Hawaii Reg. Session, 1975 New Laws p. 945, Act 171, House Bill No. 619, amending Hawaii Revised Statutes Chap. 577 A; Montana Reg. Session, 1974 New Laws Chap. 284, p. 457, Senate Bill No. 715; and Utah Beg. Session, 1974 New Laws p. 143, House Bill No. 30.

(32.) Planned Parenthood Association v. Fitzpatrick. 1975, op. cit. (concurring opinion); and State v. Koome, 1975, op. cit. (majority and concurring opinions).

(33.) R. J. Zuckerman, 1975, op. cit., pp. 117-119.

(34.) Relf v. Weinberger, 1974, op. cit.

(35.) Federal Register, Vol. 39, No. 76, p. 13872, April 18, 1974.

(36.) Relf v. Mathews, Civ. No. 1557-73 and National Welfare Rights Organization v. Mathews, Civ. No. 74-243 (D. D. C., Oct. 22, 1975).

(37.) Douglas v. Holloman, U.S.D.C., S.D.N.Y. (Complaint filed Jan. 5, 1976.)

(38.) "Girls Under 18 Can Consent to Birth Control Services in Two-Fifths of the States," Family Planning Digest, Vol. 1, No. 6, 1972, Table 1, p. 3.

Table 1

Age of majority, and ages at which state legislation, court action or
attorneys general opinions have specifically affirmed the right of
individuals to consent for medical care in general, for contraceptive
services, for examination and treatment of pregnancy and VD, and for
abortion; as of December 31, 1975 (X = any age) (*)

State     Age of               May consent medical for
          majority                 care in general
                     No             If married       In
                     limitation     (M) or           emergency
                                    emancipated (E)

Ala.      19         14             E (9), M         X
Alaska    19, MF     19             E (6,7,8)        X (5,28)
Ariz.     18         18             E, M             X (10)
Ark.      18         X (2,4)        E, M             X
Calif.    18         18             15E (6), M       X
Colo.     18 (1)     18             15E (6), M       18
Conn.     18         18             E, M             18
Del.      18         18             E, M             18
Fla.      18         18             E, M             X
Ga.       18         18 (3)         M (3)            X
Hawaii    18         18             18               18
Idaho     18         18             18               18
Ill.      18 (1)     18             M (7)            X
Ind.      18         18             E, M             X
Iowa      18, M      18             E, M             X
Kans.     18         X (4), 16 (5)  18               16
Ky.       18         18             E, M (8)         X
La.       18, M      X (21,3)       M                X
Maine     18         18             E                X
Md.       18         18             M (8)            X
Mass.     18         18             E (3,6), M (8)   X
Mich.     18         X (4)          E, M             X
Minn.     18         18             E (6), M (8)     X
Miss.     21         X (4)          E, M             X
Mo.       18 (1)     21             E, M (8)         X
Mont.     18         X (23,3,14)    E (3,14)         X
                                    M (7,3,14)
Nebr.     19, M      19             M                19
Nev.      18         18             E (3,4,14)       X (3,4,14)
                                    M (3,4,14)
N. H.     18         X (4)          E, M             X (4)
N. J.     18         18             E, M (7)         18
N. Mex.   18         18             E, M             X (10)
N. Y.     18         18             E, M (8)         X
N. C.     18         18             E, M             X
N. Dak.   18         18             E, M             18
Ohio      18         X (4)          18               X (4)
Okla.     18         X (23,3,14)    E (3,14)         X
                                    M (8,3,14)
Oreg.     18 (1), M  15             M                15
Pa.       21         18             E (9), M         X
R. I.     18         18             E                16, M
S. C.     18         16 (22)        E, M             X
S. Dak.   18         18             E, M             18
Tenn.     18         18             18               18
Tex.      18         18             16E, M           X
Utah      18, M      18             M                X
Vt.       18         18             E, M             18
Va.       18         18 (3)         E                18
Wash.     18         18             E                18
W. Va.    18         18             18               X
Wis.      18         18             E, M             18
Wyo.      19         19             19               19
D. C.     18         18 (3)         E, M (3)         X
Total
At 18     45         35             6                13
<18                  12             44               36

State                      May consent for:

          Contraception       Pregnancy  VD        Abortion
                              connected  care
                              care

Ala.      14                  X          X         14
Alaska    X                   X          X         18
Ariz.     18                  18         X         18
Ark.      X (2,4,12)          X (14)     X         18
Calif.    X (3)               X          12        X
Colo.     X (2)               18         X         X
Conn.     18                  18         X (18)    18
Del.      12 (11)             12         12        18
Fla.      X (20)              18         X         X
Ga.       XF (3)              X          X         X
Hawaii    18                  14 (27)    14 (27)   14 (27)
Idaho     X (4)               18         14        18
Ill.      X (15)              X          12        X (24)
Ind.      18                  18         X         X (24)
Iowa      18 (12)             18         X         18
Kans.     X (4)               X          X         X (4)
Ky.       X (3)               X          X         X
La.       18 (12)             X (3)      X         X
Maine     X (23)              18         X         18
Md.       X (3)               X          X         X
Mass.     18                  X          X (19)    X
Mich.     X (4,12)            X (4)      X         X (4)
Minn.     X (13)              X          X         X (29)
Miss.     X (16)              X          X         X (4)
Mo.       21                  X (14)     X         18
Mont.     18                  X (14)     X         18 (27)

Nebr.     19                  19         X         X (24)
Nev.      18                  16         X         18

N. H.     X (4)               X (4)      14        X (4)
N. J.     18                  X          X         X
N. Mex.   18 (12)             X (17)     X         18
N. Y.     X                   X (4)      X         X (4,25)
N. C.     18                  18         X         18
N. Dak.   18                  18         14        18
Ohio      X (12,4)            X (4)      X         18
Okla.     18 (12)             X (3,14)   X         18

Oreg.     15 (14)             15 (14)    12        18
Pa.       X (26)              X          X         X
R. I.     18                  18         X         18
S. C.     16                  16         X         16
S. Dak.   18                  18         X         18
Tenn.     X (3)               18         X         18
Tex.      18                  X          X         X
Utah      X                   X          X         X (27)
Vt.       18                  18         12        18
Va.       X (3,14)            X (14)     X         18
Wash.     18                  18         14        X
W. Va.    18 (12)             18         X         18
Wis.      18                  18         X         18
Wyo.      19 (12)             19         X         19
D. C.     X (3)               X (3)      X         X
Total
At 18     21                  18         0         24
<18       27                  31         51        26

(*)The fact that no affirmative legislation, court decision or attorney
general's opinion has been found in a particular state does not mean
that some or even all categories of minors below the ages shown in the
table do not have the right to obtain some or all medical services on
their own consent.

Note: Because of reporting lags, the table probably does not include all
applicable legislation, cases and attorneys general opinions for 1975.

M = Married.

F = Female.

E = Emancipated.

(1)For purposes of signing contracts.

(2)Excluding voluntary sterilization if under 18 and unmarried.

(3)Excluding voluntary sterilization.

(4)If mature enough to understand the nature and consequences of the
treatment. See discussion in text (p. 00) of the "mature minor
doctrine."

(5)If parent not Immediately available.

(6)Emancipated defined as living apart from parents and managing own
financial affairs.

(7)And/or pregnant.

(8)Or parent.

(9)Emancipated defined as a high school graduate, a parent or pregnant.

(10)If no parent available, others may consent in loco parentis.

(11)If sexually active.

(12)Comprehensive family planning law permits (or does not exclude)
services to minors without parental consent.

(13)Unless parent has previously notified treating agency of objection.

(14)Excluding abortion.

(15)If referred by clergyman, physician or Planned Parenthood or if
"failure to provide such services would create a serious health hazard."

(16)If referred by clergyman, physician, family planning clinic, school
or institution of higher learning or any state or local government
agency.

(17)Examination only.

(18)In public health agencies, public or private hospitals or clinics.

(19)In publicly maintained facilities.

(20)If married or pregnant or "may suffer, in the opinion of the
physician, probable health hazards if such services are not provided."
Surgical service excluded.

(21)If minor "is or believes himself to be afflicted with an illness or
disease."

(22)Except for operation essential to health or life.

(23)If physician finds probable health hazard.

(24)Parental consent requirement temporarily enjoined by court.

(25)In New York City, municipal hospitals perform abortions on minors
without parental consent if married, emancipated or at least 17 years
old or if seeking parental consent would endanger the physical or mental
health of the patient.

(26)Minors are being served under a state law which permits doctors to
serve minors of any age if delay in treatment "would increase the risk
to the minor's life or health."

(27)Parent notification, but not consent, is required, where possible.

(28)If parent refuses to grant or withhold consent.

(29)County Attorney stated that legislature did not intend to include
abortion as pregnancy-related treatment.