Reference Card: Minors' Rights to Reproductive Health Care in New York

When a young person seeks health care, a parent or guardian is usually involved. However, communication with parents is not always best for young people. In some cases, involving a parent can result in harm to the young person, like being abused or being forced to leave home. Fear of disclosure may prevent some adolescents from seeking necessary treatment or preventive care, leading to serious health consequences.

This card outlines the protections in New York state law that allow minors to consent on their own to confidential health care under certain circumstances.

Definitions

A minor is a person under the age of 18.

A minor who understands the risks, benefits and proposed alternatives to the health services outlined in this card may give informed consent. Informed consent may be verbal or written and should be noted in the patient record. There is no minimum age for informed consent: this is an individualized determination.

Confidentiality requires that information about a patient’s treatment not be disclosed without his or her permission. Confidential health care for adolescents means a provider may not disclose medical records to anyone, including parents, without the patient’s consent.

If minors consent to care on their own, providers cannot give parents information about that care without written consent, unless required by law.
There are some specific situations that permit or require a breach in confidentiality. Please consult the resources listed at the end of this card for more information.

Communication is critical. When young people are assured that health care providers will respect their right to confidentiality, they are more likely to seek reproductive and sexual health care.

To facilitate communication providers should:

• Initiate conversations with adolescents about their right to confidential health care
• Discuss if and how a minor’s parents will be involved in her/his care
• Establish a trusting relationship with the patient and the parent; discuss confidentiality with each individually
• Encourage the adolescent to involve a parent when appropriate

Certain types of minors can consent to any kind of health care on their own.

If a minor falls into one or more of these categories, then he or she can consent to any and all medical treatment confidentially, without involving a parent:

• Emancipated minors—this includes:
  • Minors in the armed forces
  • Minors who are living on their own and are financially independent of their parents
• Married minors
• Minors who have children
• Mature minors: parental consent is not required for minors who can give informed consent and are mature enough to make their own health care decisions. The determination of maturity is up to the health care provider, and should be documented in the medical record.

New York law permits all minors to consent to certain types of health care on their own.

Types of confidential care all minors can consent to on their own include:
Family Planning Services

• Pregnancy tests and options counseling
• Abortion services
• Contraceptive care and counseling, including Emergency Contraception (EC). Emergency Contraception is a form of contraception that can be used up to 120 hours following intercourse, though it is most effective the sooner it is used. It is intended for emergency situations such as unprotected intercourse, contraceptive failure or rape. Consistent with a recent FDA decision, EC is available “over-the-counter” for individuals age 18 or older, but minors must still obtain a prescription from a licensed health care provider. The National EC Hotline (1-888-NOT-2-LATE) offers more information on EC options and providers.

Prenatal Care

• Medical, dental, health and hospital services relating to prenatal care
• Labor and delivery services
• All medical care for themselves and their child, once the child is born

Sexually Transmitted Infections (STIs)

• Testing for STIs
• Treatment for STIs

HIV Testing and Treatment

• Testing for HIV
• Written informed consent is required
• Anonymous testing is available. This means that the patient’s name is not revealed and the test results cannot be traced to the individual.
• Treatment for HIV, but only under the following circumstances:
• For emergency care; or
• When parental involvement is impossible or could cause harm; or
• When the minor is sufficiently mature to follow the treatment regimen

Test results for STIs and HIV are confidential. However, positive test results for HIV and certain STIs must be reported to the New York State Department of Health.

Minors may be able to consent to the following types of health care on their own under certain circumstances. You may wish to consult with a supervisor or seek legal advice.

Types of care minors can consent to on their own under certain circumstances
Drug and Alcohol Abuse Care

• Minors can consent to confidential alcohol and substance abuse counseling
• Minors may sometimes consent to medical treatment for substance abuse

Mental Healthcare

• Minors may sometimes consent to mental health services

For more information about providing minors with mental health care or substance abuse treatment, consult with a supervisor or seek legal advice

Emergency Medical Care

• Parental consent is not required in cases of emergency

• This includes medical treatment and forensic examination following sexual assault
• Records of emergency treatment may be disclosed to a parent unless the provider determines that disclosure would harm the minor patient
• If the minor could have consented to the care on his/her own under the rules above, then the care must remain confidential

Billing/payment/record keeping can compromise confidentiality

To minimize the risk of involuntary disclosure, a provider can:

• Inform the minor if the billing process may compromise confidentiality
• Ask the minor patient for alternative contact if she/he does not want to be contacted at home
• Discuss insurance, billing and alternative forms of payment with the minor (cash is the most confidential/safest payment method)
• Educate the billing department about minors’ rights to confidentiality and be sensitive to the diagnosis and treatment listed on bills sent home
• Consult with legal counsel before releasing any medical records that might result in harm to the minor patient

This publication is intended as a guide, and does not provide individual legal assistance. Please check with your legal counsel for site-specific clarification about confidentiality and disclosure issues, including any policies related to the HIPAA privacy rule. Be aware that laws related to any or all of the subjects addressed in this pamphlet may have been added, repealed, or amended since publication.



Developed by:
Mount Sinai Adolescent Health Center,
New York Civil Liberties Union Reproductive Rights Project,
Physicians for Reproductive Choice and Health (PRCH).
Updated April 2008

If you have further questions, or want to order more cards or other publications, call the NYCLU’s Reproductive Rights Project at 212-607-3300.
For Adolescent Health Services, contact the Mount Sinai Adolescent Health Center at 212-423-3000.
To become a physician member of Physicians for Reproductive Choice and Health, call 646-366-1890 or visit http://www.prch.org.