THE LIBERTARIAN ENTERPRISE
Number 168, April 8, 2002
Doctors Question Teens Without Parental Consent
by Wendy McElroy
Special to TLE
Dianne Neely has no official way to complain about an intrusive "Teen Questionnaire" www.massnews.com/31102intrude2.htm that a pediatrician gave to her 13-year-old daughter, Amanda, without parental consent. The 27 questions -- ranging from sexual activity to drug use, including "Is there a gun in your home?" and "is there conflict [domestic violence]?" -- violated no law.
Indeed, Dr. Stephen Kanarek -- a physician at the Pediatric Health Care Associates where Amanda has been a patient since 1996 -- calls such questionnaires "common practice" across America. Certainly, they are endorsed by such powerful organizations as the American Pediatric Association (APA), the American Academy of Family Physicians, and the American College of Obstetricians and Gynecologists.
The questionnaires may exclude parents from aspects of their child's medical care. For example, the heading of Amanda's questionnaire offered her two options: "I would not like this information shared with my parents;" or, "I am willing..." An APA Policy Statement entitled "Confidentiality in Adolescent Health Care (RE9151)," states "health risks to the adolescent are so impelling that legal barriers and deference to parental involvement should not stand in the way of needed health care." www.aap.org/policy/104.html
The "Teen Questionnaire" is not designed to protect the privacy of those teens who ask doctors for help against sexual molestation in the home, for example. It is given pre-emptively and without parental consent to every teen who is a patient, whether or not abuse is suspected.
Some of the questions reach beyond traditional health care. For example, Amanda was asked, "[H]ave you ever ridden with a driver who has used drugs or alcohol?" And, "Do any of your friends use drugs?" As policy, the APA states, www.aap.org/policy/re9801.html "Inquiry regarding the extent of tobacco, alcohol, or other drug use by peers and family should be a part of the routine history of every child who is seen in the pediatrician's office."
The answers cannot strictly be called "confidential" as doctors may notify state agencies if they believe a threat to the child exists or if an illegal activity is indicated. An answer such as "yes, my parents sometimes have wine when dining at a nearby restaurant and they drive home afterward," may be reported to child protective services or the police. (Such matters are decided at the doctor's discretion and according to widely varying state laws.)
At the doctor's discretion, the child's consent as well as confidentiality can be sidestepped. The APA's recommendation on "Tobacco, Alcohol, and Other Drugs," is "Patient consent should generally be obtained before testing for drugs of abuse, but may be waived when the patient's mental status or judgment is impaired."
Even in the absence of imminent danger or illegality, the doctor may breach confidentiality. Dr. Karanek explained that concern over a teen's unprotected sexual activity might lead a pediatrician to inform the parents even if the confidentiality box in the header had been checked.
Again, the APA concurs. It advises doctors to inform adolescents of the circumstances under which "confidential" information will be disclosed. But does a 13-year-old realize how accounts of occasional drinking, the ownership of guns or domestic squabbles by parents might be viewed by Child Protective Services? www.ifeminists.com/introduction/editorials/2001/0731.html
Dianne Neely is not a bad parent with secrets to hide. Quite the contrary. Active in both church and community, Neely wants to play a fully-informed role in shaping her children's values.
Neely learned of the questionnaire by accident when she took her two daughters to a pediatric office. Her 10-year-old went into one room and, at Amanda's request, Neely joined her in another. In the room, a nurse handed Amanda the questionnaire and instructed her to give the completed form "directly to the doctor."
Dismayed, Amanda told her mother that she could not bring herself to answer questions such as "have you ever experienced...fondling or sexual intercourse that was against your will?" According to a story in Massachusetts News www.massnews.com/31102intrude.htm, the doctor then advised the complaining Neely that "state law requires that all children are treated as if they are promiscuous and doctors have every right to offer sexual advice, birth control, etc. without parental permission." Claudette Houle of the state Board of Registration, which regulates doctors, denies that the Board has any regulation on teen questionnaires.
Few people would object to third parties interceding to prevent a child from being physically abused within the family. And the sincerity with which pediatricians such as Dr. Kanarek argue for the best interests of the child is unmistakable. But the APA questionnaire policies resemble a generalized witch hunt that allows state agencies to enter the homes of parents who seek even mundane medical care for their children. The APA advises, "Even an apparently straightforward complaint such as headaches or sore throat may be associated with an underlying substance abuse problem."
Dianne Neely used to have confidence in her pediatricians who -- in fairness -- are pursuing accepted policy in teen health care. Neely doesn't accept it. She intends to ask new doctors some pointed questions before allowing them access to her children. Will she be fully informed of her child's medical history? What questions does the doctor ask of children and will information be sent to state agencies without her consent or that of her child?
More generally, Neeley asks, "Does doctor-patient confidentiality exist for my child and why are doctors assuming parental authority?"
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