united-states privacy minor hipaa
If a minor requested a doctor prescribe her birth control, can she demand the doctor not disclose her request to her parents?
<p>Let's say a 16 year old girl manages to speak to her doctor in private during a regular appointment and requests birth control.  She is afraid her parents would respond poorly to knowing she is considering sexual intercourse, and so requests the doctor make up some other excuse for prescribing the medicine, such as to regulate or manage her periods.</p>
<p>I assume the doctor has the right to decline to make up an excuse for the prescription, and in absence of doctor being willing to justify it a minor may not request the prescription since their parents may guess on the reason for it.</p>
<p>Aside from that though I'm more wondering can the doctor inform her parents of her request, and that she is considering sexual activity?  Legally does she have a legal right to demand her request be kept private from her legal guardians?</p>
<p>Assume the minor is living with her parents and hasn't been emancipated.</p>

<p><a href="/questions/tagged/united-states" class="post-tag" title="show questions tagged &#39;united-states&#39;" rel="tag">united-states</a><a href="/questions/tagged/texas" class="post-tag" title="show questions tagged &#39;texas&#39;" rel="tag">texas</a></p>
<p>In the US, it depends on the consent-to-treat laws of the state. In Washington, under <a href="https://app.leg.wa.gov/rcw/default.aspx?cite=9.02.100" rel="nofollow noreferrer">RCW 9.02.100</a>, everybody has a right to reproductive privacy (be it contraceptives or abortions). Under the federal HIPAA privacy rule, the minor requesting contraceptives would therefore be &quot;the individual&quot;, which means that disclosure to others requires consent from the patient. Given the supremacy clause, that's all she wrote for Washington. The majority of states similarly allow 16 year olds to request contraceptives. <a href="https://statutes.capitol.texas.gov/Docs/FA/htm/FA.32.htm" rel="nofollow noreferrer">Texas Family Code §32.003</a> spells out the conditions where a minor can consent to their own medical treatment, which does not include the situation you describe, therefore parental consent would be required (which clearly implies parental notification). Furthermore, that law also says</p>
<blockquote>
<p>(d)  A licensed physician, dentist, or psychologist may, with or
without the consent of a child who is a patient, advise the parents,
managing conservator, or guardian of the child of the treatment given
to or needed by the child.</p>
</blockquote>
<p>Therefore in Texas there is no prohibition against informing the parent(s). (Note that in the Texas Family Code, &quot;child&quot; is a synonym for &quot;minor&quot;, so this also applies to teenagers, not just small children.)</p>
<p><a href="https://supreme.justia.com/cases/federal/us/431/678/" rel="nofollow noreferrer">Carey v. Population Services Int'l</a>, 431 U.S. 678 is an important ruling regarding the rights of minors to make their own decisions regarding contraception, but it does not go so far as to declare that minors have a constitutional right to give consent to the requisite medical examination.</p>

<p><a href="/questions/tagged/england-and-wales" class="post-tag" title="show questions tagged &#39;england-and-wales&#39;" rel="tag">england-and-wales</a></p>
<p>A 16 year old is not considered, for these purposes, a minor so she can legally engage in consentual sexual activity (with certain exemptions not relevant here).</p>
<p>A child under 16 can get professional advice from a medical practitioner about birth control without their parents' knowledge or consent - and have it prescribed - as long as they satisfy the <a href="https://www.cqc.org.uk/guidance-providers/gps/gp-mythbuster-8-gillick-competency-fraser-guidelines" rel="noreferrer">Fraser Guidelines<sup>1</sup></a>:</p>
<blockquote>
<ul>
<li><p>He/she has sufficient maturity and intelligence to understand the nature and implications of the proposed treatment</p>
</li>
<li><p>He/she cannot be persuaded to tell her parents or to allow the doctor to tell them</p>
</li>
<li><p>He/she is very likely to begin or continue having sexual intercourse with or without contraceptive treatment</p>
</li>
<li><p>His/her physical or mental health is likely to suffer unless he/she received the advice or treatment</p>
</li>
<li><p>The advice or treatment is in the young person’s best interests.</p>
</li>
</ul>
</blockquote>
<hr />
<p><sup>1</sup>These guidelines stem from the House of Lords judgement in <a href="https://www.bailii.org/uk/cases/UKHL/1985/7.html" rel="noreferrer">Gillick v West Norfolk et al</a> which was primarily concerned with determining a child’s capacity to consent to medical treatment.</p>

<p><a href="/questions/tagged/france" class="post-tag" title="show questions tagged &#39;france&#39;" rel="tag">france</a></p>
<p>Parental consent is normally needed for any intervention made on a minor but two topics are exception, in which they incur secrecy and never needing parental consent, birth control and <em>IVG</em> (Voluntary Abortion)</p>
<p>As per article L5134-1 of the <em>Code de santé publique</em> (Law for public health)</p>
<blockquote>
<p>I.-Le consentement des titulaires de l'autorité parentale ou, le cas échéant, du représentant légal n'est pas requis pour la prescription, la délivrance ou l'administration de contraceptifs aux personnes mineures.</p>
</blockquote>
<blockquote>
<p>La délivrance de contraceptifs, la réalisation d'examens de biologie médicale en vue d'une prescription contraceptive, la prescription de ces examens ou d'un contraceptif, ainsi que leur prise en charge, sont protégées par le secret pour les personnes mineures.</p>
</blockquote>
<p><em>Translation and emphasis mine</em></p>
<blockquote>
<p>I.-The consent of the holders of parental authority, or, if applicable, the legal representative is not needed for the prescription, issuance or administration of birth control for minors</p>
</blockquote>
<blockquote>
<p>The issuance of birth control methods, lab exams for the prescription of birth control, prescription of these exams or birth control and the covering of care costs are protected by medical secret for minors</p>
</blockquote>

<p><a href="/questions/tagged/south-africa" class="post-tag" title="show questions tagged &#39;south-africa&#39;" rel="tag">south-africa</a></p>
<p>In South Africa a girl can request birth control without the need to have permission from parents at the age of 13.</p>
<p>This is not a right specifically given to girls. A boy can also request to be circumsised without a parents permission at age 13.</p>
<p>In general a person's right to choose over his or her body is not predicated on a parent's opinion.</p>
<p>This conduct is regulated by the HPCSA (Health Professions Council of South Africa). The statutory body dealing with the various medical professions.</p>
<p>Although if she tries to obtain birth control from a private facility they may refuse her access to the drugs if she cannot pay for them. If she goes to a government clinic there is no such problem.</p>

<p><a href="/questions/tagged/germany" class="post-tag" title="show questions tagged &#39;germany&#39;" rel="tag">germany</a></p>
<p><strong>tl;dr:</strong></p>
<p><strong>Generally, yes.</strong> The doctor may not inform the parents against the patient's wishes, as long as the doctor considers the patient to be &quot;sufficiently mature&quot;, which is generally accepted for patients aged 14 and older.</p>
<hr />
<p>Details:</p>
<p>In Germany (as in most other countries), medical professionals are generally required to respect a patient's privacy. Violating a patient's privacy is punishable with up to one year of imprisonment (<a href="https://www.gesetze-im-internet.de/stgb/__203.html" rel="nofollow noreferrer">Strafgesetzbuch §203</a>).</p>
<p>In principle, this applices even if the patient is a minor. However, the parents or legal guardians may be informed and must consent to treatment if the patient lacks the maturity (<em>Einsichts- und Urteilsvermögen</em> - literally <em>ability for comprehension and judgement</em>) to make an informed decision (see e.g. <a href="https://www.aerztezeitung.de/Wirtschaft/Bei-jungen-Patienten-lauern-juristische-Fallstricke-270093.html" rel="nofollow noreferrer">Bei jungen Patienten lauern juristische Fallstricke</a>).</p>
<p>In practice, the medical professional must make an individual judgement whether the patient posesses the required maturity. If they do, patients may take decisions alone, both on what treatment they want and who may be informed about it. This is a difficult area for the professional, because there are no fixed rules for assessing maturity. However, it is generally recognized that patients 14 years and older usually are sufficiently mature.</p>
<p>The standard is also different depending on the seriousness of the decision in question. For example, if a major intervention is planned, the legal guardians may have be informed even if the patient is considered mature - on the other hand, medically minor interventions may be performed without the consent or knowledge of the parents. Prescription of birth control pills would probably not be considered a major intervention, since it is a widely practiced treatment where serious side effects are rare.</p>
