Consent for Treatment of an Adolescent: Unaccompanied Adolescents

Not all adolescent consent issues involve sensitive treatment scenarios. As adolescent patients become drivers, they are more likely to present for treatment without a parent. Although a patient may seem mature enough to consent for general treatment, a parent’s consent is still required. Consider the following case.

Case File

A dermatologist called NORCAL Risk Management after a 17-year-old patient arrived without a parent for a six-month acne follow-up. The patient’s mother was contacted, and she consented to the treatment over the telephone. Since her child was able to drive himself to appointments, and she felt he was competent to consent to his own acne treatment, she asked if her son could continue acne treatment without her involvement. The dermatologist wanted to know how to accommodate her request and whether it was appropriate to obtain her consent over the telephone.

Discussion

When an unaccompanied adolescent patient presents for non-urgent treatment, a parent’s consent is necessary. In this example, because the parent and patient had an established relationship with the dermatologist, telephone consent from the parent for this simple follow-up appointment was sufficient. If, during the appointment, the dermatologist decided that the patient needed treatment requiring informed consent (i.e., the mother needed to consider risks, benefits, and alternatives to determine whether she wanted her son to undergo the treatment), she would need to call the mother back to obtain a full informed consent. As for the patient returning regularly without a parent, the dermatologist could obtain consent from the mother for the series of follow-ups, if those appointments were not expected to involve new risks, benefits, and alternatives. However, if any of the future appointments involved treatment that fell outside of the anticipated follow-up services (e.g., excision of a mole), the dermatologist would have to obtain separate consent to treat and, if necessary, informed consent.

Medical Liability Risk Management Recommendations

Prior to obtaining consent over the telephone for the treatment of an unaccompanied minor, or when obtaining consent for a series of treatments, it is important to establish a relationship with the patient and their parent(s). Parents should be told up front whether and under which circumstances their unaccompanied adolescent child will be treated. This can be accomplished by developing a written policy statement or handout that is provided to all parents whose children are approaching adolescence. For the treatment of unaccompanied minors, consider the following:

Telephone Consent

• Verify the authenticity of the parent/guardian giving consent by requesting the patient’s full name, date of birth, address, phone number(s), and details of the situation.
• If possible, have a second responsible person witness the call.
• Discuss the risks, benefits, and alternatives with the person authorized to consent as if he or she were present.
• Document in the minor’s medical record who consented, who obtained the consent, and who witnessed it.
• Document that the consent was obtained by telephone.
  
  

Practical Tip

After verifying the authenticity of the parent or guardian by telephone and discussing the care and treatment, you may request that the parent/guardian provide documentation of his or her informed consent by email or fax. Have the legal representative giving consent send or affirm a message with words such as:

“I have been informed by Dr. X of the risks, benefits, and alternatives associated with the proposed treatment and grant permission for him/her to provide medical treatment [or a specific procedure or treatment] to [patient’s name], [relationship to the patient].”

Attach a copy of the email or fax to the medical record. Whenever possible, original, signed consents should be obtained and filed in the medical record.

Consent for a Series of Treatments

• In a written policy or handout, clarify with parents what services may and may not be performed without explicit consent.
• Do not provide treatment outside of the scope of the agreed-upon services without obtaining additional consent from the parent.
  • Err on the side of caution.

Although some parents may expect it, only accommodate parents’ requests to treat unaccompanied adolescents to your level of comfort and capabilities. Policies and procedures should be created and consistently adhered to throughout the practice to avoid confusion.