Consent, Competence, and Confidentiality Related to Psychiatric Conditions in Adolescent Medicine Practice

Adolescents who seek health care may encounter a health care system that encourages autonomy and a legal system that considers them as “minors” without decision-making authority. Their concerns for privacy in care and confidentiality of health care information can affect if, when, and how they seek out care, especially when their health care issues are of a more sensitive nature. Of particular concern are “sensitive” issues in adolescent health care such as psychiatric conditions where issues of who can consent (ie, who is competent to consent, when, and how) and how to protect confidentiality often play a central role in debates over how best to ensure that adolescents get the care they need while parental/guardian rights and family interests are respected. In addition, mental health conditions may require override of usual consent procedures to effect involuntary hospitalization. This article reviews the legal and ethical issues related to consent, competence, and confidentiality as they arise in adolescent mental health care.