The Mature Minor Rule: Teens and patient confidentiality
History of the Mature Minor Rule
The Mature Minor Rule was created as a result of a 1967 court case, Smith v. Seibly, 72 2n.2d 16.
What is the Mature Minor Rule?
The Mature Minor Rule is part of Public Health - Seattle & King County's Policy and Procedure which allows health care providers to treat youth as adults based upon an assessment and documentation of the young person's maturity. The Mature Minor Rule enables the provider to ask questions of the young person in order to determine whether or not the minor has the maturity to provide his or her own consent for treatment.
If clients have coupons in their own name and are under the age of 18, they are considered to be Mature Minors.
Clarification of the Mature Minor Rule
- Age 15 or older?
The age guideline is not as restrictive as it was when the Mature Minor Rule was developed. Treating both 13 and 14 year olds as Mature Minors when they demonstrate key qualities of the Mature Minor is reasonable. Treating youth who are 12 and under is up to the provider's best judgment.
- Freedom from parents or guardian: Lives apart, managing his/her own affairs?
A teenager living apart from his/her parents or guardians and managing his/her own affairs.
- Intelligence: Capable of understanding and appreciating the implication of treatment?
Intelligence relates directly to the young person's ability to understand both the benefits and risks of treatment. A young person's ability to recognize his/her need for care and present him/herself at a health care site is an indicator of intelligence.
- Maturity: Absence of control by parents?
Maturity relates directly to the young person's ability to provide reliable information and make important decisions.
- Training: Self-supporting?
Economic independence from parents or guardians. In some cases, involvement in a work-training program may indicate an individual who is self-supporting. A self-supporting individual may be considered to be both "intelligent" and "mature."
- Experience: General conduct of an adult?
The provider can use his/her own judgment in determining an individual's general conduct as an adult.
- Marital status: Married?
If it has been determined that an individual is intelligent and mature, then marriage can be used to further support the case of applicability.
What is the most important thing you should remember?
DOCUMENTATION!! Any decisions you make using the Mature Minor Rule must be documented with your name, date of treatment, and the criteria that a youth meets indicating that they are a "mature minor." This information should be clearly indicated in the patient's chart or medical record.
Medical treatment that can be provided without parental consent (regardless of age):
- Family Planning Services
- Pregnancy Care (including Prenatal Care)
- Emergency Services (if it is impractical to obtain consent first if needed)
- Court Order: For legally emancipated minors (very uncommon)
- Minor who is married to someone 18 years or older
- Treatment requested for a suspected STD
Categorical services with age limits
Chemical dependency services:
- Any person 13 or older may give consent for him/herself to receive outpatient treatment by a chemical dependency treatment program certified by the DSHS.
- Any person under 18 needs parental or guardian consent to be admitted to inpatient treatment. Exceptions will be made for individuals meet the definition of "a child in need of services" defined in RCW 13.32A.030(4) and determined by the DSHS (from the Becca Bill).
- The parent or guardian of a minor is not liable for the cost of their child's care unless they have joined in the consent to treatment.
- Any person 13 or older may give consent for him/herself to receive outpatient treatment by a non-residential licensed services provider identified in RCW 71.34.030(1).
- Any person 13 or older may, with the concurrence of the professional person in charge of an evaluation and treatment facility, admit him/herself without parental consent to the evaluation and treatment facility, provided that notice is given by the facility to the minor's parent. Notification must occur within 24 hours of the minor's voluntary admission [RCW 71.34.042(1).]
- Parental or guardianship authorization is required for any treatment of a minor under 13 years of age.
- The minor's parent or legal guardian is not liable for the cost of their child's care unless they have joined in the consent to treatment.
Any person 14 and older can give consent for STD diagnosis and treatment (this includes Hepatitis B Immunizations).
Clients under 18 years of age.
Provider name, date of treatment, Mature Minor Rule criteria used to treat an individual under 18 years of age.
- Emancipated Minor
A legal term in which an individual approaches the court to become legally separated from his/her parents or legal guardian. The process is extremely difficult and time consuming. Individuals who become "emancipated" are legally liable for their actions and their care. Emancipated minors are very uncommon.
- Mature minor
Individuals who meet the guidelines of maturity contained in the Health Department Policy (Procedure 5.5) and outlined in this document. Guidelines for an individual to be considered a mature minor include: age, living apart from parents or guardian, maturity, intelligence, economic independence, experience and marital status.
- Consent to treatment
When an individual agrees to receive medical services.
- Informed consent
Consenting to receive a specific procedure which may or may not have health implications. Clients need to understand the implications and general nature of the procedure or treatment.