Caring for Adolescents: Unique Ethical Considerations

Abstract

Adolescence is a period of rapid physical, cognitive and psychosocial growth that represents a progressive transition from childhood to adulthood. With this transition come unique health care concerns, an emerging quest for autonomy, and desire and capacity to make one’s own health care decisions. Health care providers (HCPs) caring for adolescents require a general framework for navigating issues of confidentiality and consent for this unique segment of the pediatric population. An adolescent’s decision-making capacity depends not only on their age, but on their developmental level and maturity, emotional intelligence, personal experience making determinative decisions, and other factors including, but not limited to, influence by peers, family, and their dominant culture. Providers should use all the information at their disposal to evaluate decision-making capacity and, therefore, the adolescent’s ability to meet criteria for the provision of informed assent/consent on a case-by-case basis. Given adolescents legal standing as minors, some level of parental involvement is typically expected, and HCPs must possess appropriate communication skills for managing situations when there is disagreement between an adolescent patient and their parents or where parental involvement represents a barrier to confidential care. In general, relying upon principles of shared decision-making (SDM), providers must strive to provide comprehensive, accessible care for adolescents that is respectful of their evolving autonomy and emerging capacity, while supporting and facilitating open and honest communication between adolescents and their parents.