Parental Consent and Access to Oral Health Care for Adolescents

Abstract

While most states allow minors 12 years and older to consent to services for contraception, prenatal care, or sexually transmitted infections, the same adolescents are required to have parental consent for even preventive oral health care. Many adolescents are denied access to preventive oral health care because of the challenge of securing parental consent for care when parents are unwilling, unable, or unavailable to consent. Our purpose is to examine the barriers to preventive oral health care for U.S. adolescents related to parental consent laws, explore the issues surrounding these laws, and recommend policy changes. We explain the current range and status of consent laws across the country and arguments for parental consent law as it now stands. We discuss the difficulty of applying general medical consent law to preventive oral health care, neuroscience research on cognitive capacity among adolescents, and the distinction between parental consent and adolescent assent. We recommend replacing required “opt-in” consent with simpler “opt-out” consent; developing a tool for assessing adolescent decision-making capacity; advocating for consent laws that apply specifically to preventive oral health care; and empowering school nurses to lead local, state, and nationwide policy and legislation efforts.

Keywords

access to care adolescent oral health parental consent

Get full access to this article

View all access options for this article.

References

American Academy of Pediatric Dentistry (2015) Guidelines on informed consent. Clinical Practice Guidelines 37(6): 315–317. Retrieved from http://www.aapd.org/media/policies_guidelines/g_informedconsent.pdf.

American Academy of Pediatrics Committee on Bioethics. (2016). Informed consent in decision-making in pediatric practice. Pediatrics, 138(2), e20161485.

American Academy of Pediatrics (1976) Consent. Pediatrics 57(3): 414–416.

American Academy of Pediatrics Committee on Bioethics (1995) Informed consent, parental permission, and assent in pediatric practice. Pediatrics 95(2): 314–317.

American Academy of Pediatrics Committee on Bioethics (2016) Informed consent in decision-making in pediatric practice. Pediatrics 138(2): e20161485.

American College of Pediatricians (2015) Parental notification/consent for treatment of the adolescent. Issues in Law & Medicine 30(1): 99–105.

Anderson

J. E.

(2015) Brain development in adolescents: New research—Implications for physicians and parents in regard to medical decision making. Issues in Law & Medicine 30(2): 193–196.

Association of State and Territorial Dental Directors. (2015). Best practice approaches for state and community oral health programs. Retrieved from http://www.astdd.org/docs/bpar-selants-update-03-2015.pdf.

Centers for Disease Control and Prevention. (2015). Oral health, data briefs, United States statistics. Retrieved from http://www.cdc.gov/nchs/data/databriefs/db191.htm.

10.

Consent by Minor 16 or Over to Hospital, Medical or Surgical Treatment or Procedures, Kansas Statute § 38-123b (2014).

11.

Consent by Minors to Medical Procedures Act, 410 ILCS (Illinois Compiled Statutes) § 210. (1992). Retrieved from http://www.ilga.gov/legislation/ilcs/ilcs3.asp?ActID=1539&ChapterID=35.

12.

Coyne

Harder

(2011) Children's participation in decision-making: Balancing protection with shared decision-making using a situational perspective. Journal of Child Health Care 15(4): 312. doi:10.1177/1367493511406570.

13.

DeVoe

Tillotson

Angier

Wallace

(2015) Predictors of children's health insurance coverage discontinuity in 1998 versus 2009: Parental coverage continuity plays a major role. Maternal & Child Health Journal 19(4): 889–896. doi:10.1007/s10995-014-1590-0.

14.

Dodd

V. J.

Logan

Brown

C. D.

Calderon

Catalanotto

(2014) Perceptions of oral health, preventive care, and care-seeking behaviors among rural adolescents. Journal of School Health 84(12): 802–809. doi:10.1111/josh.12215.

15.

Dye, B. A., Thornton-Evans, G., Li, X., & Iafolla, T. J. (2015, March). Dental caries and sealant prevalence in children and adolescents in the United States. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics, 2011–2012. Retrieved from https://www.cdc.gov/nchs/data/databriefs/db191.pdf.

16.

Emancipation of Minors Act, 750 ILCS (Illinois Compiled Statutes) § 30/1 et seq. (2003). Retrieved from http://www.ilga.gov/legislation/ilcs/ilcs3.asp?ActID=2094&ChapterID=59.

17.

Geertsen

S. S.

Thomas

Larsen

M. N.

Dahn

I. M.

Andersen

J. N.

Krause-Jensen

Lundbye-Jensen

(2016) Motor skills and exercise capacity are associated with objective measures of cognitive functions and academic performance in preadolescent children. Plos ONE 11(8): 1–16. doi:10.1371/journal.pone.0161960.

18.

Glasscoe-Watterson

(2012) Informed consent and informed refusal. RDH 32(9): 44–134.

19.

Grant, J., & Peters, A. (2016). Children's dental health disparities: New research on the problem and what can be done. N.p.: Dental Campaign. Retrieved from http://www.pewtrusts.org/en/research-and-analysis/analysis/2016/02/16/childrens-dental-health-disparities.

20.

Griffith

Tengnah

(2012) Assessing children's competence to consent to treatment. British Journal of Community Nursing 17(2): 87–90.

21.

Guttmacher Institute (2017) An overview of minors' consent laws, New York, NY: Author. (State policies in brief). Retrieved from https://www.guttmacher.org/state-policy/explore/overview-minors-consent-law.

22.

Institute of Medicine and National Research Council (2011) Improving access to oral health care for vulnerable and underserved populations, Washington, DC: The National Academies Press. doi: 10.17226/13116.

23.

Jackson

S. L.

Vann

W. F.

Kotch

J. B.

Pahel

B. T.

Lee

J. Y.

(2011) Impact of poor oral health on children's school attendance and performance. American Journal of Public Health 101(10): 1900–1906. doi: 10.2105/AJPH.2010.200915.

24.

Jones

E. E.

Shi

Hayashi

A. S.

Sharma

Daly

Ngo-Metzger

(2013) Access to oral health care: The role of federally qualified health centers in addressing disparities and expanding access. American Journal of Public Health 103(3): 488–493.

25.

Kakar

Gambhir

R. S.

Singh

Kaur

Nanda

(2014) Informed consent: Cornerstone in ethical medical and dental practice. Journal of Family Medicine and Primary Care 3(1): 68–71. doi:10.4103/2249-4863.130284.

26.

Katz

A. L.

Webb

S. A.

(2016) Informed consent in decision-making in pediatric practice. Pediatrics 138(2): e1. doi:10.1542/peds.2016-1485.

27.

Kinscherff

Latham

(2014) Informed consent or assent for assessment, treatment and releases of information. In: Bromberg

D. S.

O'Donohue

W. T.

(eds) Toolkit for working with juvenile sex offenders, San Diego, CA: Elsevier Academic Press, pp. 1–28. doi: 10.1016/B978-0-12-405948-1.00001-3.

28.

Koppelman, J., Vitzthum, K., & Simon, L. (2016). Expanding Where Dental Therapists Can Practice Could Increase Americans' Access To Cost-Efficient Care. Health affairs, 12, 2200.

29.

Lambelet Coleman

Rosoff

P. M.

(2013) The legal authority of mature minors to consent to general medical treatment. Pediatrics 131(4): 786–793. doi:10.1542/peds.2012-2470.

30.

Lee

J. Y.

Divaris

DeWalt

D. A.

Baker

A. D.

Gizlice

Rozier

R. G.

Vann

W. F.

Jr. (2014) Caregivers' health literacy and gaps in children's Medicaid enrollment: Finding from the Carolina Oral Health Literacy Study. Plos ONE 9(10): e110178. doi:10.1371/journal.pone.0110178.

31.

Mancini, T. (2012). Lack of dental care poses health risk to children. Retrieved from https://ccf.georgetown.edu/2012/09/17/lack-dental-care-poses-health-risk-children.

32.

Maradiegue

(2002) The Health Insurance Portability and Accountability Act and adolescents. Pediatric Nursing 28(4): 417–420.

33.

Moore

Kirk

(2010) A literature review of children's and young people's participation in decisions relating to health care. Journal of Clinical Nursing 19(15/16): 2215–2225. 11 pp. doi:10.1111/j.1365-2702.2009.03161.x.

34.

Morgan

Monaghan

N. P.

Jones

S. J.

Morgan

M. Z.

(2011) Do parents of children with caries choose to opt out of positive consent dental surveys in Wales?. British Dental Journal 210(2): 1–5.

35.

Oana-Maria

(2012) Child rights and the limits of parental consent in medical procedures. Challenges of the Knowledge Society 2: 916–921.

36.

Parsapoor

M. B.

Rezaei

Asghari

(2014) Autonomy of children and adolescents in consent to treatment: Ethical, jurisprudential and legal considerations. Iranian Journal of Pediatrics 24(3): 241–248.

37.

Ruud Hansen

T. W.

(2016) Patient autonomy—What does it mean for clinical decision-making in children and adolescents?. International E-Journal of Science, Medicine & Education 10(1): 3–9.

38.

Seirawan

Faust

Mulligan

(2012) The impact of oral health on the academic performance of disadvantaged children. American Journal of Public Health 102(9): 1729–1734. doi:10.2105/AJPH.2011.300478.

39.

Sharma

Chhabra

Sharma

Bopiah

(2011) Patient consent in dentistry: Are we legally safe?. Journal of Oral Health & Community Dentistry 5(2): 68–72.

40.

Sirbaugh

P. E.

Diekema

D. S.

(2011) Policy statement—Consent for emergency medical services for children and adolescents. Pediatrics 128(2): 427–433. doi:10.1542/peds 2011-116.

41.

Society for Adolescent Health and Medicine (2013) Adolescent consent for vaccination: A position paper of the Society for Adolescent Health and Medicine. Journal of Adolescent Health 53(4): 550–553.

42.

Soubelet

Salthouse

T. A.

(2011) Correlates of level and change in the Mini-Mental State Examination. Psychological Assessment 23(4): 811–818. doi:10.1037/a0023401.

43.

Spurr

Bally

Ogenchuk

(2015) Integrating oral health into pediatric nursing practice: Caring for kids where they live. Journal for Specialists In Pediatric Nursing 20(2): 105–114. 10p. doi:10.1111/jspn.12108.

44.

Steinberg

(2013) Does recent research on adolescent brain development inform the mature minor doctrine?. The Journal of Medicine and Philosophy 38(3): 256–267. doi: 10.1093/jmp/jht017.

45.

Steinberg

Cauffman

Woolard

Graham

Banich

(2009) Are adolescents less mature than adults? Minors' access to abortion, the juvenile death penalty, and the alleged APA ‘flip-flop.’. American Psychologist 64(7): 583–594. doi:10.1037/a0014763.

46.

Validity of Consent of Minor for Health Services, Montana Statute § 41-1-402. (2003). Retrieved from http://leg.mt.gov/bills/mca/title_0410/chapter_0010/part_0040/section_0020/0410-0010-0040-0020.html.

47.

Vera-Estay

Dooley

J. J.

Beauchamp

M. H.

(2015) Cognitive underpinnings of moral reasoning in adolescence: The contribution of executive functions. Journal of Moral Education 44(1): 17–33.

48.

Vernillo

(2011) Routine opt-out HIV testing in dental health care—Its implementation and the advancement of public health. American Journal of Bioethics 11(4): 46–48. doi:10.1080/15265161.2011.552162.

49.

Ziegler

Dahnke

Winkler

Gaser

(2013) Partial least squares correlation of multivariate cognitive abilities and local brain structure in children and adolescents. Neuroimage 15(82): 82284–88294. doi: 10.1016/j.neuroimage.2013.05.088.