The Big Picture: Teenagers & Medical Consent

Editor's note: The following was a comment posted by State Rep. Mary Nolan (D-Portland) on Randy Leonard's post "Protect our Children- Vote No on 43", but it deserves its own thread.

First, thanks to Randy for his clear and passionate explanation of why a "NO" vote on 43 is the way to help protect Oregon teens' safety and health.

Second, the thread here is a great demonstration of the hazards of legislating by ballot measure. Before you move to change one part of the law, it really would be helpful to understand the context and history of the law.

Current law in Oregon and every state I'm aware of requires medical providers (doctors, dentists, nurses, chiropracters, etc.) to receive the informed consent of their patients before providing medical care. This is a good thing. It prevents the abuses of years past where black men were sterilized under the guise of medical care/research and where inmates have been used to experiment on with new drugs.

In Oregon, when the patient is 14 years or younger, we have decided that the medical provider need only explain the proposed course of medical care to the parent (or legal guardian) and receive consent from that adult.

But when the patient is 15 years or older the medical provider must first explain the proposed medical care to the patient her/himself and get consent. If that patient says, "No, thanks," that's the end of it. The medical provider cannot ask mom, dad or guardian to overrule the patient. This is also a good thing. A parent cannot unilaterally give consent to perform an abortion or sterilization on an unwilling 16-year-old. A parent cannot force a 15-year-old to take psychoactive medication.

But if a 15-, 16- or 17-year-old says "Yes" to medical care, Oregon law already allows the medical provider to notify or even consult the parent or guardian if the medical provider believes the minor patient's mental or physical health would benefit by having the parent know or be involved in the decision. The doctor does not need the minor's permission to involve the parent (although most let the patient know, unless circumstances such as imminent danger of suicide demand other action).

The important distinction here is that the law already allows such notification for every medical service from tooth extraction or suicide counseling to birth control prescription to abortion, but does not require it. As written and practiced today, the laws of our state rely on the medical expertise and good judgement of doctors (dentists, nurses, etc.) to weigh the factors and take the action that they believe best serves the health of their patients. In making those decisions, medical providers take into account both the immediate physical well-being of their patient and the long-term emotional and mental well-being of the patient.

Measure 43 would take that judgement call out of the hands of medical professionals and put it in the hands of administrative law judges with no particular expertise or insight. But Measure 43 would make that distinction for only one medical procedure which, we should not ignore, can be requested by only half the population.

If the motives of the proponents were truly to assure that parents have the chance to guide their young adult children in times of medical need, I wonder why they didn't propose to change the underlying law and require parental notice or consent for all medical service until age 18.
My own daughter is fast approaching her teen years. I know I would be crushed if she chose to make such an important decision without my help. But I also know that it is my responsibility now to lay the foundation for her to feel completely comfortable seeking my support. And that standing in her way 5 years from now because I couldn't or wouldn't be accessible to her now isn't fair, and is far from safe.
Please join Randy and me in voting "NO" on 43.

Comments

  • Jamie (unverified)
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    Thanks, Mary. I believe that the most important point raised is your note about "the hazards of legislating by ballot measure." It's true for M43, and for so many other ballot measures, too. An up or down vote on matters of great complexity, where there are strongly held, divergent viewpoints, is a blunt instrument at best. What we need is a deliberative legislative body, representing the many views of the electorate, collaborating to find the ways to best meet the various interests... Sadly, that's not even close to what we have, so we get BMs. Yes, that was a pun.

  • RayCeeYa (unverified)
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    But if a 15-, 16- or 17-year-old says "Yes" to medical care, Oregon law already allows the medical provider to notify or even consult the parent or guardian if the medical provider believes the minor patient's mental or physical health would benefit by having the parent know or be involved in the decision.

    This is the most important point concerning this measure and I don't know why I don't hear it more often. This measure would remove the ability for trained medical professionals to make the decision. Frankly if you can't trust someone who went to college for eight years to become a doctor then who can you trust?

  • Marty Wilde (unverified)
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    Your average voter has no idea the hellish families some of these girls come from. We tend to have a rather rosy view of families, but I've worked in the child protective system, and I'll tell you that these kids have been through things that most people can't imagine. Telling her parents about her pregnancy often results in serious abuse. Also consider that, in a shocking number of cases, the pregnant girl's mother's boyfriend or husband is the father. Telling her mother that does not result in a good heart to heart, but rather serious abuse and the kid ending up on the street. I'd advocate for calling the police before I'd support parental notification.

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    Although this is slightly off topic (and yet not) my mom works at a hospital. She brought up a point about the Federal privacy laws. I wish I could remember exactly what she said, but it had to do with privacy laws that already exsist and whether or not this law (if passed) would interfere with that process. If someone knows, maybe they can correct me.

  • Janna (unverified)
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    Why a no vote on 43? Today I visited my local health dept. to recieve a shot my doctor's office doesn't provide. As I walked in, I saw a pretty young lady about 15 years old. As we made eye contact she smiled at me and I at her. Although there was the smile on her face, her eyes told me a different story. She seemed nervous and a bit scared, but at the same time the smile on her face showed the brave front she was trying to put forth. As I looked at this young lady, I imagined my own 17 year old daughter and wondered what brought this young lady to this place alone. Now while the county health dept. provides many services, I had a feeling why she was here. Later in another waiting room as I waited for the nurse to call me for my shot, the young lady came in. This time armed with papers, a brochure on birth control and information on folic acid. While I have no real information on this young lady and her reason for visiting, my mothering instincts kicked in and I wanted to give her a hug tell her everything would be okay and she was smart for seeking medical advice. Again she smiled at me and I at her. I asked her how she was doing. With a faint smile and a bit of sadness in her eyes she said, "Okay". I again thought of my own daughter and went back to our conversation about birth control. I was one of the lucky ones, my daughter came to me. For what ever reason she felt she could talk to me about wanting to "get on the pill", I certainly haven't been the picture perfect mom, and my daughter knows it! I then thougth of Measure 43 and how a yes vote would affect my daughter and this young lady sitting before me. I am one of the lucky ones, the mom my daughter knew she could talk to, or maybe my daughter was the lucky one to have the courage to voice her concerns to me regardless of the outcome. Still not all families have that, and while I hope that some day all families will, that is far off in the future and Measure 43 will not speed up the process. So for my daughter, your daughter, the neighborhood girl and all the nameless young ladies out there with or without supportive families vote no on 43. And to the young lady at the health department, I wish you well no matter what you decide. And know that you are thought of today as I cast my ballot.

  • James Vincent (unverified)
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    Just like the illogical! All emotion! Look people if my young daughter were raped I would want to know. I would want to prosecute those who did this too my little girl. And also anyone who took it on their own to have this procedure made without my consent. How dare anyone assume that they can take my child and based on what she says, maybe she is embarrassed or just doesn't want to let her parents know or hurt them? What if she is lying? Damn anyone who would take it on their own to touch my wife, my children or my home. Who makes you people the Authority over my family? The people, who do things to children whether they are Father’s, Uncle’s neighbor or some punk kid should be prosecuted, not let go to do it again. Your only reason for voting "NO" on this bill is because you have no respect for life in the womb or out of the womb. You dishonor a young girl by putting her through such an ordeal, and you dishonor the family by usurping the authority of the family. If a young girl is made pregnant by an adult why not let the School, the Police and the Family get together so that the proper procedures for arrest and care for the young lady can be made. But the STATE taking upon their own to do this is a breach of my parental rights and conforms with Fascist and Marxist doctrine!

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    James, the simple truth is your parental rights to own what happens to your childrens' bodies ends when they turn 15. For good reason.

    There is no breach happening here. It merely seems that you want abortion to be an exception to current law, no special reason given.

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    James, the simple truth is your parental rights to own what happens to your childrens' bodies ends when they turn 15. For good reason.

    There is no breach happening here. It merely seems that you want abortion to be an exception to current law, no special reason given.

  • Ross Williams (unverified)
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    Who makes you people the Authority over my family?

    Who makes you the "Authority" over your family? The answer is no one. Your daughter has her own authority to get medical treatment for herself once she turns 15 whether you like it or not. That isn't fascism or marxism, its freedom.

    I think in many ways this goes to the heart of this discussion. Most parents attempt to guide their children and their children make use of that guidance. But some parents don't. They see themselves as the sole decision maker and their children, no matter how old, as subject entirely to their authority regardless of what the law might say. And some of them enforce their decisions through violence and abuse. Measure 43 puts those young women at risk with nothing to protect them.

  • Madam Hatter (unverified)
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    "Who makes you people the Authority over my family?"

    <h2>And who makes you the Authority over my family? Which is what you want to do by creating legislation that affects my daughter. What a lame, hypocritical argument.</h2>
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