When Teens With Consent Authority Refuse Life-Saving Care: Weighing Capacity and Confidentiality

What should a clinician do when an adolescent refuses a treatment that might save their life? What if the proposed treatment is in the realm of reproductive health care, which demands heightened attention to autonomy and confidentiality? This Ethics Rounds considers the case of a 15-year-old patient who refused treatment of an ectopic pregnancy, a potentially life-threatening condition, raising difficult questions about whether a clinician should override the treatment decisions of a minor patient who has legal authority in her state to make her own decisions, or breach medical confidentiality by notifying her parents. We consider these questions from 3 perspectives-medical, legal, and ethical-guided by practitioners in each area. Two specialists in adolescent medicine and pediatric gynecology and obstetrics, respectively, discuss the clinical dimensions of the case that inform ethical decision-making. An attorney/clinical ethics consultant contextualizes the case in relation to state legal protections for adolescent confidentiality in reproductive health care, as well as the complex legal landscape nationwide. Finally, a clinical ethics consultant identifies relevant ethical frameworks for balancing the realities of adolescent decision-making in high-stakes, high-stress situations with the strong duty to protect adolescents' reproductive autonomy. These perspectives converge to present a multipronged argument: in highly pressured situations, adolescent patients who generally have decision-making capacity may not have the capacity to refuse life-saving treatment and, in that case, should not be permitted to do so; however, they still have a right to confidentiality that should be prioritized and protected.