{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T12:53:47Z","timestamp":1792068827329,"version":"4.4.0"},"reference-count":40,"publisher":"American Academy of Pediatrics (AAP)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,6,1]]},"abstract":"<jats:p>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\u2014medical, legal, and ethical\u2014guided 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\u2019 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.<\/jats:p>","DOI":"10.1542\/peds.2025-073049","type":"journal-article","created":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T00:02:48Z","timestamp":1778630568000},"source":"Crossref","is-referenced-by-count":0,"title":["When Teens With Consent Authority Refuse Life-Saving Care: Weighing Capacity and Confidentiality"],"prefix":"10.1542","volume":"157","author":[{"given":"Liz","family":"Bowen","sequence":"first","affiliation":[{"name":"1SUNY Upstate Medical University, Syracuse, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen","family":"Teelin","sequence":"additional","affiliation":[{"name":"1SUNY Upstate Medical University, Syracuse, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia","family":"Huguelet","sequence":"additional","affiliation":[{"name":"2University of Colorado School of Medicine, Aurora, Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward","family":"McArdle","sequence":"additional","affiliation":[{"name":"1SUNY Upstate Medical University, Syracuse, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2026,5,13]]},"reference":[{"issue":"6","key":"2026101508313626000_r1","doi-asserted-by":"crossref","first-page":"1218","DOI":"10.1097\/01.AOG.0000127595.54974.0c","article-title":"Sudden death: ectopic pregnancy mortality","volume":"103","author":"Anderson","year":"2004","journal-title":"Obstet Gynecol."},{"issue":"10","key":"2026101508313626000_r2","first-page":"599","article-title":"Ectopic pregnancy: diagnosis and management","volume":"101","author":"Hendriks","year":"2020","journal-title":"Am Fam Physician."},{"issue":"8","key":"2026101508313626000_r3","doi-asserted-by":"crossref","first-page":"798","DOI":"10.1056\/NEJMcp2402787","article-title":"Tubal ectopic pregnancy","volume":"392","author":"Schreiber","year":"2025","journal-title":"N Engl J Med."},{"issue":"4","key":"2026101508313626000_r4","first-page":"778","article-title":"The medical management of ectopic pregnancy: a meta-analysis comparing \u201csingle dose\u201d and \u201cmultidose\u201d regimens","volume":"101","author":"Barnhart","year":"2003","journal-title":"Obstet Gynecol."},{"issue":"1","key":"2026101508313626000_r5","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1016\/j.jadohealth.2017.10.011","article-title":"Adolescents\u2019 and young adults\u2019 reports of barriers to confidential health care and receipt of contraceptive services","volume":"62","author":"Fuentes","year":"2018","journal-title":"J Adolesc Health."},{"issue":"6","key":"2026101508313626000_r6","doi-asserted-by":"crossref","first-page":"710","DOI":"10.1001\/jama.288.6.710","article-title":"Effect of mandatory parental notification on adolescent girls\u2019 use of sexual health care services","volume":"288","author":"Reddy","year":"2002","journal-title":"JAMA."},{"issue":"12","key":"2026101508313626000_r7","doi-asserted-by":"crossref","first-page":"1029","DOI":"10.1001\/jama.1997.03550120089044","article-title":"Influence of physician confidentiality assurances on adolescents\u2019 willingness to disclose information and seek future health care. A randomized controlled trial","volume":"278","author":"Ford","year":"1997","journal-title":"JAMA."},{"issue":"5","key":"2026101508313626000_r8","doi-asserted-by":"crossref","first-page":"e2024066326","DOI":"10.1542\/peds.2024-066326","article-title":"Confidentiality in the care of adolescents: policy statement","volume":"153","author":"Chung","year":"2024","journal-title":"Pediatrics."},{"issue":"5","key":"2026101508313626000_r9","doi-asserted-by":"crossref","first-page":"e2024066327","DOI":"10.1542\/peds.2024-066327","article-title":"Committee on Adolescence, & Committee on Practice & Ambulatory Medicine. Confidentiality in the care of adolescents: technical report","volume":"153","author":"Chung","year":"2024","journal-title":"Pediatrics."},{"key":"2026101508313626000_r10","article-title":"Confidentiality in adolescent health care","author":"American College of Obstetricians and Gynecologists Committee on Adolescent Health Care","year":"2020"},{"key":"2026101508313626000_r11","article-title":"Adolescent health care, confidentiality","author":"American Academy of Family Physicians","year":"2024"},{"issue":"4","key":"2026101508313626000_r12","doi-asserted-by":"crossref","first-page":"791","DOI":"10.1016\/j.jadohealth.2025.06.006","article-title":"Confidential healthcare for adolescent minors and young adults: a position paper of the Society for Adolescent Health and Medicine","volume":"77","author":"Society for Adolescent Health and Medicine","year":"2025","journal-title":"J Adolesc Health."},{"issue":"1","key":"2026101508313626000_r13","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1037\/lhb0000315","article-title":"Adolescents\u2019 cognitive capacity reaches adult levels prior to their psychosocial maturity: evidence for a \u201cmaturity gap\u201d in a multinational, cross-sectional sample","volume":"43","author":"Icenogle","year":"2019","journal-title":"Law Hum Behav."},{"issue":"suppl 1","key":"2026101508313626000_r14","doi-asserted-by":"crossref","first-page":"S18","DOI":"10.1542\/peds.2020-0818F","article-title":"Adolescent brain development and medical decision-making","volume":"146","author":"Diekema","year":"2020","journal-title":"Pediatrics."},{"issue":"2","key":"2026101508313626000_r15","first-page":"213","article-title":"Adolescent refusal of lifesaving treatment: are we asking the right questions?","volume":"22","author":"Diekema","year":"2011","journal-title":"Adolesc Med State Art Rev."},{"issue":"2","key":"2026101508313626000_r16","first-page":"207","article-title":"Adolescent brain development and the mature minor doctrine","volume":"22","author":"Silber","year":"2011","journal-title":"Adolesc Med State Art Rev."},{"issue":"3","key":"2026101508313626000_r17","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1016\/j.jadohealth.2009.05.016","article-title":"Adolescent maturity and the brain: the promise and pitfalls of neuroscience research in adolescent health policy","volume":"45","author":"Johnson","year":"2009","journal-title":"J Adolesc Health."},{"issue":"3","key":"2026101508313626000_r18","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1093\/jmp\/jht017","article-title":"Does recent research on adolescent brain development inform the mature minor doctrine?","volume":"38","author":"Steinberg","year":"2013","journal-title":"J Med Philos."},{"key":"2026101508313626000_r19","article-title":"Minor consent and confidentiality: a compendium of state and federal laws","author":"English","year":"2024"},{"issue":"6","key":"2026101508313626000_r20","doi-asserted-by":"crossref","first-page":"e2021053458","DOI":"10.1542\/peds.2021-053458","article-title":"State-by-state variability in adolescent privacy laws","volume":"149","author":"Sharko","year":"2022","journal-title":"Pediatrics."},{"issue":"Suppl 1","key":"2026101508313626000_r21","doi-asserted-by":"crossref","first-page":"S25","DOI":"10.1542\/peds.2020-0818G","article-title":"When does a minor\u2019s legal competence to make health care decisions matter?","volume":"146","author":"Weithorn","year":"2020","journal-title":"Pediatrics."},{"key":"2026101508313626000_r22","year":"1979"},{"key":"2026101508313626000_r23","year":"2000"},{"key":"2026101508313626000_r24","year":"1979"},{"key":"2026101508313626000_r25","article-title":"Guttmacher","author":"Guttmacher Institute. Interactive map: US abortion policies and access after Roe","year":"2025"},{"key":"2026101508313626000_r26","volume-title":"After Roe fell: U.S. abortion laws by state","author":"Center for Reproductive Rights","year":"2025"},{"key":"2026101508313626000_r27","article-title":"Tracking abortion laws across the country","volume-title":"The New York Times.","author":"McCann","year":"2022"},{"key":"2026101508313626000_r28","first-page":"1","volume-title":"Care Post-Roe: Documenting Cases of Poor-Quality Care since the Dobbs Decision","author":"Grossman","year":"2024"},{"issue":"1","key":"2026101508313626000_r29","first-page":"79","article-title":"Parens patriae and parental rights: when should the state override parental medical decisions","volume":"33","author":"Stern","year":"2019","journal-title":"J Law Health."},{"issue":"1","key":"2026101508313626000_r30","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1016\/j.jadohealth.2023.08.008","article-title":"Adolescent access to clinicians\u2019 notes: adolescent, parent, and clinician perspectives","volume":"74","author":"Sprackling","year":"2024","journal-title":"J Adolesc Health."},{"issue":"5","key":"2026101508313626000_r31","doi-asserted-by":"crossref","first-page":"577","DOI":"10.1016\/j.jadohealth.2017.11.296","article-title":"The catch to confidentiality: the use of electronic health records in adolescent health care","volume":"62","author":"Stablein","year":"2018","journal-title":"J Adolesc Health."},{"issue":"1","key":"2026101508313626000_r32","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1001\/jama.2014.15391","article-title":"New challenges for electronic health records: confidentiality and access to sensitive health information about parents and adolescents","volume":"313","author":"Bayer","year":"2015","journal-title":"JAMA."},{"issue":"3","key":"2026101508313626000_r33","doi-asserted-by":"crossref","first-page":"e20190193","DOI":"10.1542\/peds.2019-0193","article-title":"Teenager, parent, and clinician perspectives on the electronic health record","volume":"145","author":"Carlson","year":"2020","journal-title":"Pediatrics."},{"issue":"5","key":"2026101508313626000_r34","doi-asserted-by":"crossref","first-page":"646","DOI":"10.1080\/13218719.2024.2346716","article-title":"Standardised capacity measures and cognition in the assessment of capacity in children and adolescents: a systematic review","volume":"32","author":"Beaumont","year":"2024","journal-title":"Psychiatr Psychol Law."},{"issue":"3","key":"2026101508313626000_r35","doi-asserted-by":"crossref","first-page":"302","DOI":"10.1017\/S0963180109090471","article-title":"Against the tide: arguments against respecting a minor\u2019s refusal of efficacious life-saving treatment","volume":"18","author":"Ross","year":"2009","journal-title":"Camb Q Healthc Ethics."},{"key":"2026101508313626000_r36","volume-title":"The Ethics of Care: Personal, Political, and Global","author":"Held","year":"2006"},{"issue":"3","key":"2026101508313626000_r37","doi-asserted-by":"crossref","first-page":"e2022058780","DOI":"10.1542\/peds.2022-058780","article-title":"The Adolescent\u2019s Right to Confidential Care When Considering Abortion","volume":"150","author":"American Academy of Pediatricscommittee on Adolescence","year":"2022","journal-title":"Pediatrics."},{"key":"2026101508313626000_r38","volume-title":"Caring for Patients Who Have Experienced Trauma","author":"American College of Obstetricians and Gynecologists\u2019 Committee on Health Care for Underserved Women","year":"2024"},{"issue":"5","key":"2026101508313626000_r39","doi-asserted-by":"crossref","first-page":"671","DOI":"10.1016\/j.ajog.2021.08.012","article-title":"Universal precautions: the case for consistently trauma-informed reproductive healthcare","volume":"226","author":"Owens","year":"2022","journal-title":"Am J Obstet Gynecol."},{"issue":"2","key":"2026101508313626000_r40","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1001\/virtualmentor.2012.14.2.coet1-1202","article-title":"AMA Code of Medical Ethics\u2019 opinions on confidential care for sexually active minors and physicians\u2019 exercise of conscience in refusal of services","volume":"14","author":"AMA Council on Ethical and Judicial Affairs","year":"2012","journal-title":"AMA J Ethics."}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/doi\/10.1542\/peds.2025-073049\/1932070\/pediatrics.2025073049.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/doi\/10.1542\/peds.2025-073049\/1932070\/pediatrics.2025073049.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T12:31:48Z","timestamp":1792067508000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/157\/6\/e2025073049\/207529\/When-Teens-With-Consent-Authority-Refuse-Life"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,13]]},"references-count":40,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2026,5,13]]},"published-print":{"date-parts":[[2026,6,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.2025-073049","relation":{},"ISSN":["0031-4005","1098-4275"],"issn-type":[{"value":"0031-4005","type":"print"},{"value":"1098-4275","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,13]]},"article-number":"e2025073049"}}