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Letter to House and Senate Members on Tiahrt Amendment
June 7, 2001
United States Senate
Washington, DC 20510
U.S. House Of Representatives
Washington, DC
20515
Dear Representative/Senator:
As national organizations representing health professionals dedicated to
improving the health of adolescents, we write in strong opposition to an
amendment offered by Representatives Tiahrt and Graham that was adopted during
consideration of H.R. 1, the Elementary and Secondary Education Act
reauthorization. The Tiahrt/Graham provision requires prior written, parental
consent for medical or mental health examination, testing, treatment, or
immunization, among other things. This provision jeopardizes adolescent health
and should not be enacted into law.
Adolescents are a relatively healthy subgroup of the U.S. population. Much of
their behavior, however, puts them at substantial risk for poor health,
including alcohol and substance abuse, sexually transmitted diseases (STDs),
human immunodeficiency virus (HIV), pregnancy, depression, injury, violence, and
suicide. Because these behaviors can jeopardize an adolescent’s development,
future opportunities, and even life, barriers to needed health care services
should not stand in the way of delivery of health care to adolescent patients.
A major obstacle to the delivery of health care to adolescents is concern about
confidentiality. Health professionals have an ethical obligation to provide the
best possible care and counseling to respond to the needs of adolescent
patients. This obligation includes every reasonable effort to encourage parental
involvement.
However, the potential health risks to adolescents if they are unable to
obtain certain health services are so compelling that lack of confidentiality
can actually jeopardize adolescent health care. We encourage family involvement,
but forced parental involvement deters teens from seeking timely medical advice
and needed medical care.
The Tiahrt provision could have a dilatory impact on the delivery of health care
to adolescents. The provision applies to all health service in a school,
including routine visits to the nurse’s office, appointments with a school
psychologist, sports physicals, and almost any service from a school-based
health center. A school would be denied all federal funding if it "requires
or otherwise causes" a student to obtain -- without prior written, parental
consent -- medical or mental health examinations, testing, treatment, or
immunizations.
This provision could prevent any counseling, referral, or assistance by school
nurses, health professionals, guidance counselors, or even teachers from whom
minors often seek advice. A broad range of activities on the part of school
personnel might "cause" a minor to seek such care including suggesting
that a student seek counseling for alcohol or substance abuse, advising a minor
to seek treatment for an STD, providing a young person the phone number of a
domestic violence or suicide-prevention hotline. The Tiahrt provision could
prevent a coach from suggesting that an athlete with signs of anorexia seek
medical help or counseling.
Further, although the amendment does not preempt explicit state laws that allow
minors to self-consent for certain services, in all states, for some services,
there is no "express" statute that allows minors to consent. Rather,
the silence in the state law has been interpreted to permit minors to
self-consent for sensitive services. This amendment would preempt the legal
practice in all of the states in which there is no express statute on this
point.
While we support efforts to encourage family involvement in adolescent health
care, we believe that mandated parental consent could deter teens from seeking
needed care and may harm adolescents. Health professionals and parents share a
common goal – the health and well being of their minor patients. Family
communication is the desired goal, and health care providers are able to assist
in that effort. Confidential care does not preclude working toward this goal.
The Tiahrt provision from H.R. 1, the Elementary and Secondary Education Act
reauthorization should not be enacted into law. We urge you to oppose any
efforts to maintain this provision.
Sincerely,
American Academy of Pediatrics
American College of Obstetricians and Gynecologists
American Medical Association
American Medical Women's Association, Inc.
American Nurses Association
American Public Health Association
Society for Adolescent Medicine
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