Testimony Regarding Absolute Confidentiality For Teens Regarding Their Medical Care 2

I am Ross Olson, a pediatrician with 4 children and 4 grandchildren. I have practiced for over 35 years, including the US Navy, Pilot City Health Center in Minneapolis, a College Health Service and Emergency Room in Illinois, a Hospital and Clinic in Hong Kong and most recently 23 years with a large HMO here in the Twin Cities.

My opinions arise from my experience and concern for the long term consequences not only to my own patients, but also to all children and adolescents growing up in our increasingly dangerous world.

The idea that teens need absolute confidentiality in their medical care is based on a reasonable assumption, that otherwise they will not seek care. After all, it is hard enough to get them to talk about significant issues anyway. But it does not necessarily work that way and there are serious unintended consequences to the policy, because it is based on a number of unwarranted assumptions.

One is this: It is assumed that the average family is dysfunctional. When a 16 year old girl says, “My Mom will kill me if she finds out I’m sexually active,” the caring professional may downgrade the potential scenario from murder to mild mayhem, but still basically agree that telling the parents would result in nothing good. This means that the professional thinks he or she knows better and cares more for that adolescent than the parent, or perhaps assumes that the teen is completely competent to make these decisions independently.

Yet the parent, for better or for worse, is the parent for life and the professional will be in the picture, at best, for a relatively short term. Thus the policy drives a wedge between parent and child and separates the parents from life-changing decisions whose consequences will affect them regardless.

Another effect of this policy is to promote the illusion that if nobody knows, nothing happened, or that things can be undone as if they never occurred, or even that with proper technology, risky behavior can be made safe. Teens are not good at long term planning and many professionals have the attitude that the best we can do for them is to blunt some of the effects of their actions. I call this “the animal model of adolescence.” That sort of thinking never considers that there is great value to a high standard – as we now have with smoking – even if many fall short.

Would repeal of total confidentiality leave medical providers in the uncomfortable position being “stool pigeons” with no room for wisdom? When a teen comes in to see me with a concern and says, “Don’t tell my parents,” I can say, “Your parents really need to know about this and I think YOU should tell them. I can help you with that.”

Interestingly at the House Committee Hearings, those testifying for the other side of this issue, stated that they almost always attempt to get the parents of teens involved and rarely fail to do so. Moreover, they stated that this is the standard of care so that no change in the law is needed. The teens think they are confidential and thus come in for care, but the medical providers always get in touch with their parents anyway. To hear them tell it, it is the best of both worlds.

Contradicting this is the testimony of many young people who are regularly transported to and from medical care during school hours to avoid suspicion by parents. Elaborate measures are taken by many clinics to avoid contacting the teens at home by phone or letters because it might alert the parents to what is going on. Information is even rigidly denied parents when they ask point blank.

Maybe the medical providers here testifying against this bill indeed are unusually conscientious, diligent and successful in involving parents in their children’s medical decisions and maybe they even have exactly the same goals for the adolescents under their care as the families would have, but there is a significant and growing counter-culture that has a dramatically different agenda. And the opponents of parental notification are either naively playing into those hands or are not telling us the whole truth about their own agenda.

Margaret Sanger, Founder of Planned Parenthood way back in 1922 wrote this: "Through sex, mankind may attain the great spiritual illumination which will transform the world, which will light up the only path to an earthly paradise." (The Pivot of Civilization, NY Brentano's, 1922, p.270)
Former US surgeon General Jocelyn Elders said: “Everybody in the world is opposed to sex outside of marriage, and yet everybody does it. I’m saying, ‘Get real.’"

Minnesota Sociologist Ira Reiss claims that the first sexual revolution did not go far enough because people are still feeling guilty. In An End To Shame: Shaping Our Next Sexual Revolution, he envisions a guilt-free society in which no sexual expression is prohibited and everybody feels wonderful. Isn't that just great? Maybe he will entitle his next book, Psychopaths in Wonderland.

Another clue that some march to a different drummer is opposition to the promotion of abstinence. Planned Parenthood and the ACLU have complained in various forums that sexual abstinence before marriage is a religious concept and does not even belong in the public schools.

There is also a growing scholarly literature defending and justifying "intergenerational sex," what those of us trapped in an "outmoded morality" used to call child molestation. University of Minnesota published Judith Levine in her book Harmful to Minors at least gives aid and comfort to this radical movement. She makes statements like this: "Protecting children is one of our chief duties as adults, whether we are parents, professionals, or friends. But we also have to ask: What are we protecting them from? My book says that sexuality is a fact of life, and a potentially wonderful part of growing up for children at all stages of their lives. It's not sex itself that is harmful to children, but the conditions under which they might express themselves sexually that can leave them vulnerable to harms like HIV, unwanted pregnancy, or sexual violence."

And is it really true that talking about birth control does not influence children’s behavior? As far back as 1986, a Harris Poll showed that teens who had comprehensive sex education – including information on birth control and abortion – later engaged in more sexual experimentation than those who had no sex education at all, and markedly more than those who had the simple biologic facts. The recent so-called failure of abstinence sex education in Minnesota was actually a failure of a program that said, 'Wait until you are ready,' not 'Wait until marriage."

But finally, unconsidered in the equations of the confidentiality proponents, is the deterrent effect of potential discovery. If we as adults are honest, we will all admit that, at least sometimes, the reason we control impulses we KNOW are wrong boils down to fear of what would happen if we were found out. A concrete example of this phenomenon occurred when Minnesota had a parental notification law for minors seeking abortion. During that time, not only did abortions decline, but also births for girls under 18. Apparently because of fear of disclosure, behavior actually changed. (Rogers, JL and Boruch, RF and Stoms, GB and DeMoya, D, “Impact of the Minnesota Parental Notification Law on Abortion and Birth,” Am J Public Health: 8:3, pp 294-298, 1991, http://www.ajph.org/cgi/content/abstract/81/3/294 )

The present confidentiality policy makes it easy for teens to think that nobody will ever know. It is not true, of course, and even if it were, the consequences are still real. What we don’t know, or what parents don’t know, can hurt. It can hurt them, their children and all of us. I guess it amounts to a philosophical difference; do we just want to wait at the bottom of the cliff to pick up the injured, or build a fence at the top?

Ross S. Olson MD ross{at}rossolson.org

Presented 3/9/04 at hearings of the Senate Health and Human Services Committee of the Minnesota Legislature.

For reactions to this testimony, click HERE.

Send comments to me at ross{at}rossolson.org

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