PEDIATRICS Vol. 107 No. 2 February 2001, p. e16
Conflict Between Confidentiality and Physician Reporting
Requirements Under Child Abuse Laws
, and
From the * Division of Adolescent Medicine,
Center for
Children's Support, and the § Department of Pediatrics, University of
Medicine and Dentistry of New Jersey, School of Osteopathic Medicine,
Stratford, New Jersey.
| The first 20% of the full text of this article appears below. |
Over the past several decades, sexual activity between unmarried adolescents and adult partners has received increased public scrutiny, especially as it relates to teenage pregnancy.1 Although the total adolescent birth rate has declined over the past decade, the birth rate for teenagers younger than 15 years has remained stable.2 Adult fathers are responsible for one quarter of births to adolescents <15 years of age, and they typically are nearly 9 years older than the mothers.3
Because this sexual behavior is associated with an increase in teenage pregnancy, with all of its associated social consequences, public policy has dictated better enforcement of laws that prohibit such activity. This is one reason for the revision and increased enforcement of many state statutory rape laws that criminalize certain sexual activity between adolescents and adult partners. Individuals, however, generally do not have a legal duty to report a crime. Thus, physician reporting of such sexual behavior under these criminal statutory rape laws is premised on ethical and other considerations.
Physicians encountering teenagers involved in sexual
relationships with adults may, however, be mandated to report such activity because of reporting requirements of child protection laws
(ie, abuse and neglect), if the sexual activity is construed as abuse
or neglect. A physician who becomes aware of sexual activity between an
adolescent and an adult partner must then decide between confidentiality and disclosure. Physicians may be ethically troubled about maintaining confidentiality when parents are unaware of such
activity, particularly if reporting to child protection
agencies is also needed. Conversely, confidentiality between
adolescents and their physicians is essential for their continued
participation in medical care.4,5 In fact, physicians who
specialize in treating adolescents prefer