Consent and confidentiality issues among school-age children and adolescents

This article supports the moral viewpoint that minors with decision-making capacity, regardless of their age, should be involved in their health care decisions. When clinical care proceeds without attention to a child's emotional and developmental potential, the needs of a young person to be socialized to take care of his or her health care from an early age are not met. This is ethically irresponsible. Developing competence for informed consent decisions is associated with cognitive capacity. Explicit federal guidelines and laws exist for the inclusion of minors in research. By contrast, minors are often left out of participating in the health care decisions that may affect them for a lifetime in illness and wellness preservation. For day-to-day care, respect for children as increasingly autonomous individuals, members of families, and society is derived from the ethical principle of autonomy. The school nurse is often in a unique position to promote this professional behavior because most interactions are directly with the minor and without parental presence. In addition, the health office is a "safe" place where students can go for a variety of concerns. The school nurse must be concerned about ethical practice while staying within the limits of state and federal laws regarding minors' consent to treatment and confidentiality.