Adolescent Decision Making: Legal Issues with Respect to Treatment for Substance Misuse and Mental Illness

Richard C. Boldt, University of Maryland Francis King Carey School of Law

Document Type Article


This article examines how decision-making authority with respect to the treatment of adolescents for substance misuse is (or should be) organized within the triad made up of an adolescent patient, his or her parents, and a treatment provider. Subsumed within this discussion is a consideration of the respective capacity of adolescents and their parents both to grant and to withhold consent for treatment. The article then takes up a related set of questions concerning a treatment provider’s disclosure of confidential information about an adolescent’s diagnosis and/or treatment for substance misuse to the adolescent’s parents. This discussion is related to a larger analysis of decision-making, because communication with an adolescent’s parents for purposes of arranging informed consent for treatment may itself constitute a legally prohibited disclosure of confidential information.

The article concludes that adolescents’ rights should be safeguarded in those situations in which the law treats them as the ultimate decision-maker. When the law does not permit adolescents to exercise independent and final authority, however, parents and clinicians should still seek to structure opportunities for adolescents to participate in the decision-making process, while openly acknowledging the limits of that participation. Tensions in the law between according decision-making authority to adolescents for some purposes and withholding it for others are likely to be managed best in practice rather than resolved in advance on the basis of abstract legal analysis. This process of working out the sometimes competing interests of adolescents and their families, both with respect to making treatment decisions and managing confidential information, requires sensitive contextualized judgments by treatment professionals and others concerned about the wellbeing of minors with substance misuse disorders and other mental disabilities. Legal rules have an important role to play in framing the decision-making processes by which these choices are made by and on behalf of adolescents, but ultimately, the outcomes in individual cases are just as likely to be driven by clinical and interpersonal considerations that require sensitive attention to the individual circumstances presented by each adolescent in need of treatment services.