May 21, 1980
Subject:
Health; Counseling Minors for Sickle Cell Disease; Definition of treatment under G.S. 90-21.2
Requested By:
Dr. Sarah T. Morrow, M.D., M.P.H., Secretary
Questions:
- Does counseling minors for sickle cell disease and related genetic disorders constitute "treatment" as defined under G.S. 90-21.2?
- May minors be counseled for sickle cell disease and related genetic disorders without parental consent?
- If parental consent is required for counseling minors for sickle cell disease and related genetic disorders, would such consent remain valid for later counseling if obtained at the time of testing?
Conclusions:
- No.
- To provide genetic counseling to minors without consent would appear to be a violation of the common law principles governing the parent-child relationship and thus would leave the individual providing these services protentially vulnerable to litigation.
- Yes.
Generally, the consent of the parent is necessary before his child is medically treated. See Sharpe
v. Pugh. 270 N.C. 598 (1972). Statutory relief from that duty is provided by G.S. 90-21.1 through 90-21.5. Protection from failure to gain such consent is only available when: (1) the treatment fits the statutory definition, and (2) the treatment is only given in those particular circumstances outlined by the statute.
G.S. 90-21.2 defines that treatment" which will be protected by the statute; it states:
The word "treatment" as used in G.S. 90-21.1 is hereby defined to mean any medical procedure or treatment, including x-rays, the administration of drugs, blood transfusions, use of anethetics, and laboratory or other diagnostic procedures employed by or ordered by a physician licensed to practice medicine in the State of North Carolina that is used, employed, or ordered to be used or employed commensurate with the exercise of reasonable care and equal to the standards of medical practice normally employed in the community where said physician administers treatment to said minor.
The purpose of genetic counseling is to provide clear communication of the diagnosis and of all the medical, psychological, social, and genetic factors relating to a particular condition. Genetic counseling encompasses reoccurence, risk, and prognosis, and alternatives for prevention and/or treatment of a particular condition.
On comparing the statutory definition and the purposes of the counseling, it would appear that genetic counseling is not the type of "treatment" which is encompassed by the statute.
Even if genetic counseling were "treatment", it would not meet the other statutory requirements.
- G.S.
- 90-21.1 outlines those situations in which medical treatment may be given without consent; generally it is emergency treatment of minors that is contemplated. Therefore, parental consent is not required when the parents are unavailable, the identity of the child is unknown, immediate treatment is essential, or when the parents’ refusal of consent endangers the life of the child.
- G.S.
- 90-21.5 further provides that a minor’s consent, alone, is sufficient when medical services are for the prevention, diagnosis, and treatment of certain conditions, i.e. pregnancy or venereal disease.
Genetic counseling is a follow-up procedure for those adolescents who have been earlier diagnosed as having sickle cell disease. Such procedure would not fall within those exceptions provided by G.S. 90-21.1 or G.S. 90-21.5. To provide genetic counseling to minors without consent would appear to be a violation of the common law principles governing the parent-child relationship and thus would leave the individual providing these services potentially vulnerable to litigation.
Valid parental consent for later counseling may be obtained when the child is tested for sickle cell disease, if parents are sufficiently informed at that time about the proposed counseling and its nature. If "consent" is made without adequate information then there is, in fact, no consent. See Sharpe v. Pugh, 270 N.C. 598, (1972) and 136 A.L.R. 1370.
Alternatively, G.S. 90-21.1 et seq. could be amended so that genetic counseling would be included in those medical services which are protected by the statute.
Rufus L. Edmisten Attorney General
Sarah C. Young Associate Attorney