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Mature Minor

Under the heading of ``Consent of Minors for Health Services,'' Minnesota's statutory scheme351 covers many aspects of consent without granting minors broad legal permission to consent to general health care. The eight statutes that comprise the statutory scheme were all passed in 1971, with the exception of the Hepatitis B vaccination statute,352 enacted in 1993. In addition, this statutory scheme remains relatively unchanged, with minimal amendments. Three of the statutes, Emergency Treatment,353 Information to Parents,354 and Financial Responsibility,355 remain unchanged since enactment in 1971. Three of the statutes, Living Apart from Parents and Managing Financial Affairs, Consent for Self,356 Marriage or Giving Birth,357 and Representations to Persons Rendering Service,358 have undergone one amendment, occurring in 1986. Lastly, the statute covering pregnancy, STD, substance abuse, and abortion359 has experienced four changes, with the last one occurring along with the others, supra in 1986. For a statutory scheme that includes all those sensitive issues, especially abortion, this reflects minimal changes. Certainly no recent legislative activity on these statutes may reflect that it has not been a ``hot'' topic in Minnesota or that currently no one is willing or able to advocate for change in Minnesota. This, however, does not indicate that Minnesota is a model that Massachusetts should look toward for further guidance in expanding the existing MMR. In fact, the two states' statutory schemes have many similarities.

Currently, Minnesota may suffer downfalls similar to those that Massachusetts experiences with respect to minors' rights to consent. Indeed, some of the Michigan provisions cover similar treatment as those found in Massachusetts statutes, including the right to consent to health care based on marriage or parent status, emergency treatment, pregnancy, substance abuse, abortion, living apart from parents and managing financial affairs, and addressing health care provider liability.

However, there are two statutes in the Minnesota scheme that Massachusetts should consider. First, in 1993, the legislature passed a specific statute granting the right to consent to a Hepatitis B vaccination. The assumption may be that Hepatitis B had become a highly publicized public health policy issue in the early 1990's. The legislature may have been responding to real concerns that youth are more likely to engage in unsafe sex and inject drugs, thus increasing their risk of contracting the disease.360 With the legal ability to consent to a vaccination, the legislature may have reasoned that at-risk youth, homeless or not, would be more likely to receive a vaccination if parental consent was not mandatory.

However, this leads to the question of why the legislature enacted a separate statute, rather than amending another statute, such as the substance abuse statute. It also leads to a more substantive question about why the legislature seems to enact piecemeal legislation in response to high profile public health issues, rather than to enact a general consent statute that would be proactive rather than responsive to minors health care needs. This, of course, implicates the underlying issue of inconsistency with respect to what health care treatment services minors are deemed capable of offering consent to and why the ``sexy'' topics receive quick legislative attention and solution. In addition, this raises the fundamental argument between child versus parental rights to control minors' health care access and decisions. Again, this vaccination statute suggests that the legislature acknowledges a minor's ability to consent to her own health care, and yet wants to grant legal rights narrowly to minors in order to maintain parental control over at least some aspect of their youth's health care.

Second, Minnesota specifically addresses payment issues as the last statute within its statutory scheme. Titled ``Financial Responsibility,'' Minn. Stat. 144.347 states: ``A minor so consenting for such health services shall thereby assume financial responsibility for the cost of said services.'' While JRI did not specifically request research on the payment issue, it should be put on the radar screen when expanding the mature minor consent statutes in Massachusetts, since payment concerns are often at the heart of gaining legislative support. As implied by this Minnesota payment statute, health care is not inexpensive and someone must bear the burden of those costs. Here, the legislature has put the burden on the minor who, through the statutory scheme, has been granted the right to consent to her own health care in certain circumstances. While this statutory snapshot does not give us the full picture of payment procedures and options in Minnesota, it does show that along with this right, the legislature seems to declare that there is a duty (of payment), as well.

Overall, Minnesota does not offer Massachusetts a model statutory scheme upon which to base an expansion effort. However, it does raise fundamental issues surrounding when the legislature is willing to consider amendments or new statutes in the face of high profile public health issues, but still not grant full rights for minors to consent to all health care. Possibly this information could be used to show the inconsistencies of piecemeal legislation that is reactive instead of proactive. In addition, the Minnesota payment statute may provide a basis for answering payment questions that this project will face in expanding the mature minor statutes in Massachusetts.361



Footnotes

... scheme351
Minn. Stat. 144.341 - 347 (2001).
...352
Minn. Stat. 144.3441 (2001).
...353
Minn. Stat. 144.344.
...354
Minn. Stat. 144.346.
...355
Minn. Stat. 144.347.
...356
Minn. Stat. 144.341.
...357
Minn. Stat. 144.342.
...358
Minn. Stat. 144.345.
... abortion359
Minn. Stat. 144.343.
...360
Immunization Action Coalition. Website: <www.immunize.org>.
...361
Obviously, this exact Minnesota statute would not be helpful for our target homeless youth population since they are not financially solvent. However, it is important to note how other states handle the payment issue.

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