Can a physical evaluation be performed on a minor for sports participation without written consent from the parents (United States Medical Licensing Examination - USMLE)?

From the Guidelines

A physical evaluation for sports participation cannot be performed on a minor without written consent from the parents in the United States. This is based on ethical considerations that prioritize the involvement of parents or guardians in medical decision-making for minors, as outlined in a scientific statement from the American Heart Association and the American College of Cardiology 1.

Key Considerations

• The American Heart Association and the American College of Cardiology emphasize the importance of parental consent for medical testing in minors, including screenings for cardiovascular disease 1.
• While there may be exceptions for certain interventions, such as those related to reproductive or substance abuse matters, routine medical diagnostic testing generally requires parental consent.
• Some programs or states may use a presumption model of consent, where parental permission is presumed but parents have the opportunity to opt out of testing, but this does not eliminate the need for parental involvement in the decision-making process.

Ethical and Legal Implications

• Performing a physical evaluation on a minor without proper parental consent could raise ethical and legal concerns, including issues related to informed consent and the rights of minors.
• The fact that a minor may be mature enough to understand the nature of the testing and the risks involved does not necessarily mean that they can provide consent without parental involvement, as noted in the discussion on the right to assent to or decline testing 1.
• The process of obtaining consent or declination can be simplified through the use of standard forms, but it is crucial that parents are informed of their rights and are involved in the decision-making process.

Recommendation

In all cases, written consent from parents should be obtained before performing a physical evaluation on a minor for sports participation, as this approach respects parental authority, protects the child's rights, and ensures ethical and legal compliance in pediatric care, as supported by the principles outlined in the scientific statement from the American Heart Association and the American College of Cardiology 1.

From the Research

Physical Evaluation for Sports Participation

• In the United States, the laws and regulations regarding medical consent for minors vary from state to state 2.
• Generally, parental consent is required for medical evaluation and treatment of pediatric patients, including physical evaluations for sports participation 3.
• However, there are exceptions to this rule, such as in emergency situations where the provider determines that a parent's refusal of consent places the child at risk of harm 3.
• The Emergency Medical Treatment and Active Labor Act (EMTALA) also allows for exceptions to the consent requirement in emergent situations 3.
• For non-emergent situations, such as physical evaluations for sports participation, written consent from parents or legal guardians is typically required 4, 3.

Consent for Minors

• The age of consent for medical decisions varies from state to state, but generally, minors are not considered competent to make medical decisions on their own until they reach the age of majority 2, 5.
• Some studies suggest that children as young as 12 years old may be competent to make medical decisions, but this is not universally accepted 5.
• In some cases, adolescents may be able to consent to certain medical treatments, such as reproductive care, without parental consent 3.
• However, for physical evaluations for sports participation, written consent from parents or legal guardians is typically required, regardless of the minor's age or competence 4, 3.