A groundbreaking study conducted by researchers from Emory University’s Rollins School of Public Health and Vanderbilt University Medical Center has revealed striking disparities in parental support for adolescent medical consent based solely on the framing of survey questions. This research sheds new light on the complexities of public opinion surrounding adolescent autonomy in healthcare decisions and offers valuable insights into the nuanced ways political and cultural contexts can shape perceptions.
The study centers on Tennessee’s Mature Minor Doctrine, a legal framework that permits certain minors to consent to medical treatment without parental approval under specified conditions. This doctrine garnered significant attention during the COVID-19 pandemic, becoming a focal point for contentious political debates. Opponents claimed it allowed children inappropriate medical access, particularly in relation to COVID-19 vaccinations, sparking legislative action that temporarily restricted its application and curbed public health messaging around adolescent consent.
Amid these heated policy disputes, the researchers aimed to disentangle actual parental attitudes from the politically charged rhetoric by conducting a randomized survey of 1,026 Tennessee parents. Their goal was to assess whether parental opinions truly aligned with restrictive political measures or if reactions might shift when questions were framed differently. Specifically, participants were divided into groups where support for adolescent medical consent was either presented as the abstract “Mature Minor Doctrine” or concretely described through relatable scenarios such as 17-year-olds receiving meningitis vaccines while at college or teenagers aged 14 to 18 consulting with therapists without parental involvement.
The findings disclosed a pronounced divergence, with parental support varying by over 20 percentage points depending on framing. When the concept was referred to merely as the “Mature Minor Doctrine,” only 22.9% expressed support. However, when the doctrine was contextualized as a practical rule accompanied by tangible examples of adolescents managing specific healthcare decisions, support nearly doubled to 43.2%. This suggests that abstract legal terminology may provoke skepticism or opposition, whereas concrete, relatable explanations foster greater parental acceptance.
Sarah Loch, the study’s lead author and Health Policy and Management program director at Rollins, commented on these nuances: “While our survey is localized to one state, it exemplifies how pandemic-era national vaccine debates resonate on the ground. It also illuminates if parental views are truly aligned with the political actions being taken. Importantly, parents often respond more pragmatically when the implications of adolescent consent are clearly illustrated—demonstrating support for scenarios where their child’s autonomy serves a real and reasonable health need.”
The research underscores the critical role of communication in shaping public opinion, particularly in an era where misinformation surrounding vaccines has proliferated. Since the study was conducted, Tennessee lawmakers passed the 2023 Mature Minor Clarification Act, effectively countermanding the original doctrine by mandating parental consent for most childhood vaccines and requiring explicit written consent for COVID-19 vaccinations. Public health advocates have expressed apprehension that these legal changes may exacerbate declines in childhood vaccine coverage.
The discrepancy between existing legislation and parental sentiment revealed by this survey highlights a fundamental challenge for public health: bridging the gap between policy and the population’s evolving perceptions. The investigators emphasize the urgency of delivering accurate, detailed, and context-sensitive health messaging to parents, in ways that resonate beyond polarized political narratives and address real concerns regarding adolescent healthcare autonomy.
Stephen Patrick, MD, senior author and chair of Health Policy and Management at Rollins, elaborated on the importance of clarity in communication: “In the wake of the COVID-19 pandemic, widespread misinformation has undermined vaccine confidence, contributing to reductions even in routine immunizations. Our data illustrate that parents value straightforward, scenario-based explanations that help them understand how adolescent consent applies in everyday health decisions.”
This study exemplifies how the framing effect—a well-documented psychological phenomenon where the presentation of information influences decision-making—operates in healthcare contexts, particularly in legal and ethical spheres concerning minors. It highlights the limitations of policy debates grounded solely in technical or legal terminology without accessible contextualization.
The survey’s methodology, which randomized parental respondents into different framing cohorts, allowed for robust comparisons and generated evidence that effective health policy must consider not only the content but the framing of messages conveyed to the public. Insights from this work suggest that policymakers and clinicians alike should prioritize transparency and practical clarity when discussing adolescent consent laws to foster informed parental engagement.
Moreover, the findings prompt further inquiry into how such framing effects might generalize beyond Tennessee or extend to other domains where adolescent healthcare decision-making is contested, ranging from mental health services to sexual and reproductive health. Understanding the balance between protecting parental rights and respecting adolescent autonomy remains an ongoing societal challenge, underscored by dynamic political, cultural, and ethical factors.
In sum, this investigation provides a compelling argument for nuanced and empathetic communication strategies that acknowledge parental values while promoting adolescent health empowerment. It represents a pioneering step toward reconciling the complexities of legal doctrine, political response, and parental perspectives in shaping the future of adolescent medical consent.
Subject of Research: People
Article Title: Parental Perceptions of Tennessee’s Mature Minor Doctrine
News Publication Date: 18-Apr-2025
Web References:
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2832978
http://dx.doi.org/10.1001/jamanetworkopen.2025.5798
Keywords: Public health, COVID 19 vaccines, Adolescents, Children, Vaccine research, Legislation, Public opinion, Scientific publishing
