The Right to Consent, Competency and Responsibility in Teens – A rather exceptional stand was taken in the 1970’s by Washington State regarding youth rights. Their legislature acted to lower the age of consent for mental health and substance abuse treatment to 13. This came on the heels of legislation assuring the right to consent to reproductive healthcare from the time of fertility, a woman’s rights issue with youth rights implications. I have practiced adolescent psychiatry in a social climate influenced by this policy my entire professional life. It seems to me to have had a positive impact on the nature of treatment in our state as it has forced caregivers to focus more on treatment relationships. It certainly has positively shaped my work with youth. These Washington state laws have less to do with the right to obtain mental health or substance abuse treatment independent of parental approval (a right rarely exercised) than with the corollary of the right to consent; the right to refuse care.