Ethics question

SDN Members don't see this ad. (About Ads)

A married woman does not need husband's consent for obtaining an abortion.

Does a married person need his or her partner's consent for sterilization procedures?

I have annotated in my FA from somewhere that consent is needed from the husband if a woman is to obtain a tubule ligation.

However I do recall having encountered a Kaplan QBank question where the answer was consent is NOT required.

Any thoughts?

Originally Posted by Phloston

A married woman does not need husband's consent for obtaining an abortion.

Does a married person need his or her partner's consent for sterilization procedures?

I have annotated in my FA from somewhere that consent is needed from the husband if a woman is to obtain a tubule ligation.

However I do recall having encountered a Kaplan QBank question where the answer was consent is NOT required.

Any thoughts?

I can't answer based on a certain source, but I would think that she does not require consent. The principle is that a person is in charge of what they want to do with their body, so it doesn't make any sense for a woman to have to have her husband's consent for tubal ligation.

I had spent probably about 20 minutes going through literature on the topic some time ago, and the general consensus is that she doesn't require consent, but the fact that I have that annotated into my FA (I think from BRS Behavioral) made me question my memory. For some reason though, I feel like it's just wrong to not get the husband's consent. I mean, we're not talking an OCP; we're talking about permanence. But that's just me, and I'm not the law.

The law is messed up. What with that news piece about the gay man who was forced to pay child support 13 yrs after he donated sperm for a lesbian couple to have a child.

I can't think of a single place that would claim that a competent adult needs any other adult's consent for any medical procedure done to themselves.

Originally Posted by withrye

I can't think of a single place that would claim that a competent adult needs any other adult's consent for any medical procedure done to themselves.

Very trenchant. I like it.

Originally Posted by Phloston

I had spent probably about 20 minutes going through literature on the topic some time ago, and the general consensus is that she doesn't require consent, but the fact that I have that annotated into my FA (I think from BRS Behavioral) made me question my memory. For some reason though, I feel like it's just wrong to not get the husband's consent. I mean, we're not talking an OCP; we're talking about permanence. But that's just me, and I'm not the law.

Tubal Ligation is supposed to be reversible anyways. I think what you are referencing, is that the patient is encouraged to discuss this procedure with her significant other before making the decision.

So if one of the options was "tell the patient to go talk with her husband before deciding" then that would likely be correct. But there is no reason for her to require actual consent.

I refer you to Ponter v. Ponter (1975) [bit.ly/X1Ovbo]

"It is this court's opinion that Judith Ponter has a constitutional right to obtain a sterilization operation without the consent of her husband. Such protection is available whether it be in the form of the proscription of state action requiring the contrary or refusing to recognize the spouse's civil suit against the treating physician as meritorious"

Also note that passive paternalism is very warranted when a physician has a moral objection to the procedure. Thus if a physician or hospital wants to require consent, that is fine, but legally they do not need to.
See Beauchamp and Childress "Principles of Biomedical Ethics" 5th ed. pg 191

There's no way the husband has ANY say whatsoever unless his wife is also his daughter and below the age of 18.

Originally Posted by ijn

There's no way the husband has ANY say whatsoever unless his wife is also his daughter and below the age of 18.

Speaking hypothetically, wouldn't she then be emancipated? Then refer to the no need for husband consent. I suppose it must be hard to be a doctor in Kentucky.

Originally Posted by Nesir

Speaking hypothetically, wouldn't she then be emancipated? Then refer to the no need for husband consent. I suppose it must be hard to be a doctor in Kentucky.

Pregnancy doesn't make you emancipated. Having a kid just means you can make medical decisions about the kid. You couldn't get treated for Strep throat as a 16 y/o without parental permission just because you got knocked up.

Originally Posted by Nesir

Speaking hypothetically, wouldn't she then be emancipated? Then refer to the no need for husband consent. I suppose it must be hard to be a doctor in Kentucky.

Nevada has a weird thing where a minor with a child is capable of making decisions for her kid but not herself

When it comes to issues of abortion/children, women will always have the upper hand, legally & societally?, since if a man does not want a kid he is a slacker, dead-beat who doesn't want to be responsible for his actions BUT when a woman wants it (even if guy disagrees) then it's her body so she can do whatever she wants.
Courts say they rule in the best interest of the child, which turns into them ordering guys to pay child-support for some kid that is NOT theirs just because they didn't think their woman was a skank & accepted that the kid was theirs. Guy finds out years later...tough. Since he is now an established part of the kid's life, he is now stuck paying for it, yet the woman does not have to bear any consequences
Reason enough for all guys to get a DNA test every time their girl is pregnant
Everyone's rights (except the man's) are protected. Woman can keep or abort as she pleases, regardless of what man says
Child gets money/support from man (even if not the father)
For all the people so gung-ho on women's rights....they seem to not care too much for the guy's

Originally Posted by ijn

Pregnancy doesn't make you emancipated. Having a kid just means you can make medical decisions about the kid. You couldn't get treated for Strep throat as a 16 y/o without parental permission just because you got knocked up.

Yes I agree but in our little world here she is also married.

Consent is not required for an abortion....it's similar to that of a teenager getting pregnant, and then getting an abortion, she doesn't need parental consent....however, for other medical decisions, she would require consent from her parents. Personally, I believe that the father should be informed, I mean the kid is 50 percent him, and he technically deserve a right to know, what he decides to do with that information, is his decision.

Men and women alike are required to go through a lot of counseling and get consent from their spouses to get a vasectomy or even have their tubes tied. Why do you think it is different (not needing consent for an abortion, but needing consent for not being able to procreate anymore)?

I heard about the gay man having to pay child support also. Honestly, that is one of the stupidest things I have ever heard. The courts should rule in favour of him. The couple had thirteen years to ask for child support, but now that they have divorced, they want support? Really? Do people not see through that?

Originally Posted by futuresurgeon00

Honestly, that is one of the stupidest things I have ever heard. The courts should rule in favour of him. The couple had thirteen years to ask for child support, but now that they have divorced, they want support? Really? Do people not see through that?

Probably some lunatic / gun-touting judge who had voted for McCain, and who, not to mention, had probably wanted Rick Perry this time around.

Or it could have been a 3 judge appelate panel in arguably liberal penssylvania....just maybe

Originally Posted by futuresurgeon00

I heard about the gay man having to pay child support also. Honestly, that is one of the stupidest things I have ever heard. The courts should rule in favour of him. The couple had thirteen years to ask for child support, but now that they have divorced, they want support? Really? Do people not see through that?

We have slowly but surely crossed the line from being sensitive to sensitive issues, to bending over backwards to be politically correct (when we no longer even know what the term means). The judgement of judges is being thrown out of the window in favour of literal (mis)interpretation of the written law, which is being exploited very successfully.

Men and women alike are required to go through a lot of counseling and get consent from their spouses to get a vasectomy or even have their tubes tied.

Are you sure? Counselling may be indicated to make sure both are clear on the consequences, or lack thereof. But consent from the spouse? I don't think it's a legal requirement.

Originally Posted by ijn

Pregnancy doesn't make you emancipated. Having a kid just means you can make medical decisions about the kid. You couldn't get treated for Strep throat as a 16 y/o without parental permission just because you got knocked up.

Unless of course she supports herself and her kid.

Anyway another basic ethics question: Can parents refuse a treatment for their child in a life or death situation? For example, a Jehovah's Witness kid requiring transfusion.

Question 2: Is domestic violence / physical abuse mandatory reportable or is it the victim's decision? I know child and elder abuse are reportable, but I'm not sure about the domestic abuse.

Originally Posted by futuresurgeon00

... a teenager getting pregnant, and then getting an abortion, she doesn't need parental consent....

Are you sure about this? Abortion is not listed as one of the "not required" parental consent in FA2012.

I actually recall from BRS Behavioral that Washington DC is one of the only places in the US (there are two other states, but they weren't listed for some reason) where a minor can obtain an abortion without parental involvement, no questions asked.

In 25/50 states, consent from one parent is needed for an unmarried minor to obtain an abortion.

However, in all states, minors have the right to petition the courts to obtain the abortion. This usually doesn't happen because 1) the minors aren't aware that they can do this and 2) it takes time/money/energy to make that happen. The bottom line though is that minors have the right to have an abortion.

In terms of the USMLE, because minors have the right to have an abortion in conjunction with the fact that some, but not all, states require one parent's consent, encouraging discussion with parents is the best choice, but the minor always ultimately has the right to terminate.

Originally Posted by Old Style Nanny

Unless of course she supports herself and her kid.

Anyway another basic ethics question: Can parents refuse a treatment for their child in a life or death situation? For example, a Jehovah's Witness kid requiring transfusion.

Question 2: Is domestic violence / physical abuse mandatory reportable or is it the victim's decision? I know child and elder abuse are reportable, but I'm not sure about the domestic abuse.

1) Children are never refused emergency care requiring blood transfusions, even if the parents are right there waving around their Jehovah's witness autographed religious documents. However, if the blood transfusion is not an emergency, the parents need to be respected. The bottom line is that, as physicians, we have the obligation to save children under all circumstances.

2) You need to remember that many abused people are too terrified of their abusers to admit to the physician that there's a real problem. If you genuinely see signs of abuse, you always report that abuse, period.

Originally Posted by Phloston

2) You need to remember that many abused people are too terrified of their abusers to admit to the physician that there's a real problem. If you genuinely see signs of abuse, you always report that abuse, period.

So, should Kaplan and FA add this to the list of reportable abuse? Did you find this from BRS?

My current understanding of this issue is that you inform the patient about a place where she can go for refuge, record the abuse in the file and inform her that this is a criminal offense and she has a right to complain to the law enforcement agencies. The physician, however, does not have the authority to break the confidentiality code without her consent.

Originally Posted by Phloston

I actually recall from BRS Behavioral that Washington DC is one of the only places in the US (there are two other states, but they weren't listed for some reason) where a minor can obtain an abortion without parental involvement, no questions asked.

In 25/50 states, consent from one parent is needed for an unmarried minor to obtain an abortion.

However, in all states, minors have the right to petition the courts to obtain the abortion. This usually doesn't happen because 1) the minors aren't aware that they can do this and 2) it takes time/money/energy to make that happen. The bottom line though is that minors have the right to have an abortion.

In terms of the USMLE, because minors have the right to have an abortion in conjunction with the fact that some, but not all, states require one parent's consent, encouraging discussion with parents is the best choice, but the minor always ultimately has the right to terminate.

So, you mean to say that the minors have the right to terminate (by law) but the physician does not have the right to execute that law. In other words, the physician cannot perform the procedure without either the consent of the parent(s) or a court order. Right?

Child abuse = Report straightaway to CPS
Domestic abuse = You cannot report. You can give info about shelters, etc.

Originally Posted by Old Style Nanny

So, should Kaplan and FA add this to the list of reportable abuse? Did you find this from BRS?

My current understanding of this issue is that you inform the patient about a place where she can go for refuge, record the abuse in the file and inform her that this is a criminal offense and she has a right to complain to the law enforcement agencies. The physician, however, does not have the authority to break the confidentiality code without her consent.



So, you mean to say that the minors have the right to terminate (by law) but the physician does not have the right to execute that law. In other words, the physician cannot perform the procedure without either the consent of the parent(s) or a court order. Right?

In Washington DC and two other states, the minor can get the abortion no questions asked. In 25/50 states, a parental consent is required; if that's not obtained, the minor can petition to have the abortion anyway, and she ultimately is allowed that right. In other words, 25/50 states allow abortion but just make it a more circuitous process if the parents don't support it. To simplify things though, on the USMLE, just know that abortion is legal and that although first encouraging discussion with the parents is always the best answer, the minor is still ultimately granted the termination-right even if the parents refuse.

Originally Posted by thehundredthone

Child abuse = Report straightaway to CPS
Domestic abuse = You cannot report. You can give info about shelters, etc.

Yeah, child/elder abuse is always reportable.

BRS Behavioral interestingly didn't touch upon domestic abuse (as far as I can recall). In relation to hundredthone's statement, IIRC, I had seen a question in one of the NBMEs about a woman who was abused, and giving her information about abuse shelters was most appropriate.

Originally Posted by Phloston

In Washington DC and two other states, the minor can get the abortion no questions asked. In 25/50 states, a parental consent is required; if that's not obtained, the minor can petition to have the abortion anyway, and she ultimately is allowed that right. In other words, 25/50 states allow abortion but just make it a more circuitous process if the parents don't support it. To simplify things though, on the USMLE, just know that abortion is legal and that although first encouraging discussion with the parents is always the best answer, the minor is still ultimately granted the termination-right even if the parents refuse.

What happened to the other 22 states?

Anyway, since USMLE tests only the physician's roles, the best answer would be to ask her to get consent from a parent, failing which to produce a court order? Did any of the Qbanks even have a question on this issue?

On a related topic, is sexual assault reportable by the physician? In the cases of the victim being a). a minor, and b). an adult.

Originally Posted by Old Style Nanny

What happened to the other 22 states?

Anyway, since USMLE tests only the physician's roles, the best answer would be to ask her to get consent from a parent, failing which to produce a court order? Did any of the Qbanks even have a question on this issue?

On a related topic, is sexual assault reportable by the physician? In the cases of the victim being a). a minor, and b). an adult.

As ridiculous as it is, out of >13,000 unique practice question that I've done so far, I don't think I've seen one on abortion. On the other hand, it can and has shown up on the real deal. There was someone who had posted on the Scores thread, probably around March-April, who had said, IIRC, that he had had a "really ANNOYING question on abortion that did not have an answer: it basically forced you to take a stand on the issue. Ridiculous." In that case, my guess would be that the minor wanted it and the parents didn't, and you'd have needed to know that it's still legal for the minor to have it done. I would obviously need to see the question myself, but if you know the rules, you can use your intuition.

Sexual assault --> child/elder is reportable. If it's the spouse, then it's domestic.

Originally Posted by Phloston

As ridiculous as it is, out of >13,000 unique practice question that I've done so far, I don't think I've seen one on abortion. On the other hand, it can and has shown up on the real deal. There was someone who had posted on the Scores thread, probably around March-April, who had said, IIRC, that he had had a "really ANNOYING question on abortion that did not have an answer: it basically forced you to take a stand on the issue. Ridiculous." In that case, my guess would be that the minor wanted it and the parents didn't, and you'd have needed to know that it's still legal for the minor to have it done. I would obviously need to see the question myself, but if you know the rules, you can use your intuition.

I suppose.

Originally Posted by Phloston

Sexual assault --> child/elder is reportable. If it's the spouse, then it's domestic.

No, I meant a stranger of course. I was trying to be politically correct. The actual question is, what is the role of the physician in a case of (alleged) rape?

USMLErx had a question on abortion. The question asked 'in which of the following might parental consent be required?

The answer was abortion. Explanation was similar to what you guys have said earlier, in that consent isn't required in all states, but is required in most states. However emancipated minors do not need parental consent.

This was question ID 1293, for anyone who has USMLErx.

Originally Posted by mayn

USMLErx had a question on abortion. The question asked 'in which of the following might parental consent be required?

The answer was abortion. Explanation was similar to what you guys have said earlier, in that consent isn't required in all states, but is required in most states. However emancipated minors do not need parental consent.

This was question ID 1293, for anyone who has USMLErx.

I still have my subscription to Rx, but I don't remember that question. For some reason, I'm having trouble finding on their platform where to search for a specific question. On UWorld, you can just type the ID# in.