Ethics Q: Legal obligations for contraception/abortions in minors

[ofthesun]

One issue that seems to come up a lot in ethics during interviews is what a physician should do with a 12-14 year old who wants an abortion/contraception and confidentiality.

I've read that there are state exeptions that may protect a doctor from having to inform parents of sexual issues a minor is having, but little more.

Does anyone have more information on the legal obligations of a physician faced with such a situation? What is the default 'correct' approach for such a scenario, once communication has revealed the minor is resolute in his/her desire for privacy?

Canadian laws especially.

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[Shredder]

laws aside, test for iq then make the decision on abortion. im sure the interviewer will understand if you explain that you have good intentions for humanity

its late...posting inhibitions drop. anyway just tell the nosy interviewer that youll call up your lawyer to find out what to do--expecting us to master medicine is enough as it is without this and that legal issue

 

[Depakote]

Most interviewers won't expect you to know the laws of the specific locality that you're interviewing in.

That said, here's how I answered said question (having been coached by a Ped's ER doc):

I would try to bring in some sort of advocate for the child. If I can't convince her to allow me to bring her parents in, I would at least try to bring in the father, or social services... someone to help her make this decision so she doesn't feel like she rushed into this huge decision all by herself in a less than sound state of mind. I would be reluctant to perform this procedure otherwise.

They then threw a spin on the scenario. What if the child's father was abusing her and was also the father of the baby?

That one caught me off guard, but I stuck with the fact that the child should still not be making the decision alone. I would attempt to get social services and hopefullly the child's mother involved if the child would allow it. Then would I perform the procedure.

Afterward they told me that the state I was interviewing in would have allowed me to circumvent the parental notification due to the circumstances.

 

[g3pro]

Physician autonomy and physician advocacy.

'Nuff said.

 

[nikibean]

In California, you do not have to inform the parents (thank goodness prop 73 didn't pass) if the person is 12 or older. I do counseling for these people- usually they are older than 14, but I've seen about 3 or so 14 year olds in the past 5 months. Some of them are there because their uber-religious physician decided that they were "too young" for birth control. Grr. I give them their privacy rights and then counsel them on what they wish to do. In many cases (including the ones I haven't seen) they have supportive parents. In some cases they are being abused and we have to report it. In most of the cases they are foster kids who have very little guidance. I always ask if they have a guardian with whom they can speak and who they trust. Almost every time they say yes- but it's not always the parent.
Personally, I think anyone who wants birth control should have access to it with the proper information. A little info never hurt anyone.

You know though, this thread probably belongs in Topics in Healthcare.

 

[ND2005]

One issue that seems to come up a lot in ethics during interviews is what a physician should do with a 12-14 year old who wants an abortion/contraception and confidentiality.

I've read that there are state exeptions that may protect a doctor from having to inform parents of sexual issues a minor is having, but little more.

Does anyone have more information on the legal obligations of a physician faced with such a situation? What is the default 'correct' approach for such a scenario, once communication has revealed the minor is resolute in his/her desire for privacy?

Canadian laws especially.

When an interviewer asks a question like this, I don't think they are trying to test your knowledge of the legal system w/r/t patient privacy and physicians. The whole point of asking an ethical question is to understand the ethical beliefs of the interviewee, not to make sure the interviewee is up on medicinal law.

I wouldn't spend time trying to find legal info; I would spend it thinking about my personal morals and how I personally would want to handle the situation.

 

[emack]

The whole point of asking an ethical question is to understand the ethical beliefs of the interviewee...

I have to disagree with that. It's not your "ethical beliefs" (whatever that means) that they want to discover. They just want some demonstration of your ability to approach an ethical quandary rationally & fairly. I daresay that if your personal, idiosyncratic beliefs become a bit too evident in answering a question like this, then it might raise red flags.

 

[Depakote]

I have to disagree with that. It's not your "ethical beliefs" (whatever that means) that they want to discover. They just want some demonstration of your ability to approach an ethical quandary rationally & fairly. I daresay that if your personal, idiosyncratic beliefs become a bit too evident in answering a question like this, then it might raise red flags.

True, I actually said I would do something I don't know I could ever actually do personally. I'd probably have to refer that out. It's an unrealistic situation anyway... The Practice of Medicine relies on you having experienced these things before flying solo, yet they suddenly make you an attending and won't let you call in a consult?

 

[Law2Doc]

I have to disagree with that. It's not your "ethical beliefs" (whatever that means) that they want to discover. They just want some demonstration of your ability to approach an ethical quandary rationally & fairly. I daresay that if your personal, idiosyncratic beliefs become a bit too evident in answering a question like this, then it might raise red flags.

Agreed. You address the question by indicating that there are laws that govern the situation, which you would of course follow, but within those constraints, you would do what you could to ensure the autonomy of the patient to make decisions affecting her/his own healthcare, protect the confidentiality of the doctor patient communications to the extent permitted by law, and ensure that the patient is not put at health risk. You do NOT want to address your own personal belief system, because (1) the interviewer could have a belief system that conflicts with yours, and (2) to the extent your views conflict with what is legally mandated, civil disobedience is definitely not something med schools are shooting for.

 

[t33sg1rl]

I'm sure the guidelines for abortion are a bit different, but in the United States, you can't share any patient's medical information with another person without explicit permission. This applies to both contraceptives and minors. As in, if your 12 year old patient asks for birth control pills, you can be sued and disciplined for telling her parents without the patient's permission. Some conservative states may have their own exceptions, but on a national level, that's how it stands here. Not sure how things go in Canada, but if anything you would think that there would be more emphasis on patient privacy and autonomy, not less.
Obviously if you know of a child suffering any kind of abuse, you are obligated to report it to the appropriate social services or police.

 

[THP]

I'm sure the guidelines for abortion are a bit different, but in the United States, you can't share any patient's medical information with another person without explicit permission. This applies to both contraceptives and minors. As in, if your 12 year old patient asks for birth control pills, you can be sued and disciplined for telling her parents without the patient's permission. Some conservative states may have their own exceptions, but on a national level, that's how it stands here. Not sure how things go in Canada, but if anything you would think that there would be more emphasis on patient privacy and autonomy, not less.
Obviously if you know of a child suffering any kind of abuse, you are obligated to report it to the appropriate social services or police.

I'm pretty sure this is incorrect. I think a 12 year old girl does not have the capacity to make informed consent and it is up to the physician to determine whether or not she does. Generally, parents have the final say in the health care provided for minors. I a doctor ever gave my daughter birth control pills without discussing it with me first, he would have hell to pay.

As a side note: it is completely ridiculous that minors can get abortions without their parent's consent. A minor can't even get her ears pierced at the mall without parental permission or see a rated R movie. If there is any time in a young girl's life that she needs her parents its to make this decision that will have lasting consequences.

 

[Gut Shot]

As a side note: it is completely ridiculous that minors can get abortions without their parent's consent. A minor can't even get her ears pierced at the mall without parental permission or see a rated R movie. If there is any time in a young girl's life that she needs her parents its to make this decision that will have lasting consequences.

In a perfect world I might agree with you. Spend a month on a child abuse elective in the ER and your opinion might change somewhat.

The irony here is that minors cannot make many medical decisions for themselves, but if one gets pregnant and gives birth, she can legally make medical decisions for her baby. Good times.

 

[docB]

I'm sure the guidelines for abortion are a bit different, but in the United States, you can't share any patient's medical information with another person without explicit permission.

That is actually not true as there are various exceptions to complete confidentiality of medical records.
-HIPPA expressly allows the sharing of information between clinicians for the purposes of treating a patient. It also allows transfer of info for billing and making payments (ie. insurance companies). The reason that hospitals make everyone fill out those idiotic forms is that the penalties for giving out info inappropriately are high so they all made blanket policies.
-If a patient tells you they are going to kill someone you are obligated to take steps to protect that person even if it comprimises your patient's confidentiality. This stems from the Tarasoff decision.
-The age of consent for various things is state dependent. Some states hold that any girl who is pregnant is automatically emancipated and can make her own decisions regardless of age, some don't.

The bottom line is that the legality of giving info, talking to parents and giving or witholding treatment is very complex and changes from place to place.

 

[Gut Shot]

Friggin duplicates...

 

[Gut Shot]

I'm pretty sure this is incorrect. I think a 12 year old girl does not have the capacity to make informed consent and it is up to the physician to determine whether or not she does. Generally, parents have the final say in the health care provided for minors. I a doctor ever gave my daughter birth control pills without discussing it with me first, he would have hell to pay.

The specifics depend on where you are.

BACKGROUND: Over the past 30 years, states have expanded minors’ authority to consent to health care,
including care related to sexual activity. This trend reflects U.S. Supreme Court rulings extending the
constitutional right to privacy to a minor’s decision to obtain contraceptives and concluding that rights do not
“come into being magically only when one attains the state-defined age of majority.” It also reflects the
recognition that while parental involvement is desirable, many minors will remain sexually active but not seek
services if they have to tell their parents. As a result, confidentiality is vital to ensuring minors’ access to
contraceptive services. Even when a state has no relevant policy or case law, physicians may commonly provide
medical care to a mature minor without parental consent, particularly if the state allows a minor to consent to
related health services.



HIGHLIGHTS:
- 21 states and the District of Columbia explicitly allow all minors to consent to contraceptive services.

- 25 states explicitly permit minors to consent to contraceptive services in one or more circumstances.

• 3 states allow minors to consent to contraceptive services if a physician determines that the minor would
  face a health hazard if she is not provided with contraceptive services.
• 21 states allow a married minor to consent to contraceptive services.
• 6 states allow a minor who is a parent to consent.
• 6 states allow a minor who is or has ever been pregnant to consent to services.
• 10 states allow a minor to consent if the minor meets other requirements, including being a high school
  graduate, reaching a minimum age, demonstrating maturity or receiving a referral from a specified
  professional, such as a physician or member of the clergy.

- 4 states have no explicit policy on minors’ authority to consent to contraceptive services.

 

[oldManDO2009]

Where do we draw the line maybe a 10 year old should be allowed to ask for an abortion or birth control?

I worked for 10 years in county, state, and private mental health and group home (foster care) institutions and it is the EXCEPTION that a child is abused an needs an abortion. In that case I think it is appropriate to spare the child a life time of trauma. In the majority of cases it is elective and parental abuse is not a factor. The parents might be upset and disappointed but that does not equal abuse.

The most worrisome problem is a child who has had an abortion and then dies of complications and the parents only thought the child had the flu. I would want to know if my child had an elective surgical procedure and could die form infection or bleeding - regardless of the far flung claims that every child is a victim of abuse.

A child can not receive Tylenol in school w/o consent and if injured the parents must be notified immediately. Apparently, children can have abortions and parents are none the wiser - how sad.

It is a bit off topic but a sensitive subject.

 

[t33sg1rl]

OK, I guess there's quite a bit of state variation... but even if your state has laws about whether or not you should or can prescribe birth control, the original question was whether or not you could tell the parents that their child had made the request. We just had this in class a couple of weeks ago and the doctor was pretty firm on it being illegal to tell parents that their child of any age had asked about birth control. She didn't tell us about any actual legal restrictions on giving information or prescriptions-maybe state doesn't have any. wouldn't that be nice, to leave prescriptions to doctors?

 

[ofthesun]

Awesome - far more thorough information than I expected.

In conclusion:

I would first attempt to confirm through conversation that she was competent to make the decision herself, ensuring there were no mental deficits or emotional imbalances that would prevent her from making proper informed consent.

Next, I would want to ensure that her request is not the product of her suffering any abuse, asking if she can tell me a little about her experience so far. I would encourage her, making sure she understood why I was asking. I would try my best to ensure she was in whatever sexual relationship she was entering for healthy reasons.

Following that, I would check if she has talked about this with her parents. If she would be comfortable with it, I would encourage her to bring them into the consideration. If not, I would ask if she has any other adult guardian that she would feel comfortable knowing, say an aunt of uncle or Big Brother or Sister.

If there was no one she felt she would be comfortable with getting support from, I would feel best contacting social services and bringing in someone to help her make this decision (only with her ok of course - forcing social services involvement would be equal to forcing parents I think.), so she doesn't feel like she rushed into a huge decision all by herself.

Lastly, I would want to confirm my legal obligations with a lawyer or ethics council.

Barring any unforeseen circumstances along the way, I would then prescribe whatever birth control/ abortion.

 

[nikibean]

I'm pretty sure this is incorrect. I think a 12 year old girl does not have the capacity to make informed consent and it is up to the physician to determine whether or not she does. Generally, parents have the final say in the health care provided for minors. I a doctor ever gave my daughter birth control pills without discussing it with me first, he would have hell to pay.

As a side note: it is completely ridiculous that minors can get abortions without their parent's consent. A minor can't even get her ears pierced at the mall without parental permission or see a rated R movie. If there is any time in a young girl's life that she needs her parents its to make this decision that will have lasting consequences.

And it's completely ridiculous that a 12 year old girl should have to carry a pregnancy to term because her parents decide it's punishment or "god's will" or she's not old enough to have an abortion (but she's old enough to carry a pregnancy to term?). Or a 9 year old or a 10 year old or an 11 year old. Children are sexual, whether we want to believe it or not - and whether we believe it's morally right or not. As physicians, we will face these quandaries.
As to giving a young woman/child/teen birth control without her parents' consent- think about how you would react if your daughter told you she was sexually active? Do you think she'd feel comfortable? Would YOU feel comfortable? Would you try to ground her/control her forever (I'm not trying to attack you, these "yous" are the royal kind). If she disagreed with your morality concerning sex, wouldn't you feel better that she was at least trying to retain some kind of responsibility and protect herself?
As to the physician's part in it- I've stated this before: I've seen a pregnant 13 year old (just barely 13) who could have avoided it if her doctor had agreed to prescribe birth control- she had asked her physician for pills. His reply? "You're too young." Her mother brought her into the clinic and was there for her during her counseling when her PT came up positive. Her mother left it up to her- if she decided to terminate the pregnancy, she had full support. If she decided to carry to term, her mother agreed to raise another child until her daughter was 18. That's RARE in my experience. I think about that every time I have an under-15 walk in and ask for anything. I'm happy to teach them how to use a pill/patch/ring or give them DMPA. I ALWAYS hand out condoms, and I counsel on abstinence too. It would be lame not to cover everything.
I posit my earlier questions with the intention of a rational discussion, not an emotional mudsling.
There are a lot of young women who come from very supportive families who feel like they cannot speak to their parents about sex let alone abortion. As to judges- What if a judge is anti-choice? How fair is that? Think about it.

 

[oldManDO2009]

BCP are not protecting yourself - they are actually more like killing yourself. There is a rise in gonorrhea and HIV which is highest in young adults. It would seem to me that BCPs just perpetuate the problem. I would think condoms should be the only choice when it comes to sex with unknown partners.

As for children having babies - bad choices can not be corrected with more bad choices. There is a huge difference between a 16 year old and a 12 year old being pregnant - the latter being illegal in most states (or it should be) and should be reported as child abuse and not as reproductive choice.

 

[docB]

Awesome - far more thorough information than I expected.

In conclusion:

I would first attempt to confirm through conversation that she was competent to make the decision herself, ensuring there were no mental deficits or emotional imbalances that would prevent her from making proper informed consent.

Next, I would want to ensure that her request is not the product of her suffering any abuse, asking if she can tell me a little about her experience so far. I would encourage her, making sure she understood why I was asking. I would try my best to ensure she was in whatever sexual relationship she was entering for healthy reasons.

Following that, I would check if she has talked about this with her parents. If she would be comfortable with it, I would encourage her to bring them into the consideration. If not, I would ask if she has any other adult guardian that she would feel comfortable knowing, say an aunt of uncle or Big Brother or Sister.

If there was no one she felt she would be comfortable with getting support from, I would feel best contacting social services and bringing in someone to help her make this decision (only with her ok of course - forcing social services involvement would be equal to forcing parents I think.), so she doesn't feel like she rushed into a huge decision all by herself.

Lastly, I would want to confirm my legal obligations with a lawyer or ethics council.

Barring any unforeseen circumstances along the way, I would then prescribe whatever birth control/ abortion.

That's a great plan. Hopefully you have 12 or 14 hours during your office visit or ER stay to accomplish all that.

 

[Gut Shot]

The most worrisome problem is a child who has had an abortion and then dies of complications and the parents only thought the child had the flu.

AGI data quoted here:

Maternal mortality risk from abortion:
Up to 8 weeks - 1:500,000
16-20 weeks - 1:27,000
21+ weeks - 1:8,000
Term delivery - Not statistically different from 20+ weeks

 

[oldManDO2009]

I agree the risk is low for complications secondary to abortions. As a parent it seems unreasonable that the state parses which responsibilities I have and which decisions a "mature"13 year old should make.

The law is cumbersome - all these criteria for a child to get an abortion are what part of the problem is. As mentioned previously, there are 5 or 6 steps that must be taken by the physician to determine if this is appropriate. I do not want that responsibility.

How about if a child is in an abusive situation - then child welfare should be notified and the child removed from the home. As a ward of the state - a judge can decide if the child requires further medical care.

In other words, it would be assumed all children are not in abusive situations because they want an abortion. The State would place the child in a foster home and investigate allegations of abuse. How novel, actually deal with the abuse instead of use it as an excuse.

 

[THP]

And it's completely ridiculous that a 12 year old girl should have to carry a pregnancy to term because her parents decide it's punishment or "god's will" or she's not old enough to have an abortion (but she's old enough to carry a pregnancy to term?). Or a 9 year old or a 10 year old or an 11 year old. Children are sexual, whether we want to believe it or not - and whether we believe it's morally right or not. As physicians, we will face these quandaries.
As to giving a young woman/child/teen birth control without her parents' consent- think about how you would react if your daughter told you she was sexually active? Do you think she'd feel comfortable? Would YOU feel comfortable? Would you try to ground her/control her forever (I'm not trying to attack you, these "yous" are the royal kind). If she disagreed with your morality concerning sex, wouldn't you feel better that she was at least trying to retain some kind of responsibility and protect herself?
As to the physician's part in it- I've stated this before: I've seen a pregnant 13 year old (just barely 13) who could have avoided it if her doctor had agreed to prescribe birth control- she had asked her physician for pills. His reply? "You're too young." Her mother brought her into the clinic and was there for her during her counseling when her PT came up positive. Her mother left it up to her- if she decided to terminate the pregnancy, she had full support. If she decided to carry to term, her mother agreed to raise another child until her daughter was 18. That's RARE in my experience. I think about that every time I have an under-15 walk in and ask for anything. I'm happy to teach them how to use a pill/patch/ring or give them DMPA. I ALWAYS hand out condoms, and I counsel on abstinence too. It would be lame not to cover everything.
I posit my earlier questions with the intention of a rational discussion, not an emotional mudsling.
There are a lot of young women who come from very supportive families who feel like they cannot speak to their parents about sex let alone abortion. As to judges- What if a judge is anti-choice? How fair is that? Think about it.

You have no right to impose your moral values onto how I raise my children. I don't care if you disagree with me but it is very offensive that you think you know what is best for my children in this situation. Obviously, this doesn't apply to situations of abuse.

 

[Law2Doc]

I would try my best to ensure she was in whatever sexual relationship she was entering for healthy reasons.

Just bear in mind that in most states, someone aged 12-14 (your original numbers) is not legally allowed to give sexual consent. There are also plenty of studies showing a relationship between younger onset of sexual activity and cervical cancer. Thus I think you can cross this "healthy reasons" analysis off your list as an unworkable standard.

 

[Gut Shot]

In other words, it would be assumed all children are not in abusive situations because they want an abortion.

I'm not sure where you're getting this thing that all children seeking abortions are assumed to be in abusive situations. Certainly some are, and that is why I believe there should be some reasonable recourse for them to obtain medical services without parental consent. Will minors from non-abusive situations utilize this recourse as well? Sure they will, but there is no perfect solution... not by a long shot.

 

[Gut Shot]

You have no right to impose your moral values onto how I raise my children. I don't care if you disagree with me but it is very offensive that you think you know what is best for my children in this situation.

I fail to see how providing education and contraception, where legal, equates to a moral imposition on others. To me that it's a pragmatic approach to the unfortunate fact that reproductive maturity happens sooner than we'd like.

 

[oldManDO2009]

I'm not sure where you're getting this thing that all children seeking abortions are assumed to be in abusive situations. Certainly some are, and that is why I believe there should be some reasonable recourse for them to obtain medical services without parental consent. Will minors from non-abusive situations utilize this recourse as well? Sure they will, but there is no perfect solution... not by a long shot.

That seems to be the mentality (as you expressed) if some children are abused then there should be no recourse for parents because some children are abused.

The last time I checked - we were required to report abuse. So if a child is abused then it MUST be reported. At that point, child social services, the legal system and a judge are involved and can make a decision that is in the best interest of the minor. It is a ridiculous position to defend that because of a few abused children every child should have access to abortions and BCPs. It is a sad day when a 12 or 13 year old can request an abortion and no one is concerned about rape or molestation. It is not normal for such a young child to be sexually active and it is even more concerning you would find it acceptable or the "right" of a CHILD.

 

[Law2Doc]

It is a sad day when a 12 or 13 year old can request an abortion and no one is concerned about rape or molestation. It is not normal for such a young child to be sexually active

The youth of today are getting sexually active younger and younger. If you are not aware of this, you need to watch more daytime TV. It may be a "sad day", but certainly in a lot of the country, coming across sexually active junior high age kids is not particularly unusual.

 

[oldManDO2009]

A lot does not mean a majority and TV is not the arbiter of what is right or acceptable. If that were the case and MTV was the standard then morality would be a thing of the past.

There is still a great deal of this country and I happen to be part of that "red state" majority that is okay drawing the line and stating a child of 12-13 should not be sexually active. What is the hurry -they will grow up and we need to provide an appropriate environment and not rob them of their childhood.

 

[Law2Doc]

A lot does not mean a majority and TV is not the arbiter of what is right or acceptable.

It's not an issue of right/acceptable/red state/blue state. TV is a window into what is happening in the country. If you practice medicine in any metropolis, you will see sexually active pre-teens. It's simply a fact, and doesn't matter if it's right or wrong. It is something someone in the profession has to be ready to address.

 

[oldManDO2009]

I understand your point and it is a look (even if somewhat skewed) into our society. But it does not mean I have to acquiesce and give up my value system because TV says so...

 

[Gut Shot]

It is a sad day when a 12 or 13 year old can request an abortion and no one is concerned about rape or molestation. It is not normal for such a young child to be sexually active and it is even more concerning you would find it acceptable or the "right" of a CHILD.

 

[THP]

I fail to see how providing education and contraception, where legal, equates to a moral imposition on others. To me that it's a pragmatic approach to the unfortunate fact that reproductive maturity happens sooner than we'd like.

By distributing contraception to my child you are bypassing my right as a parent to raise her in the way I deem acceptable. You may think you are simply being pragmatic but in reallity you are judging my value system.

Clearly, every situation must be handled differently. If we are talking about a 13 year old girl who is already addicted to drugs, her father is in jail, and her mother is also a drug addict, then maybe giving the contraception is legitimate. I am pretty sure the mother would care less in this situation. However, there are plenty of sexually active suburbanite children who might also want birth control; but if they come from a more stable situation then you should talk to the parents first.

 

[Shredder]

TV is a window into what is happening in the country.

what comes first, the chicken/media or the egg/whats happening in the country. tv is a very unrealistic portrayal of the real world for the most part. ER is the case in point for premeds. i dont know if this statement was made hastily but i did a double take

 

[Gut Shot]

By distributing contraception to my child you are bypassing my right as a parent to raise her in the way I deem acceptable. You may think you are simply being pragmatic but in reallity you are judging my value system.

I would not be judging your value system any more than the corner liquor store here is judging mine. It is, after all, my choice to walk in and purchase a liter of Rumpelminze. Or not. Availability does not equate to imposition.

The only way I would be potentially bypassing your right as a parent is if I were to actively encourage your daughter to step into my Gingerbread Clinic, get fitted for a diaphragm, and then start giving it up for the middle school basketball team.

Since that won't be happening, please return to square one.

 

[Law2Doc]

what comes first, the chicken/media or the egg/whats happening in the country. tv is a very unrealistic portrayal of the real world for the most part. ER is the case in point for premeds. i dont know if this statement was made hastily but i did a double take

No - ER is totally fiction. Made up by Michael Crichton - the same guy who writes science fiction about dinosaurs.
I was talking about the fact that you can turn on TV any afternoon and see parents bemoaning their pregnant or promiscuous 12 year old. Or if you prefer, you can go into any ED in a big city and you will almost guaranteed see a pregnant teen come in to deliver a baby during any shift.
I was responding to the fact that somehow oldmanDO felt I (or MTV) was advocating this or that it was somehow a red state/blue state issue. I think neither color state is in favor of pregnant junior high schoolers.
(The way I see it, if I wasn't getting any at 12, no one should be ) But you cannot disagree that something isn't occurring -- it is. It's not a right or wrong issue, it's a don't stick your head in the sand issue.

 

[oldManDO2009]

I would not be judging your value system any more than the corner liquor store here is judging mine. It is, after all, my choice to walk in and purchase a liter of Rumpelminze. Or not. Availability does not equate to imposition.

The only way I would be potentially bypassing your right as a parent is if I were to actively encourage your daughter to step into my Gingerbread Clinic, get fitted for a diaphragm, and then start giving it up for the middle school basketball team.

Since that won't be happening, please return to square one.

If I remember correctly, a child cannot just walk in and buy a bottle of booze. We have laws that protect minors - even if someone thinks it is okay to allow a 13 year to drink and get drunk. Some laws do not support a parent's right to make decisions for our children and that should change.

If a teenager wants BCP's then we should be talking about sexually transmitted diseases (as a parent) - it is my job to educate my child not some fanatic that supports a child's right to abortion.

There will be situations that don't allow a teenager to talk to their parent - fine they should be explaining it to a judge. My parents will be disappointed is not a good enough reason. I am responsible for my children - I will not abdicate that responsibility to some healthcare professional that has a political view contrary to my value system.

 

[Gut Shot]

If I remember correctly, a child cannot just walk in and buy a bottle of booze.

That is irrelevant to my analogy, which I was using to illustrate availability vs. imposition. If you would prefer, I will change it to this:

The Shell station down the block sells Twinkies, but they are not pushing me to buy any of them. Are they imposing their rich, sugary values on me? I'm no lawyer, but I think children can purchase delectable, cream-filled snacks.

If a teenager wants BCP's then we should be talking about sexually transmitted diseases (as a parent) - it is my job to educate my child not some fanatic that supports a child's right to abortion.

I'm not disagreeing with you here. But if your daughter decides she's going to have sex, would you rather her have contraception or no?

 

[nikibean]

You have no right to impose your moral values onto how I raise my children. I don't care if you disagree with me but it is very offensive that you think you know what is best for my children in this situation. Obviously, this doesn't apply to situations of abuse.

I'm not trying to tell you how to raise your children, just as I would not want you to tell me how to raise mine. I believe I stated that, albeit implicitly, by clarifying that I posited questions to think about, not necessarily at YOU. I don't know you, I don't care if I ever meet you, and I'm just trying to raise a point. This debate is extremely polemical, and I realize that. I do disagree with you, which is obviously clear. How you raise your child is up to you, just as what I do with my body is up to me. However, if your child came to me in my clinic, I would advise her according to state law, and I would advise her to speak to an adult she trusts- hopefully that would be you- I honestly think it's a good idea to discuss something of this magnitude with a parent or trusted guardian. That's what I always do, whether a 14 year old wishes to continue or terminate a pregnancy.

Thank you, and apologies if you took my post the wrong way - it was not directed explicitly at you. I'm done with this debate, it's going to just go 'round and 'round as it always does.

Peace.

 

[oldManDO2009]

That is irrelevant to my analogy, which I was using to illustrate availability vs. imposition. If you would prefer, I will change it to this:

The Shell station down the block sells Twinkies, but they are not pushing me to buy any of them. Are they imposing their rich, sugary values on me? I'm no lawyer, but I think children can purchase delectable, cream-filled snacks.



I'm not disagreeing with you here. But if your daughter decides she's going to have sex, would you rather her have contraception or no?

This is a tough personal and political issue and I don’t think we are going to agree - my position changed when I had children. I respect your views and want to thank you for a cordial conversation. I don’t have to agree with you but we can at least respectfully state our positions.

Thanks again.

 

[neuroscan20]

Needless to say, South Dakota's all out, bar none ban on abortion really pisses me off. But I suppose, if you don't like the law, move some where else right?

here is an article i wrote on the issue, after hearing about it from a Dr. Crippen, NHS doctor, UK.

"A bar none ban on abortion in South Dakota?"

beneath the article, you'll find interesting links to other interesting posts concerning ethics...such as how do we argue rights for machines...?
I wrote the latter piece after considering the implications of human A.I.

 

[Larch]

Because it is late and I have an exam tomorrow, I will keep this breif:

1. Information about abortion procedures and risks should be available to minors, just as information on the procedures and risks of carrying to term should be available. Similarly, information about various forms of contraceptives should be readily available. Minors should be allowed to choose what forms of contraception they will use, and those decisions should be aided by the advice of a physician if possible. The average age of first intercourse in this country is 15. Let's stop arguing about whether or not that is the way things should be and start trying to do what we can to ensure the safety of sexually active minors.

2. Minors should be allowed to make their own reproductive health decisions. Pregnant minors are allowed to have all other prenatal procedures performed on them without the notification of a caretaker. If a minor is mature enough to decide to carry to term and raise a child herself, she is mature enough to decide to abort. Both decisions require considerable weighing of risks, and we currently are only trying to legislate one of those. Clearly, this is NOT about a minor's capacity to make her own medical decisions, or we would be placing limitations on gestation and birth for minors. I do think that minors should be advised to talk with a trusted adult about these decisions. As it is, most of them already do (I think the number was 85%).

3. Providing minors with accurate information about sexuality at a doctor's office does not impose morals on the patients or the patients' families anymore than teaching about heredity in a biology classroom forces secularism on students. Providing accurate information about sex, contraception, STIs, and relationship issues dramatically decreases an individual's likelihood of engaging in risky behaviors in the future. As a matter of public health, such resources should be available to children in the years prior to them becoming sexually active.

 

[QuikClot]

By distributing contraception to my child you are bypassing my right as a parent to raise her in the way I deem acceptable. You may think you are simply being pragmatic but in reallity you are judging my value system.

No. Medicine is in the business of dealing with the consequences of patients' stupid decisions. C-spining a minor does not mean that we endorse driving drunk. Giving Narcan (or methadone) to an addict does not means a thumbs up to addiction.

So a child of 12 is having sex. Stupid decision. We deal with the consequences by providing birth control. If you prefer to think of all underage sex as immoral, think of free birth control like a needle exchange program.

This is really about the Christian jihad's attempt to impose their values through the healthcare system by punishing those they deem sinful by denying them appropriate care. We can offer your kind mental health services . . . but forget about dictating medical care.