Ethical Question!

[MedHopeful221]

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Hey all! I need help with this question...
you know that ethical question that is sometimes asked about the 14yr old wanting birth control but not wanting you to tell the parents?

Do doctors legally have to tell her parents because she is a minor? Or, would a doctor be able to give it to her in confidence? Any help would be greatly appreciated!

 

[ChiDO]

I think it depends on the state in regards to the laws???

But, basically I would counsel her to the idea that she should speak with her parents regarding this and if they are not willing to talk to her, then next time she comes to visit we can discuss this topic further. I would also approach the parents and ask if they talked to her about these kinds of things since she's older (basically, maybe give them a push to talk to her); also could mention that you would be happy to speak to their daughter in regards to these issues if they feel uncomfortable.

Don't hold my words here as what should be done, but this is the approach I would take (not sure if I'm right, wrong, ect).

 

[tremulousNeedle]

In most states, when the topic is reproductive issues the patient is the primary decision maker regardless of age. So in your example, the 14 y/o female is her own decision maker. She does not have an obligation to tell her parents and in most states it is unethical and illegal for the healthcare provider to inform the parents without the patients consent.

With that being said, the most appropriate answer would be to respect the patient's wishes, but encourage her to discuss these issues with her parents or other adults that she trusts. The physician could also offer to be a mediator in this conversation if the patient so desires.

Depending on how you interpret ChiDO's post, what they are recommending could be borderline unethical.
"I would also approach the parents and ask if they talked to her about these kinds of things since she's older (basically, maybe give them a push to talk to her)".

It is unethical to approach the parents and ‘hint' to them that they need to talk to their daughter about reproductive issues if by doing so you are implying that the patient brought the issue up with the doctor. The acceptable way to go about this is to make a general recommendation to the parents that given the child's age and maturity, now would be a good time to discuss reproductive topics, withOUT implying that the patient had already discussed this issue with the doctor. In general, if you feel like you are sneaking around technicalities, what you're doing is probably unethical.

Here's another angle to this question, if giving birth control is against your own morals as a physician, you are required by law (in nearly all states) to refer her to a healthcare provider that WILL provide her birth control (obviously unless it is medically contraindicated).

Just remember to always do what is in the best interest of the patient. As a premed student, experienced interviewers shouldn't ask you questions about medical ethics, which is considerably more specific than general ethics (these questions are fair game).

-senior medical student / admissions committee interviewer / plus course in medical ethics & lots of exposure to clinical medical ethics

 

[Daedra22]

I know with certainty that the vast majority of states have to keep reproductive issues completely confidential. California is especially uptight about this law, with good reason. As a physician, you don't know what kind of parents this child has. Even if you "know" these parents, they might have extreme opinions on birth control and could harm their daughter. One should never assume that the parents of a kid are always good, kind or rational.

 

[ChiDO]

In most states, when the topic is reproductive issues the patient is the primary decision maker regardless of age. So in your example, the 14 y/o female is her own decision maker. She does not have an obligation to tell her parents and in most states it is unethical and illegal for the healthcare provider to inform the parents without the patients consent.

With that being said, the most appropriate answer would be to respect the patient’s wishes, but encourage her to discuss these issues with her parents or other adults that she trusts. The physician could also offer to be a mediator in this conversation if the patient so desires.

Depending on how you interpret ChiDO’s post, what they are recommending could be borderline unethical.
"I would also approach the parents and ask if they talked to her about these kinds of things since she's older (basically, maybe give them a push to talk to her)".

It is unethical to approach the parents and ‘hint’ to them that they need to talk to their daughter about reproductive issues if by doing so you are implying that the patient brought the issue up with the doctor. The acceptable way to go about this is to make a general recommendation to the parents that given the child’s age and maturity, now would be a good time to discuss reproductive topics, withOUT implying that the patient had already discussed this issue with the doctor. In general, if you feel like you are sneaking around technicalities, what you’re doing is probably unethical.

Here's another angle to this question, if giving birth control is against your own morals as a physician, you are required by law (in nearly all states) to refer her to a healthcare provider that WILL provide her birth control (obviously unless it is medically contraindicated).

Just remember to always do what is in the best interest of the patient. As a premed student, experienced interviewers shouldn’t ask you questions about medical ethics, which is considerably more specific than general ethics (these questions are fair game).

-senior medical student / admissions committee interviewer / plus course in medical ethics & lots of exposure to clinical medical ethics

That's what I was trying to convey; although I did it poorly. 👍

 

[tremulousNeedle]

That's what I figured ChiDO, hope I didn't offend you.

 

[rmbsstock]

I used to work in the state of Illinois in an inpatient facility for drug and alcohol addicted females that are court ordered to be there. The court system gave us a lot of control over these girls except this issue. When a girl earned a pass to go home, and asked for birth control, we could not ask questions but just give it to her. (Some of our girls come from very bad homes that their own dad or step dad or mom's boyfriend could be raping them while they are on pass!!).
Since I am totally against giving birth control especially to 12 year old, we assigned a nurse, that I can refer the girls to her and she will give them what they need. However, the nurse will educate them of many issues. Also, I gave my nurse brochures to give these girls, and she had some brochures about sexually transmitted diseases to give the girls. So, we designated a speaker and a package that has some goodies this way the girl will open it (cute pens and pencils, and very important material to read). I conscious felt a little better.

 

[marke]

i think it is important to

1. find out WHY doesn't the kid want their parents to know. ie my parents will kill me if they find out... etc
2. educate pt about safe sex, condoms, or birth control
3. find out the circumstance how the girl got pregnant. ie sex with bf or if it's because she was drunk at a part.. etc
4. find out the law of the state and act accordingly.

just my 2 cents

 

[the duck]

i think it is important to

1. find out WHY doesn't the kid want their parents to know. ie my parents will kill me if they find out... etc
2. educate pt about safe sex, condoms, or birth control
3. find out the circumstance how the girl got pregnant. ie sex with bf or if it's because she was drunk at a part.. etc
4. find out the law of the state and act accordingly.

just my 2 cents

I was under the impression, birth control works best BEFORE you become pregnant. Then again, I'm only a premed, so what do I know 😉

 

[Bacchus]

Hey all! I need help with this question...
you know that ethical question that is sometimes asked about the 14yr old wanting birth control but not wanting you to tell the parents?

Do doctors legally have to tell her parents because she is a minor? Or, would a doctor be able to give it to her in confidence? Any help would be greatly appreciated!

"I have to prescribe your daughter birthcontrol because of her cramping, hormonal imbalance, etc."

 

[marke]

I was under the impression, birth control works best BEFORE you become pregnant. Then again, I'm only a premed, so what do I know 😉

Since we are big on preventative care, i meant to educate the pt to prevent future pregnancies...