what should a doctor do in this situation?

[cardiology88]

---

Members do not see this ad.

You have a patient who is a pregnant female. She is a minor, only 15 years old. She is only pregnant because she got raped. She wants to keep the baby, mother wants an abortion.

or same situation but she wants an abortion and mother wants to keep the baby?

 

[RogueUnicorn]

call the lawyer

 

[Drrrrrr. Celty]

well..
its the choice of the women..
but
at the same time she's also a young girl.. not very understanding of her actions long term affects..

i would honestly say abort it..

 

[FallenHero]

make sure hes not the father

 

[JStephens]

well..
its the choice of the women..
but
at the same time she's also a young girl.. not very understanding of her actions long term affects..

i would honestly say abort it..

Im in agreement with this. 👍

 

[TDX]

Follow the rules.

Over here, that would mean that in the first case, no action could be taken. In the second case, the girl would have to return a few days later, and if she still supported her original decision and was able to present reasonable arguments for it, she'd get the abortion.

It might become a bigger problem if the girl was younger or mentally handicapped, however.

 

[runrunrudolph1]

I think the girl still has the legal right to do whatever she wants. So consult a psychiatrist?

 

[Theory]

.

 

[teenmachinery1]

You have a patient who is a pregnant female. She is a minor, only 15 years old. She is only pregnant because she got raped. She wants to keep the baby, mother wants an abortion.

or same situation but she wants an abortion and mother wants to keep the baby?

The daughter has legal rights to keep the baby even though she's a minor. So, a forced abortion is out of the question. BTW- Would you take part in a forced abortion anyways? Even if it was legal?

Now, if she wanted to abort it and the mother wanted to keep it, that's too effin' bad for the mother.

 

[Drrrrrr. Celty]

The daughter has legal rights to keep the baby even though she's a minor. So, a forced abortion is out of the question. BTW- Would you take part in a forced abortion anyways? Even if it was legal?

Now, if she wanted to abort it and the mother wanted to keep it, that's too effin' bad for the mother.

you could have a court order for a abortion..
my friend had that happen to her when she refused to abort her kid..
but she was a stoner and so was her bf..
so there would have been a argument for a child being born with a lot of defects..

 

[TDX]

you could have a court order for a abortion..
my friend had that happen to her when she refused to abort her kid..
but she was a stoner and so was her bf..
so there would have been a argument for a child being born with a lot of defects..

Unless you live in China, I have some doubts with regards to the veracity of that story.

 

[2011MS1]

This may have to go to court and the girl can be medical emancipated and remove her parents as surrogate. She will easily win the case unless she is really really immature.

 

[vin5cent0]

BTW- Would you take part in a forced abortion anyways? Even if it was legal?

I would. How does a 15 year old take care of a baby when she's only a kid herself? The answer.. she doesn't. The rest of us do via gov't aid.

 

[Drrrrrr. Celty]

Unless you live in China, I have some doubts with regards to the veracity of that story.

well again.. im taking the story of a stoner..
so who knows..

 

[TheMightySmiter]

In the first case, I would never partake in a forced abortion unless a patient was truly mentally incapacitated. In the second case, not all states require parental consent for abortion. Mine only requires notification, and this can be bypassed via court order in extreme circumstances (e.g. patient feels threatened if she divulges the fact that she has an abortion to her parents/guardian).

 

[TooMuchResearch]

You have a patient who is a pregnant female. She is a minor, only 15 years old. She is only pregnant because she got raped. She wants to keep the baby, mother wants an abortion.

or same situation but she wants an abortion and mother wants to keep the baby?

Consult applicable law. Decide whether or not to follow the law.

 

[teenmachinery1]

I would. How does a 15 year old take care of a baby when she's only a kid herself? The answer.. she doesn't. The rest of us do via gov't aid.

stunning that you would take part in forced abortions.

Don't count on me signing up to hold her arms down.

You'd probably give her a lecture on how her baby would be a burden for the rest of us as you're inserting the suction tube up her vagina.

it must've taken some work to come up with this opinion so congratulations.

 

[NickNaylor]

Forced abortions? Uh, no thanks. That's a pretty USSR/China-like proposition.

I believe rape/incest is usually an exception to anti-abortion laws. The real difficulty comes in determining who actually gets to make the decision. In most cases, I'd believe that's the parents.

Sorry, a 15 year-old is not mature enough to make this decision rationally.

 

[azrael87]

Let me break this up into what I would do, and what I personally feel should be done, beginning with the former.

Certain things vary depending on the state, but in general it should be up to the one who is pregnant. It's not my job to push her one way or the other. While teenage parenting is difficult, it can be done well in the right hands. On the flip side some people should NEVER be parents, let alone at 15. As per my job, I would very frankly inform her of all the risks/rewards of either aborting, keeping the baby, or giving birth and giving up to adoption (a viable middle ground oddly overlooked so far in the thread). The girl should also be checked for transferred VD's and made aware of any possible transfer of said disease to the child.

After hearing the details, if they wanted to know more I'd refer them to the appropriate sources, including a good OB/GYN (it's a specialty I'm open to, but probably won't be going into). I would then suggest they take at least a week (assuming she's not right at the critical decision point) to seriously think it over and discuss it. If after taking some time, the girl is resolute in her decision, I will follow through with her wishes no matter which it is. Again, this all depends on state law though. If the law says a legal guardian's decision overrules, then I will follow through with the guardian's wishes. Also, if state law at the time deems abortion at her stage of pregnancy illegal, then I wouldn't even entertain the idea.

As one last possible variation of the situation, certain girls have bodies ill-equipped for a viable pregnancy. For some smaller girls/women, giving birth can cause a lot of physical problems for her later, the baby may be very unlikely to survive pregnancy, or the girl may be in such a situation where her body can only really handle a full pregnancy and birth once before her system is too highly damaged to do it again. In such a situation, I'd obviously emphasize the greater risks involved, but final decisions would remain in the same hands as stated above.



With all that said I'll now go into my personal opinion, something that may not always agree with our required actions as physicians (a fact we should remember). IMO, a parent shouldn't be able to force their child to give birth against their will. It's a major risk and responsibility for a young teenager, especially for one who had the situation forced on her by rape. If she isn't ready to be a parent, she isn't ready to be a parent. Letting her mother take the reigns as acting mother isn't great for the kid either since it complicates things as they all get older. My personal preference would be that the girl gives birth and allows the baby to be adopted.

Looking at the reverse, I don't think a mother should be able to force a girl to have an abortion either. If the girl wants the child, it's a little ridiculous to have it taken from her forcefully ESPECIALLY when the child was given to her forcefully. A girl in that situation would have a seriously impaired sense of free will after that and will likely have serious psychological problems (even moreso than the rape alone likely caused).

So ultimately I feel the one who is pregnant should decide the fate of the embryo within her. She may be deciding its fate for the following 18 years or more, so the responsibility of hard decisions begins immediately, whatever the consequences.

 

[rmbsstock]

As a licensed professional Counselor and National Certified Counselor, I will be very sad if the doctor on the case did not call the mental health counselor on duty for the daughter and the mother for counseling. The young lady is traumatized by the rape. Additionally, to put her through the experience of abortion, and later the feelings of guilt that she killed a baby, can be very traumatic. However, we may also need to explore how much is she going to be affected every time she looks at herself and see herself pregnant.
Can we put ANY positive spin on this experience (if we can, and depending on what kind of rape the youth went through). We can explore the issue of adoption, and meeting several parents. The youth can decide which family her baby goes to. Maybe this will give her back some control.
As for her mother and the family in general, this is a traumatizing experience too. They feel guilt for not protecting their daughter, they feel they have lost their daughter because she will never be the same, she lost whatever innocence she had, probably now they have to be involved in the legal system, and now there is a baby's life in their hands. Any decision the mom/family make, is going to affect their daughter and her baby for life. So they are victims too. They may be filled with anger and fear of what the future hold (their own daughter's future and their financial stability too) that they might not be able to think straight.
Having a counselor will help them sort through their own ideas, feelings, direct them to good resources, and remind them that the focus should be on their daughter's mental health and the baby.
There is also the third victim in this, which is the baby. We need to look at how the youth perceive the it 1) a baby or 2) just a 'bunch of cells that makes nothing yet'. This in itself can be a major issue to explore.

 

[Funky]

when something like this happens, you could always call for an ethical consult. I think most hospitals have a person on call who can help you in situations like this.

 

[kavorca]

In many states, a pregnant female is automatically "an adult" and makes her own decisions. The parents would have no say so over her care.

 

[vin5cent0]

stunning that you would take part in forced abortions.

Don't count on me signing up to hold her arms down.

You'd probably give her a lecture on how her baby would be a burden for the rest of us as you're inserting the suction tube up her vagina.

it must've taken some work to come up with this opinion so congratulations.

Personally, I'm stunned you'd think it was ok for a 15 year old to raise a human being. Some life that child would have...

 

[sajum]

1. find father
2. find lawyer
3. sue/jail/child support
4. ??????
5. profit
6. then decide based on moniez

all boils down to money amirite?

 

[teenmachinery1]

Personally, I'm stunned you'd think it was ok for a 15 year old to raise a human being. Some life that child would have...

I guess some think that a child might turn out all right even if his/her mother is a teenager (me), and others think these teenagers should be tied down and have their pregnancy forcibly aborted (you).

Ann Dunham was 18 when in 1961 she gave birth to the 44th President of the United States, Barack Obama.

Maya Angelou, an American poet, memoirist, actress and an important figure in the American Civil Rights Movement became pregnant at the age of 16 and gave birth to her son, Guy Johnson, who also became a poet later in life.

In 1917, 17-year-old Kamala Nehru gave birth to her daughter, Indira (later prime minister of India).

At the age of 13, Lady Margaret Beaufort gave birth to her only child, who later became Henry VII of England.

Napoleon's mother, Lætitia Bonaparte, gave birth to five children before she was 20. Only two of them survived: Napoleon and his elder brother Joseph Bonaparte.

Dwayne Michael Carter Jr. aka Lil’ Wayne had his baby, Reginae, with his now ex-wife Antonia "Toya" Johnson when he was 15 and she 14. (lol?)

 

[sajum]

I guess some think that a child might turn out all right even if his/her mother is a teenager (me), and others think these teenagers should be tied down and have their pregnancy forcibly aborted (you).

Ann Dunham was 18 when in 1961 she gave birth to the 44th President of the United States, Barack Obama.

Maya Angelou, an American poet, memoirist, actress and an important figure in the American Civil Rights Movement became pregnant at the age of 16 and gave birth to her son, Guy Johnson, who also became a poet later in life.

In 1917, 17-year-old Kamala Nehru gave birth to her daughter, Indira (later prime minister of India).

At the age of 13, Lady Margaret Beaufort gave birth to her only child, who later became Henry VII of England.

Napoleon's mother, Lætitia Bonaparte, gave birth to five children before she was 20. Only two of them survived: Napoleon and his elder brother Joseph Bonaparte.

Dwayne Michael Carter Jr. aka Lil’ Wayne had his baby, Reginae, with his now ex-wife Antonia "Toya" Johnson when he was 15 and she 14. (lol?)

lets be realistic here, do you really think the number of teenage mother who raise famous people vastly outnumbers those who raise drug addicts/thugs? on top of that, half of the ladies you mentioned had babies when they were suppose to, during their tiem periods.

i dont think anybody literally meant physically 'forced'. try to persuade the girl as much as you can, if she still insists, then let her have it. i guess its her life owel

 

[GH253]

I give absolute priority to the pregnant girl's wishes totally regardless of anyone else's judgement.

 

[westeastmount]

lets be realistic here, do you really think the number of teenage mother who raise famous people vastly outnumbers those who raise drug addicts/thugs? on top of that, half of the ladies you mentioned had babies when they were suppose to, during their tiem periods.

i dont think anybody literally meant physically 'forced'. try to persuade the girl as much as you can, if she still insists, then let her have it. i guess its her life owel

I think you are totally missing the point. I do not think it is the fact that the child is being born to a young woman that causes most of these children to be bad. Quite frankly what matters is that the baby has a mother that loves it, and is capable of raising it. A large portion of the girls that get pregnant underage have zero support and don't know how to be a mother. If her mother were to loose the attitude (and quite frankly I have zero respect for what she's trying to do to her daughter. Her daughter has every right to choose what to do in this situation and her mother should not leave the realm of advise and enter the realm of coercion and a forced abortion) there might be a chance that the baby could have a decent upbringing. However, if not, adoption may be the way to go, especially with so many couples that desperately want children that can't have them.

 

[TDX]

Personally, I'm stunned you'd think it was ok for a 15 year old to raise a human being. Some life that child would have...

And while you have the right to believe that she should not have a child, as a doctor it is not up to you to decide whether she does or not.

One of the core concepts in medical ethics is autonomy. Your patients are the only ones who decide what is done to their body. It's why, barring exceptional circumstances including things such as mental incapacitation, you need informed consent for all procedures - people are considered autonomous beings, and their right to decide for themselves what is done to their bodies is considered inalienable.

To ignore that right is to ignore their humanity. It means treating people like objects rather than like autonomous agents.

Even if you are of the opinion that your patient is clearly an idiot and is making a very, very stupid choice, it's still up to the patient to make that choice. The only things you're allowed to do are to give information and to hope that the patient changes his mind.

The only exception to that is if the patient is incapable of making an informed decision - and note that it's an "informed" decision, which is not necessarily a good one.

 

[sumstorm]

Personally, I'm stunned you'd think it was ok for a 15 year old to raise a human being. Some life that child would have...

While it may not currently be culturaly acceptable in the US (it wasn't really that long ago that women were routinely 'married off' at that age, particularly in the west), 15 year olds do manage here and around the world. Alot will depend on the woman and her community. There are 15 year old 'kids' that have maturity levels that trump a lot of 21 year old college seniors, often dependent on where they have been in life.

In my family, neither my mother, nor 3 of her 4 siblings had educational oppurtunities. All had children at 18 (one at 15), with all the 18 year olds being married before getting pregnant. Now, one runs the department that creates the technical manuals for a heavy machinery company (the largest in the country), one is a licensed CPA, another is a NICU nurse (that was the 15 yo....being pregnant and young opened up educational doors that the others didn't get...not saying it was wise or anything else, but it meant she was educated and in a higher paying job before anyone else in her family), the fourth is a financial adviser who specializes in low to moderate income families (makes a nice living, not a killing, for her own ethical reasons), and the fifth is a PT.

I don't think many 18 year olds should really have kids either, but it happens, sometimes due to the family circumstances or life situations they are in. Those who are going to be successful in life will find away, even with the obstacles. Those who aren't will find an excuse to pardon themselves. In some states it is legal to marry at 14, in others it is still illegal to have a child out of wedlock (even if the law isn't enforced.) There are a lot of factors that would affect the decisions of the youth in this situation (and it is sad that we don't live in a society where she could have come forward immediatly and had the option of a morning after pill) that we aren't able to know or understand. However, I do not think a forced abortion, or even a guilt-induced abortion, is appropriate. People who have been assaulted may already be battling with (right or wrong) guilt and recrimination, and if her beliefs involve having that child, additional guilt and recrimination will not benefit her in the long run.

Also, I don't believe anyone in this country has ever made it 'all on thier own' without any support from the country as a whole, their community, or at minimum their family. Failure to realize and acknowledge that is arrogant and presumptous. I preface the next statement with the fact that I am half Oneida; I don't begrudge individuals who descended from invaders of this continent; I wish those individuals didn't begrudge others who need resources from this country.

 

[boaz]

call the lawyer

👍
+1

A lot of ethics questions can be answered simply by consulting the law. Our moral system is the basis of our laws. So, the answer that the lawyer gives you is the most ethical one. If the law says that a 15 year old has the right to abort her own fetus, we can't deny the right. If it says that the legal guardian is in charge, we must follow the decision of the guardian. If the law is ambiguous about it, then it's a different story...

 

[sr9]

As a licensed professional Counselor and National Certified Counselor, I will be very sad if the doctor on the case did not call the mental health counselor on duty for the daughter and the mother for counseling. The young lady is traumatized by the rape. Additionally, to put her through the experience of abortion, and later the feelings of guilt that she killed a baby, can be very traumatic...

wow, so much for impartial "counseling"

you clearly have an agenda of your own

 

[TheMightySmiter]

and while you have the right to believe that she should not have a child, as a doctor it is not up to you to decide whether she does or not.

One of the core concepts in medical ethics is autonomy. Your patients are the only ones who decide what is done to their body. It's why, barring exceptional circumstances including things such as mental incapacitation, you need informed consent for all procedures - people are considered autonomous beings, and their right to decide for themselves what is done to their bodies is considered inalienable.

To ignore that right is to ignore their humanity. It means treating people like objects rather than like autonomous agents.

Even if you are of the opinion that your patient is clearly an idiot and is making a very, very stupid choice, it's still up to the patient to make that choice. The only things you're allowed to do are to give information and to hope that the patient changes his mind.

The only exception to that is if the patient is incapable of making an informed decision - and note that it's an "informed" decision, which is not necessarily a good one.

+1000000000000000

 

[mbh11]

why don't you ask the baby what should be done?

oh wait, we don't ever consider that because "it's the mother's choice"

 

[Relativista]

Sticking to local legislation seems the most viable argument if the goal is to minimize trouble for yourself, from a rational, egotistical point of view.

But ppl are not rational, not even doctors, and ppl are not egotistically, materialistically rational, but chaotically influenced by manipulation by the environment (e.g moral parents) and their genes (obsessive-compulsive, e.g fanaticism, reading bibles, qurans etc. literally (and selectively)).

You can mean whatever you want, and stand on your box shouting out to the world of doctors what we should, but in the end, you have no argument persuading me to follow you, unless you have power over me.

 

[Mitch556]

Don't do abortion...refer to psychologist.

 

[GH253]

Don't do abortion...refer to psychologist.

I think it's rather profoundly insulting to the girl who has been raped to reflexively turn her over to mental health professionals. A psychologist has no moral, legal, or medical authority regarding the issue of abortion. All you're doing is evading the responsibility to exercise independent judgment by deferring to a psychologist. You're also insulting the girl by insinuating that the problem is really just between her ears.

 

[GH253]

Sticking to local legislation seems the most viable argument if the goal is to minimize trouble for yourself, from a rational, egotistical point of view.

But ppl are not rational, not even doctors, and ppl are not egotistically, materialistically rational, but chaotically influenced by manipulation by the environment (e.g moral parents) and their genes (obsessive-compulsive, e.g fanaticism, reading bibles, qurans etc. literally (and selectively)).

You can mean whatever you want, and stand on your box shouting out to the world of doctors what we should, but in the end, you have no argument persuading me to follow you, unless you have power over me.

You can do whatever you want, but not everyone is irrational, and not all of us will allow ourselves to be "manipulated" by the stupidity of others, nor choose to blank out when faced with the responsibility to act.

 

[GH253]

deleted

 

[Law2Doc]

Consult applicable law. Decide whether or not to follow the law.

Um no, you don't "decide whether or not to follow the law". If it's the law you follow it, unless you are ready to change careers over this. Laws aren't optional. And if you disagree with them, in this society your constructive options tend to be to write your congressmen, start petitions and work through the political grass roots process to change the law, not simply disobey the law. Civil Disobedience is well and fine if you are an unemployed flower child sleeping in a day-glow VW van with no career to lose. But you don't get to disobey the laws and continue to have a profession or medical license. So you have to follow the law in any event, and in your private life if it's important to you, you can work for change through other legal means.

Now you personally don't have to do any abortions in your career (and there's no law saying a particular doctor needs to do such), but one would hope you thought that through before you went into an obstetrics oriented specialty. In which case the above question doesn't turn on the abortion aspect it turns on the ethics of minors making decisions aspect. And on that, each state will have its own specific laws which you must abide if you want to continue your career.

 

[rmbsstock]

wow, so much for impartial "counseling"

you clearly have an agenda of your own

Please, do not take what I said in parts. I said IF she considers him a baby, and later I said if she considers him a bunch of cells.
Legally, I cannot have my own agenda, the client/patient dictates it to me. The problem happens when people do not explore what the client/pt. wants and later in life they come in treatment very traumatized.
I have seen it many times that due to a decision they made earlier in life, without given the alternatives, they suffer and they feel angry towards their family and themselves.
Please, read exactly what I said. Sorry if I was not clear and I hope I cleared it better now.

 

[rmbsstock]

I think it's rather profoundly insulting to the girl who has been raped to reflexively turn her over to mental health professionals. A psychologist has no moral, legal, or medical authority regarding the issue of abortion. All you're doing is evading the responsibility to exercise independent judgment by deferring to a psychologist. You're also insulting the girl by insinuating that the problem is really just between her ears.

I agree with you the Psychologist has no moral, legal, or medical authority regarding the issue of abortion. But that is the area that the work of the psychologist and actually the counselor comes. The Counselor job is to work with the family and the youth to explore what fits this youth and this family. It is case by case basis. You cannot say all should abort or all should keep the child. That is also why every hospital has a mental health department that it is your job as a doctor to send for the counselor/social worker to work with this family in crisis, in addition ofcourse you probably are the one to legally report it.
That is my understanding, and I have been called before on cases like this but not in a hospital setting. (I was called when there was an incest and a child that I put in foster care admits she was raped by a brother or father...) Now ,I am ready to learn from all if you think in a hospital setting it is different.

 

[EMS5]

Purely based on the law in my state, the daughter has the sole decision regarding whether or not to have an abortion. Even though she was raped, she is pregnant therefore making her an emancipated minor.

Before any decisions are made I would definitely say that she needs to talk to everyone involved to make an informed and healthy decision for both her and the child.

 

[johncalvin]

Forced abortion = assault. End of story.

 

[TooMuchResearch]

Um no, you don't "decide whether or not to follow the law". If it's the law you follow it, unless you are ready to change careers over this. Laws aren't optional. And if you disagree with them, in this society your constructive options tend to be to write your congressmen, start petitions and work through the political grass roots process to change the law, not simply disobey the law. Civil Disobedience is well and fine if you are an unemployed flower child sleeping in a day-glow VW van with no career to lose. But you don't get to disobey the laws and continue to have a profession or medical license. So you have to follow the law in any event, and in your private life if it's important to you, you can work for change through other legal means.

Now you personally don't have to do any abortions in your career (and there's no law saying a particular doctor needs to do such), but one would hope you thought that through before you went into an obstetrics oriented specialty. In which case the above question doesn't turn on the abortion aspect it turns on the ethics of minors making decisions aspect. And on that, each state will have its own specific laws which you must abide if you want to continue your career.

There is always a choice. I sometimes choose to not follow the law, and I am sometimes issued citations because of my choices. In the situation presented, I would follow the law, but the OP didn't ask what I would do.

 

[Bearie]

Um no, you don't "decide whether or not to follow the law". If it's the law you follow it, unless you are ready to change careers over this. Laws aren't optional. And if you disagree with them, in this society your constructive options tend to be to write your congressmen, start petitions and work through the political grass roots process to change the law, not simply disobey the law. Civil Disobedience is well and fine if you are an unemployed flower child sleeping in a day-glow VW van with no career to lose. But you don't get to disobey the laws and continue to have a profession or medical license. So you have to follow the law in any event, and in your private life if it's important to you, you can work for change through other legal means.

Now you personally don't have to do any abortions in your career (and there's no law saying a particular doctor needs to do such), but one would hope you thought that through before you went into an obstetrics oriented specialty. In which case the above question doesn't turn on the abortion aspect it turns on the ethics of minors making decisions aspect. And on that, each state will have its own specific laws which you must abide if you want to continue your career.

I assume from your name that you previously studied law (I haven't). While I respect your opinion, I would expect a more nuanced view on the theory of law and how the law is constructed and reified. The interplay between law and ethics is far more complex than you imply.

 

[scapermoya]

I assume from your name that you previously studied law (I haven't). While I respect your opinion, I would expect a more nuanced view on the theory of law and how the law is constructed and reified. The interplay between law and ethics is far more complex than you imply.

i have to agree. especially because the 'laws' that a doctor is expected to work within include more than the legally-binding local, state, and federal laws. each hospital or facility will have it's own policies, and the extent to which all of these regulations are enforced will vary considerably. nothing is as black and white as Law2Doc seems to think, especially with these sensitive moral issues.

on a separate note, characterizing all civil disobedience as a leisure activity for stoned hippies is ignorant. many of the rights you and I enjoy today were supported by civil disobedience movements, and they continue to be a powerful force for political change worldwide.

 

[loveboatdoc]

What about the Hippocratic Oath we took at graduation?

 

[Electronegative]

call the lawyer

+1
this looks like loose-loose situation, you can be sued for making either decision by daughter or mother.

 

[gettheleadout]

why don't you ask the baby what should be done?

oh wait, we don't ever consider that because "it's the mother's choice"

Actually, we don't ever consider that because the fetus is not capable of communicating. Unless you have invented a device that can read baby minds, whose choice do you think it should be?