Ethics Q: Student Having Sex with Teacher

[dr.mango]

Does anyone know how to go about answering the following question:

 

"Your patient discloses to you that she is having sex with her highschool teacher"

 

What would I consider to answer this question?

[daryn]

I believe it's illegal to have sex with a minor. So I would breach confidentiality and contact authorities. Of course, I would first explain to the patient the nature of the situation and then ask the patient to inform her parents and other authorities (police/child services) herself. Additionally, I would find out if the sexual relations were voluntary (e.g. was she raped?), because if she was assaulted, then she should seek medical advice/attention.

[Jochi1543]

I believe it's illegal to have sex with a minor.

 

Isn't the age of consent really low, like 14 or something? How does Canada define statutory rape? I know in the US, the difference in authority is just as important as the age.

[daryn]

Yeah, I guess the first thing is to see if it's illegal or not.

[Calgarymed]

I don't think you have to report anything, illegal or not, that your patient reports other than child abuse.

[miss.spoken]

Under the age of 14, children cannot consent to sex (it gets more complex if the child is between 12 & 14). Between 14 & 18, teenagers can legally consent to consensual sex, but this does not include anyone in a position of authority (teachers, camp counsellors, clergy, etc). If someone between 14 & 18 is having sex with someone in a position of authority, including a teacher, it is a child protection issue, and social services must be notified.

[dr.mango]

So do you guys think we would still have to report it if it was voluntary, would you tell her that you will be reporting her? Would you involve her parents in this? I mean, to what degree would you breach her confidentiality?

[Vallinar]

You should never breach confidentiality unless there is a risk to the patient and or general public (life-threatening risk). As a doctor, you would need to try to get more inof onthe situation such as what led to sex, was it mutal, what is the mental state of the teen etc. You should do your best to convince the teen to break confidentiality and report the teacher b/c of the illegal nature of the incident and how the teacher could take advantage of other students. If, after several attempts, she still does not want report AND it appears that it was voluntary/mutal and the teen has suffered no immediate harm, then you need to let it rest. Don't breach confidentiality.

[peachy]

So do you guys think we would still have to report it if it was voluntary, would you tell her that you will be reporting her? Would you involve her parents in this? I mean, to what degree would you breach her confidentiality?

This isn't really an ethical issue, it's a legal one. You would call Children's Aid, tell them the situation without giving names, and ask whether it is a situation of mandatory reporting. If it is, then they'll tell you that and you'll supply whatever information they need. If it is not, then you have no right to breach confidentiality. It's really not up to you as the physician to decide.

[cling]

The downlow on confidentiality is that there are very few occasions when you would breach it. As a side note, being a doctor does not apply you are a crime fighter, although I would really like to have shiny thingie on top of my car. The occasions when you do breach it is: child abuse, communicable disease, vulnerable adults (perhaps like Alzherimers), impacts on flight and driving safety, dangerous patients (no, not little 14 year old thugs apparently ) and sexual misconduct. Now, I was not 100 % on what sexual misconduct was soo I wiki'd it ->http://en.wikipedia.org/wiki/Sexual_misconduct

 

In accord to this definition, yeah you do report it...even it isn't illegal.

 

For more info you can consult "Doing Right"...

[JohnDakota]

Age of concent means nothing in this case.. the teacher is considered an authority figure, and because of this position the student must be 18 years of age or older for it not to be considered statutory rape. As a doctor it would be your obligation to inform the proper authorities.

[GeezLouise]

I think it is very important for all of us to keep in mind that we are not expected to be legal experts and lawyers for our interviews. I think that when faced with such a question (literally, in the case of MMI!), we may freak out if we don't know where the law stands on it. However, in my opinion a perfectly suitable answer would be to say:

 

1) firstly as a physician i would be suspicious of the legal implications of the situation and would look into it. i would then act accordingly. (then bla bla into what that might be if i know...if not, just having mentioned it is enough)

2) talk with the student and understand his/her capacity for decision making, psychological status, etc. in order to read into underlying issues

3) talk about pregnancy, STIs, etc.

4) try to discover whether there is more the student is trying to tell me

5) thank and commend the patient for opening this "very important" dialogue with you, explain that you are there to protect him/her

6) discover whether patient has shared this information with anyone else (it may reveal more about who is involved in the situation)

 

From my experience trying to work through the various angles is what they're looking for, and not the exact law (age, etc.)

 

Thanks for the great question!