Amnesty Posted March 4, 2009 Report Share Posted March 4, 2009 A case that I was curious what you guys think about: Suppose you have a teenage girl, pregnant. She would like an abortion because the child belongs to her father/rapist. What would you do about her social situation and medical situation? Link to comment Share on other sites More sharing options...
Wolvenstar Posted March 4, 2009 Report Share Posted March 4, 2009 A case that I was curious what you guys think about: Suppose you have a teenage girl, pregnant. She would like an abortion because the child belongs to her father/rapist. What would you do about her social situation and medical situation? Offer to provide her with information on counselling services. Depending on her age, and if she is living at home, call child services (teenager is a broad age, I believe that unless they are old enough to be living on their old, you are legally bound to call child services). I don't think I will personally be doing abortions, but I am not a doctor who is going to condemn and judge a patient for wanting to get one, so I would provide her with a list of doctors whom I know perform abortions. (considering the nature of how the child was begotten I would try to find a female abortionist). Link to comment Share on other sites More sharing options...
NewfieMike Posted March 4, 2009 Report Share Posted March 4, 2009 1.) call the cops 2.) give her the abortion how can this be made any easier? I can somewhat see the doctor having a responsibility to take the action to the next level (especially if she hasn't really told anyone about it), but I would let the social workers do what they were trained to do. She came to the doc for medical help, so I'd help her. Link to comment Share on other sites More sharing options...
w8kg6 Posted March 4, 2009 Report Share Posted March 4, 2009 Yeah, this case is pretty straight forward. Make sure that she is aware of all her options. Although the child is a product of rape, she may still prefer to give it up for adoption, or even to raise it on her own. This certainly may not be the case, but it's imperative that she's aware of all the avenues that she can go down. Once you've done that, you should help her follow it, but also make sure that she's got a safe environment to go home to. This involves calling the police, which is an ethical and legal must. Beyond that, there's not much else to it. Continue to follow up with her like you would any other patient, and help her carry out her educated decision, whether that be abortion or something else. Link to comment Share on other sites More sharing options...
polythenepam Posted March 4, 2009 Report Share Posted March 4, 2009 100% GUARANTEE you will absolutely not get a question about abortion. Link to comment Share on other sites More sharing options...
rmorelan Posted March 4, 2009 Report Share Posted March 4, 2009 100% GUARANTEE you will absolutely not get a question about abortion. Wow that is a pretty firm response May I ask why you think that would never occur? I know other equally hot button issues have appeared in the past. Link to comment Share on other sites More sharing options...
w8kg6 Posted March 4, 2009 Report Share Posted March 4, 2009 100% GUARANTEE you will absolutely not get a question about abortion. That's pretty confident, yeah. I've been asked about needle exchange clinics, which is also pretty controversial. Even if this question is 100% sure of not coming up in an interview, the OP may have just been curious about PM101's take on it. I am 100% sure that this scenario has come up sometime in the past in the real world. Link to comment Share on other sites More sharing options...
Sheena815 Posted March 4, 2009 Report Share Posted March 4, 2009 Okay, not 100%, but I can 99% guarantee you won't get asked a question on abortion either where you'd have to reveal your beliefs about the issue. Its way too heated, and your interviewers likely have their own strong opinions. Its not asked about because if your views clash with theirs, it will likely create bias. I even got a question relating to a teen pregnancy last year, where they emphatically stressed beforehand that this question was NOT about abortion or my views on it. Link to comment Share on other sites More sharing options...
Halcyon Posted March 4, 2009 Report Share Posted March 4, 2009 As noted somewhere above, her social situation will be addressed by CAS (children's aid). Police will also be involved b/c of the possible incest and associated criminal charges. From a medical point of view, you will need to work with the patient (maybe family, if any) and the team (CAS, police) to determine the best course of action. This girl will very likely require much help from a variety of sources. Link to comment Share on other sites More sharing options...
truffle Posted March 4, 2009 Report Share Posted March 4, 2009 1.) call the cops2.) give her the abortion how can this be made any easier? I can somewhat see the doctor having a responsibility to take the action to the next level (especially if she hasn't really told anyone about it), but I would let the social workers do what they were trained to do. She came to the doc for medical help, so I'd help her. what if she says don't tell anyone? or what if she's 12 and doesn't want an abortion? Link to comment Share on other sites More sharing options...
w8kg6 Posted March 4, 2009 Report Share Posted March 4, 2009 what if she says don't tell anyone? or what if she's 12 and doesn't want an abortion? For both of your questions, it's your job to determine why it is that she wouldn't want any action taken. Given her relatively young age, it's possible that her decisions are motivated by the prospect of 'getting in trouble' for fear of having done/doing a 'bad thing'. Even if she doesn't budge on this issue, you have to inform the authorities, because otherwise you're sending your patient back to a harmful environment. By doing that, you'd may as well be prescribing penicillin to a person who's allergic to it. Abortion isn't a required course of action in this case. Although it's the most prominent avenue taken in cases of rape [citation required... lol], it's not a standard. Explore the patient's reasoning for not wanting abortion, and see if it really is an educated decision. Honestly, I'd enjoy getting a question like this on an MMI. It's pretty clear cut. Link to comment Share on other sites More sharing options...
medhopeful09 Posted March 4, 2009 Report Share Posted March 4, 2009 Honestly, I'd enjoy getting a question like this on an MMI. It's pretty clear cut. I doubt that you will, as there wont be any 12 year old actors;) lol Link to comment Share on other sites More sharing options...
Satsuma Posted March 4, 2009 Report Share Posted March 4, 2009 Just a couple of things: 1) CAS (in Ontario, don`t know about other provinces) will only get involved if the child is under 16 years. So in the case of the 12 year old..yes call CAS, you are legally (and morally) obliged to do so, even if she asks you not to...in the case of the ill-defined teenager, it depends on the age. If the child is 16 or over they have to call the police. (shocking I know) 2) It is never your job to call the police, especially if the pt says they don`t want you to. In the case of the child under 16, CAS takes care of that. In the case of the pt over 16...you have to respect confidentiality. Link to comment Share on other sites More sharing options...
Wolvenstar Posted March 4, 2009 Report Share Posted March 4, 2009 what if she says don't tell anyone? or what if she's 12 and doesn't want an abortion? Seeing as how the scenario is that she came in asking for an abortion, I would assume she wants one. However in the case of a child that young, I would recommend she go for a counselling session first just to be sure. At that age, they shouldn't be going through a pregnancy. It is too hard upon them, and will disrupt they're social development considerably more than it already has from the rape. At the age of twelve, the opinions of the child are not considered to be her rights or wishes. While it is the obligation of a doctor to respect the right's of a patient, doctor's must follow the law first and foremost. The law states that you must call child services (which is seperate from the police). It doesn't matter if she wants you to or not, I wouldn't be surprised if not calling child services would be grounds for having your medical license revoked. If you as a person do not agree with abortion, it is your obligation to provide the patient with a list of physicians who are willing. It is unethical for a doctor to hinder the patient ability to have a medical procedure done, if it is what they desire. Of course there are boundaries of normality to this, I am sure someone will pipe up with some sort of extreme example in which this wouldn't be the case. What I am saying is if your personal or religious beliefs are that abortion is wrong, you have a right to not perform the procedure. If a patient comes to you wanting to have the procedure done, you as a doctor are ethically bound to give them the contact information for a doctor who will. You are not here to make life choices for a patient. Satsuma, sorry you posted just before I did so I never saw it. You say that you should never call child services if a patient does not wish you to. However in the case of a child under the age of 16, I thought it was a legal obligation you have to inform child services of this? Link to comment Share on other sites More sharing options...
youngdad Posted March 4, 2009 Report Share Posted March 4, 2009 if your personal or religious beliefs are that abortion is wrong, you have a right to not perform the procedure. If a patient comes to you wanting to have the procedure done, you as a doctor are ethically bound to give them the contact information for a doctor who will. Not in BC Link to comment Share on other sites More sharing options...
Satsuma Posted March 4, 2009 Report Share Posted March 4, 2009 Satsuma, sorry you posted just before I did so I never saw it. You say that you should never call child services if a patient does not wish you to. However in the case of a child under the age of 16, I thought it was a legal obligation you have to inform child services of this? I am sorry but I think you misread my post. You are legally and morally required to call CAS if the child is under 16. What I said you are never required to do...is call the police. If the child is under 16, it is CAS that will take care of that. If the child/patient is over 16 then they need to call themselves and if they specify that they don`t want you to tell anyone then you need to respect confidentiality. If they need moral support to call by all means, you can offer for them to use your office, for you to be there while they call etc... aside: I don`t quite understand how they came up with 16 as the cut-off age. You aren`t yet able to drive, vote or drink...but you can call the cops on your parents and risk suffering the consequences (real or imagined...cause lets face it if you grew up in an abusive environment you probably believe your parent(s) are capable of anything horrible, and as if you trust strangers to be any kinder or trustworthy than your actual parents who are supposed to love and protect you). At 16 you are still very dependent on your parents, and I really do think CAS should revisit this age cut-off. But that is just my opinion. Link to comment Share on other sites More sharing options...
Wolvenstar Posted March 5, 2009 Report Share Posted March 5, 2009 if your personal or religious beliefs are that abortion is wrong, you have a right to not perform the procedure. If a patient comes to you wanting to have the procedure done, you as a doctor are ethically bound to give them the contact information for a doctor who will. Not in BC Ethics, and procedure are not the same thing. Ethics are is a set of principles used by professionals. Procedure is what you are supposed to do, as told to you by your superiors. Not everything a doctor does has to be ethical to be legal, everything a doctor does while at work should be ethical though. So what i am saying is that a doctor can choose to be an unfair jack*ss and still be well within his legal rights. Satsuma; Yes I did misread your post, thanks for clarifying. As for the age of 16, it would be my assumption that they chose this age, because it is also the legal age at which a person is allowed to choose to move out of their parents home. Under the age of 16 and if your parents phone the cops, the police are supposed to find you and bring you home. Link to comment Share on other sites More sharing options...
Halcyon Posted March 5, 2009 Report Share Posted March 5, 2009 I am sorry but I think you misread my post. You are legally and morally required to call CAS if the child is under 16. What I said you are never required to do...is call the police. If the child is under 16, it is CAS that will take care of that. If the child/patient is over 16 then they need to call themselves and if they specify that they don`t want you to tell anyone then you need to respect confidentiality. If they need moral support to call by all means, you can offer for them to use your office, for you to be there while they call etc... aside: I don`t quite understand how they came up with 16 as the cut-off age. You aren`t yet able to drive, vote or drink...but you can call the cops on your parents and risk suffering the consequences (real or imagined...cause lets face it if you grew up in an abusive environment you probably believe your parent(s) are capable of anything horrible, and as if you trust strangers to be any kinder or trustworthy than your actual parents who are supposed to love and protect you). At 16 you are still very dependent on your parents, and I really do think CAS should revisit this age cut-off. But that is just my opinion. To clarify the the CAS "Duty to Report" for Ontario: What is the age of the children whom "Duty to Report" applies? The duty to report applies to any child who is, or appears to be, under the age of 16 years. It also applies to children subject to a child protection order who are 16 and 17 years old. People can still call their local CAS to report abuse of a child or young person, when that young person is over 16, the CAS can direct the caller/referral source to the appropriate resources/community services. In this example of the teen, it would be a good idea to contact CAS. Link to comment Share on other sites More sharing options...
JohnDakota Posted March 6, 2009 Report Share Posted March 6, 2009 To deal with the easiest part first; You're obligated to break Doctor-Patient confidentiality and inform the autorities. In this case it would be Child Services, and the Police. The best way to approach it would be to first see if the patient would like to have anyone she's comfortable with come in with her. Maybe a close friend, or someone else she has confided this secret with for support. The idea of bringing a councillor as well is great, of course this would have to be run by the patient first because in breaking confidentiality only necessairy people should be informed. If the patient is adimant that you do not break confidentiality, as sympathetically, and sensitively as possible you have to tell the patient that it is your obligation to do so. Secondly the patient has a right to an aborition. Whether you as a doctor are willing to perform the abortion is another issue, because your autonomy and moral compass does not get overwritten by the wishes of a patient. Assuming you're willing to perform the abortion then again ask if she'd like anyone to come with her for support, offer to arrange for a councillor if she'd like that etc.. If you're unwilling to perform an abortion for whatever Religious or personal value issues (they're not all religious) then you can proceed however you wish. Most people unwilling to perform abortions will also not give referrals because that is tantamount to performing the abortion yourself. Again just try to be as sympathetic, and sensitive as possible. Link to comment Share on other sites More sharing options...
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