Mock 18: A 12 year old girl asks for birth control pills...

[Guest Namgalsip]

This one, I hear, tends to come up a lot in interviews:

 

12 yr old girl requests birth control pills

 

or

 

12 yr old girl wants an abortion

 

Keep in mind, she does not want to tell her parents.

 

What do you do?

 

(does anyone know where the law stands on this....are you required by law to obtain parental consent for a minor prior to performing any procedure? If so, at what age can they give their own consent?)

 

 

 

 

Edited the subject heading to standardize them. -Ian

[Guest tappety tap]

I was under the impression that patient confidentiality is paramount if you render that the patient is capable of making an INFORMED decision, regardless of age. Am I wrong? Do they expect us to know laws regarding all these issues? I mean, these are things I expect to learn once I'm in the profession.

[Guest shutterbug]

I guess (one of) the first course of action then is to determine if she has the capacity to appreciate the situation that she is in. Does she understand what is happening to her body, what an abortion entails, or what the possible complications are.

 

Although, I'm not sure what the laws are if you 'determine' that she is capacity to make her own decisions. I always thought that it was the parent's call until they wer of legal age (whatever that is in your juristiction) and that you shoulld involve the minor in the decision making process. If you were an FP you could probably refer to a OB/GYN.

[Guest mying]

As I understand it, most interviewers would not be expecting you to know the "right" answer to ethical questions, but rather your ability to reason and describe your opinion -- which is what's so great about these "e-mocks" y'all have set up.

 

Nevertheless, for those who didn't have bioethics training in their undergraduate classes and want to get a handle on the terminology, there are a number of good resources online, which have been cited on this forum before. CMAJ has a series of Bioethics-related scenarios -- search for "Bioethics for Clinicians". It's good for more than just interviewing.

 

I also have a hard-copy journal that I cherish dearly as my first and best source of medical bioethics scenarios. You might be able to find it in a library if you're interested. I apologize for not citing it properly.

 

Annals RCPSC Volume 32 supplement Fall 1999 Bioethics for Clinicians

[Guest shutterbug]

Here is a good collection of articles including the Ethics for Clinicians series. The non-clinical section near the bottom is really good because it covers stuff on ethics, careers, managing practices, etc.

 

www.cmaj.ca/cgi/collection/

[Guest bj]

Hi guys,

 

I got this question at my U of O interview last year. The interviewer was very harsh and refused to let me answer this the way it seems many of you have answered.

 

Truth is, if I was a family physician and had a situation like this, I would be far more knowledgeable about the law than I am currently. Having worked in an abortion clinic and a sexual assault centre, I can tell you that a minor can consent to this procedure (both the pills and the abortion). Problem is, a child under the age of 14 cannot consent to sex unless (here's where the law gets tricky) the sexual partner is within 2 years of his/her age. So a 13 and 15 year old can have sex but a 13 and 16 year old can't. Make sense? I am still a little confused about this to be honest.

 

Because a child is involved, you would be legally obligated to report IF YOU SUSPECT HARM. That is, finding out who her partner is becomes very important. My interviewer essentially mocked me for saying this and said that the girl would probably run out of the office. I think it would be easier to handle in real-life than in a theoretical situation while talking to an interviewer. But that's just from my experience.

 

Feel free to challenge me on any of this. I would love to hear other opinions.

 

BJ

[Guest sassy101]

Hey BJ,

 

Do you mean that the interviewer mocked you for saying that you would question as to who the 12 year old was having sex with? If so, that is ridiculous!!

She is very much a minor and although the topic would have to be approached delicately, I do think that it should be an issue. How do you know that the girl is not subject to sexual abuse? After all, 12 years old is a very young age to decide on ones own to be sexually active.

 

P.S = Did you confront the interviewer when he said that the patient would probably run out of the room? In other words did you give your reasoning for what you said? Do you think the interviewer was just 'testing' you to see how you handle confrontation?

[Guest batman]

If I was asked those questions, the first thing I would do is REALLY try to convince her to talk to her parents. Her parents may be very upset initially, and as difficult as it might seem, they're still her parents and most likely will be there for her.

 

If she completely refuses to tell her parents that she's pregnant and wants an abortion, the last thing I would want her to do is leave my office and go to some back alley and have it done by an illegal "doctor", something potentially harmful/life-threatening. I would inform her that I would most likely have to phone up Children's aid before anything was done.

 

If she completely refuses to tell her parents that she's sexually active and wants the pill, it's still better than having unprotected sex and returning to my office a few months later asking for an abortion. If I was at a teen clinic or something, and she refuses to tell her parents, I would probably agree to give her a sample, and before committing to anything else, phone up the college of physicians and surgeons to find out the legalities of the situation.

[wanttobedoc]

I was speaking to a family doc and she brought this scenerio up in our conversation. She was telling me how age of consent/legal age is based on an individual case by case basis. The doc would consider the 12 year old girl's level of maturity, understanding of the situation and cognition. This doc suggested that if the 12 y.o. was deemed "mature" enough and able to consent for herself, then she could still consent to having an abortion without telling her parents. I was pretty surprised about this. 12 seems so young...

Just thought I'd post this again...to see if it generates any new discussion or thoughts for our learning purposes

[Satsuma]

You guys are right....there is no "age of consent" for medical treatment, at least in Ontario. You would have to determine for that case whether the pt was capable of understanding the risks/benefits etc..

A relevant aside...a 12 year old can consent to a treatment, but they cannot refuse a treatment. That is if the physician deemed a medical treatment necesary and the child refused, you would then contact the parents.

That being said, previous posters are correct that with a 12 year old, you would need to establish whether there was any harm/abuse involved.

Whether the 12 year old runs out of your office depends alot on your bedside manner!

[wanttobedoc]

You guys are right....there is no "age of consent" for medical treatment, at least in Ontario. You would have to determine for that case whether the pt was capable of understanding the risks/benefits etc..

A relevant aside...a 12 year old can consent to a treatment, but they cannot refuse a treatment. That is if the physician deemed a medical treatment necesary and the child refused, you would then contact the parents.

That being said, previous posters are correct that with a 12 year old, you would need to establish whether there was any harm/abuse involved.

Whether the 12 year old runs out of your office depends alot on your bedside manner!

Thanks for the reply....

Yes, there are so many different things to consider. I had not thought about the aside though. Very interesting and helpful!

[UBCstu]

What if the 12 year old girl tells you that the person she is having sex with is someone more than 2 yrs older than her? Would you do anything about this?

[eise]

What if the 12 year old girl tells you that the person she is having sex with is someone more than 2 yrs older than her? Would you do anything about this?

 

of course. im not sure of the law (and too lazy to read through all these posts again) but I would definitely report illegal behaviour, especially when it's harmful to my patient. she's 12 for goodness sake! id kill my daughter (if i had one)!!

[wanttobedoc]

I think most of us agree this is morally wrong and right now under Canadian laws legally wrong. As a physician we would have the duty to report this to legal authorities. The age of consent in Canada is age 14. The Conservatives have placed a bill to try and move this age to 16 with stipulations as well in regard to difference in age between partners (eg. if 16 y.o. girl was 5 years younger than the partner then that may have legal implications). This bill has not been made law yet though. I personally think that age 14 is much too young for age of consent, I also think it would be ridiculous to legally implicate the 14 y.o. boy in having sex with a 12 y.o. b/c he is just as young mentally, physically and emotionally as the 12 y.o. however, right now this is the law as far as I know it. They are also talking about some "Romeo and Juliet" clause I heard on CBC radio...but not sure of the details of that and if it is law yet...and I think it applies to the situation you have posted above (2 under age sexual partners). Morally we would also have the repsonsibility to talk to the girl and try and get her to talk to her family about it and discuss legal implications.