Guest Adam C Posted March 3, 2002 Report Share Posted March 3, 2002 Hello, I have an ethical scenario that I would appreciate any insight on. A young girl, say 11-12 yrs. old, but up to and including 16 yrs. old enters your office and asks for the birth control pill because she is sexually active. As a physician, what is your moral/ethical obligation to this patient? i.e., do you give her the pill, refuse, involve her parents?? Does it make a difference if she is mature for her age/does it influence your decision? Thank you, Adam C. Link to comment Share on other sites More sharing options...
Guest Carolyn Posted March 3, 2002 Report Share Posted March 3, 2002 There are some great CMAJ articles on ethics - including capacity and capability for consent -- I think they cover this concept of what age is appropriate -- it also may depend on the province. However, as I understand it... in Ontario it is not dependent on age but on the physician's belief as to whether the person is capable to make the decision and understand the consequences. I would highly recommend the bioethic series in CMAJ -- as well, the book "Doing Right" is also an interesting read on bioethics. Link to comment Share on other sites More sharing options...
Guest Adam C Posted March 3, 2002 Report Share Posted March 3, 2002 Hi Carolyn, You're right about the age consideration. Apparently as long as the physician believes his/her patient to be capable of consent whatever they say goes. However, in this particular scenario, say the girl does not show the proper capacity for consent. Do you simply refuse to prescribe the pills? Or do you involve her parents at this stage?? Adam C. Link to comment Share on other sites More sharing options...
Guest been asked this Posted March 4, 2002 Report Share Posted March 4, 2002 From what I've researched, a physician can prescribe for this girl. Surgical procedures must be approved by a parent but not prescriptions. Link to comment Share on other sites More sharing options...
Guest Kirsteen Posted March 5, 2002 Report Share Posted March 5, 2002 Hi there, With respect to ethical scenarios, I'd definitely second Carolyn's recommendation of Hebert's "Doing Right". In there, it goes about stating that there really is no static formula to apply to all scenarios requiring the dab of ethics--every situation, given the complexity of ethical frameworks may have a different outcome. Cheers, Kirsteen Link to comment Share on other sites More sharing options...
Guest gucio93 Posted March 5, 2002 Report Share Posted March 5, 2002 I have worked with teens and have been involved in situations like this many times. There are several issues to consider. You have to determine if sex is consensual. If it is not - you have a whole new scenario to deal with (I won't get into it here), and if it is, you have to determine how old this girl's partner is. If he is over 16 or 18 (I can't remember which), or if there is greater than 4 year's difference between their ages, then it should be reported to the Children's Aid Society who will investigate (you are obliged to do so legally). However, if they are almost the same age, or the girl's partner is also under 16, that requirement no longer applies. Having solved this, you have to decide if this girl is capable of understanding the benefits and risks of the treatment you are prescribing. If you are confident that this is the case, then you can definitely prescribe her the medication and you are by no means obligated to contact her parents. In fact, that would break patient confidentiality. In my humble opinion, I think it is definitely better to counsel the girl, make sure there are on other issues that are worthy of consideration, provide patient education re: risks of sexual activity, and provide her with the protection to prevent pregnancy than to see her a couple months later in need of an abortion. Statistics show, and it is plain common sense, that once sexual activity has been initiated, it will continue in the majority of cases, so protection and education is the best option. Now, if as a physician, you decide that this girl does not have the intellectual capacity to understand the benefits and risks of the treatment you prescribe, then the situation gets tougher. What I would do is try to ask more questions to try to figure out why she initiated sexual activity this early in life, what else is going on (as I would have done in the other scenario) and make my decisions based on the outcome of that discussion. Contacting the parents in this case may be the only solution (with the patient's knowledge ofcourse). This is only one person's perspective and there is no black and white answer to this question, so take it in the spirit in which it was intended - to provide one view of many. Link to comment Share on other sites More sharing options...
Guest Ian Wong Posted March 6, 2002 Report Share Posted March 6, 2002 Here's a link to some position papers published by the Canadian Paediatric Society. There is no one right answer, but here's an attempt at wading through these murky ethical waters. www.cps.ca/english/publications/AdolesMed.htm Ian UBC, Med 3 Link to comment Share on other sites More sharing options...
Guest JSS02 Posted March 12, 2002 Report Share Posted March 12, 2002 I just finished reading Doing Right by Dr. Philip Hebert, and I would also like to recommend it just as people above have. It gives you an idea of a broad scope of ethical issues, and is well written and easy to understand. Link to comment Share on other sites More sharing options...
Guest TimmyMax Posted March 13, 2002 Report Share Posted March 13, 2002 Hey JSS02, Where did you find that? It sounds like interesting reading. Is it a book or a website, or what's the deal? Thanks in advance! Tim Link to comment Share on other sites More sharing options...
Guest Kirsteen Posted March 14, 2002 Report Share Posted March 14, 2002 Hey there TimmyMax, Sorry to usurp JSS02, but I thought I'd try to help: it's a book and is readily available at the UT bookstore (if you're in TO) or via Amazon. Cheers, Kirsteen Link to comment Share on other sites More sharing options...
Guest TimmyMax Posted March 14, 2002 Report Share Posted March 14, 2002 Hey Kirsteen, Thanks for the heads-up! I'll have a look for it at UT bookstore (I heard somewhere that they were evil- is that true? Or is it just malcontents' sniping?) when I'm down there- a fun project for the weekend, no doubt. And while I'm there, I think I'll check in with some friends, take in a Leafs' game, maybe a show or two- ha! I wish! Best of luck with your apps! Tim Link to comment Share on other sites More sharing options...
Guest Kirsteen Posted March 15, 2002 Report Share Posted March 15, 2002 Hey again TimmyMax, The UT Bookstore people being evil? Nay. Once you're in there you can become wonderfully lost in your senses--it's quite the entrancing place. The medical section is beyond description; rarely have I seen anything like it. You name it, they have a book on it. (By the way, what is it with respect to these $300-600 medical specialty texts? Whooo!) Cheers, Kirsteen Link to comment Share on other sites More sharing options...
Guest JD Posted March 16, 2002 Report Share Posted March 16, 2002 What if we extend this a bit, and a young girl comes in and asks for an abortion but doesn't want her parents to know? Legally, do physicians have any obligation to let them know? Link to comment Share on other sites More sharing options...
Guest hmsdread Posted March 17, 2002 Report Share Posted March 17, 2002 Hi JD, From my readings (and thanks to all who recommended Doing Right - it is an excellent book), I would have to say that as long as the girl is competent - that is, she displays maturity and is able to grasp the consequences of aborting vs. not aborting, no communication to the parents is required. In fact, discussing the matter with her parents if she is clearly able to understand the matter herself would be a breach of patient confidentiality. If, on the other hand, the girl does not display the capacity to understand her predicament, and why she is asking for an abortion, well, I would think you've got a bigger problem to deal with. Did the girl understand why she was having sex? Was she being taken advantage of by an older male? If this seems to be the case, as a physician you would be obligated to inform children's aid. hmsdread Link to comment Share on other sites More sharing options...
Guest AniyaSG Posted March 17, 2002 Report Share Posted March 17, 2002 The doctor I spoke to about this question told me that minors need to have consent from their parents for any surgical procedure. This would include an abortion. If the pregnancy can be terminated by pharmaceutical means, then it is possible to do without parental permission. There may be loopholes but I thought that was a general rule with underage individuals. Please do correct me if I've been misinformed Link to comment Share on other sites More sharing options...
Guest Larry M Posted March 17, 2002 Report Share Posted March 17, 2002 So what age is considered to be a minor then? Link to comment Share on other sites More sharing options...
Guest onionsneakers Posted March 18, 2002 Report Share Posted March 18, 2002 this post is a response for the purposes of med school interviews only from what i understand, the interviewers do not expect you to know the law and may even ask you progressively harder questions until they hit an area where you don't know the law.. that means you don't need to know what defines a minor and it may be better for you to state that you would need to speak to the parents if you think the patient is not able to fully appreciate all the details. you'll likely use the law and other regulations to determine what defines such a person. the reason why laws may differ regarding surgical vs chemical abortion is that the former is more invasive and may involve a greater risk of acute complications. however, that's not to say that the patient doesn't need to be counselled regarding the health effects of chemically-induced abortion! it's just important to show that you know how to reason logically. even more, for laws that you do know of, it would be good to show that you understand why they're in place or what they should be used for. Link to comment Share on other sites More sharing options...
Guest TimmyMax Posted March 25, 2002 Report Share Posted March 25, 2002 Hey Kirsteen and JSS02, Thanks for the great heads up about Doing Right!! I picked it up on the 14th, read it as prep for my UWO interview and as it turned out, they asked me two different ethical scenarios and I think I aced both, judging from the response I got from my faculty member interviewer- he even acknowledged that I covered each of the major issues in both cases- score! So yes, anyone who hasn't read this book and is looking for an ethics primer, I'd highly recommend Doing Right! Thanks again you two and best of luck the rest of the way- may we all meet up at the Med Games sometime soon! Cheers! Timmy Link to comment Share on other sites More sharing options...
Guest Kirsteen Posted March 25, 2002 Report Share Posted March 25, 2002 Hey TimmyMax, No probs re: the recommendation; a handy wee tome, eh? In any case, glad it worked out for you in the short term, and hopefully the long! Cheers, Kirsteen PS: Just in case you have the notion, I wouldn't go passing the book off on eBay quite yet, either--it may be on your reading list, come September. Link to comment Share on other sites More sharing options...
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