Case #1: Ethical Issues & Family Practice

Patient confidentiality is an integral part of HIPAA, which insures that patient information is not disclosed improperly and their autonomy is kept. However, complications arise in the special case of minors where in most cases, parents are the personal representatives for their children. Since young children may not make sound judgment and parents provide for them financially, many agree parents should be able to make medical decisions and have disclosure of their child’s medical records. However, there is a gray area that is illustrated in the case concerning the 14-year-old patient requesting oral contraceptives.

Over recent years, it has been recognized by many state governments and the U.S. Supreme Court that many minors will forgo important sexual and reproductive healthcare services while still being sexual active if parental involvement is mandatory (An Overview of Minors’ Consent Law, 2014). The main argument revolves around whether minors can provide informed consent. There are individuals who argue that competency and maturity are not automatically bestowed at the age of 18, therefore to withhold privacy rights for minors would be wrong (Minors’ Access to Contraceptive Services, 2014). In the court case Carey v. Population Services International, the U.S. Supreme Court ruled that the "right to privacy in connection with decisions affecting procreation extends to minors as well as adults (Carey v. Population Servs. Int'l, 1977). Currently, there are 26 states and the District of Columbia who permits all minors aged 12 and older to consent to contraceptive, prenatal, and STI services while 20 states allow certain categories of minors to consent to these services (An Overview of Minors’ Consent Law, 2014). Since the patient in this case is 14-years-old, I would assess her ability to provide informed consent and her overall maturity. I would then explain to her the state law governing where I practice and whether or not I’m able to prescribe her oral contraceptives without her mom’s consent. If the state permits, I would prescribe her the contraceptives and maintain patient confidentiality concerning that service.
As her physician, I would acknowledge that she acted responsibly by letting me know about her sexual activity. I would take the time to educate her on oral contraceptives and advise her to use condoms in addition to the birth control pills since oral contraceptives do not protect against HIV and STIs (Center for Disease Control & Prevention, 2013). Another concern I would discuss with her is whether she would be using her parents’ insurance to pay for her treatment and birth control. Many insurance companies provide patients with a copy of the procedures in a claim so her parents may have access to it that way even if I do not tell them. She may want to consider paying for the birth control pills herself rather than billing it to insurance. Although I would give her all the information necessary to make an informed decision, I would still heavily advise her to talk to a family member about her sexual activity. At the end of the day, parents care about their children tremendously and her family may be more accepting of her situation than she thinks.

Concerning her mother, I would address the issue with the patient’s runny nose and sore throat without mentioning her request for contraceptives since it was a private and confidential conversation. I would make note of it in her medical records, but I would not disclose it unless mandated by state law or court ruling. The primary focus of my conversation with her mom would be what is causing her symptoms and what treatment should be pursued.

Works Cited 1. Guttmacher Institute. (May 1, 2014). “An Overview of Minors’ Consent Law” State Policies in Brief. Accessed from http://www.guttmacher.org/statecenter/spibs/spib_OMCL.pdf on May 30, 2014.

2. Guttmacher Institute. (May 1, 2014). “Minors’ Access to Contraceptive Services” State Policies in Brief. Accessed from http://www.guttmacher.org/statecenter/spibs/spib_MACS.pdf on May 30, 2014.

3. Carey v. Population Servs. Int'l, 431 U.S. 678, 693 (1977). Accessed from http://supreme.justia.com/cases/federal/us/431/678/case.html on May 31, 2014.

4. Center for Disease Control & Prevention. (Last reviewed: August 28, 2013). “Contraception” Reproductive Health. Accessed from http://www.cdc.gov/reproductivehealth/unintendedpregnancy/contraception.htm on May 31, 2014

Works Consulted 1. Morrison, E.E. (2011). Ethics in Health Administration (2nd ed.); Chapter 2, pg 27-45. Sudbury, MA: Jones and Bartlett Publishers.

2. Diekema, D.S. (March 14, 2014). “Parental Decision Making” Ethics in Medicine. Accessed from http://depts.washington.edu/bioethx/topics/parent.html on May 28, 2014.

3. American Civil Liberties Union. (July 18, 2003). “Preventing Teenagers from Getting Contraceptives Unless They Tell a Parent Puts Teens at Risk.” Accessed from https://www.aclu.org/reproductive-freedom/preventing-teenagers-getting-contraceptives-unless-they-tell-parent-puts-teens- on May 30, 2014

4. Feierman, J., Lieberman, D., Schissel, A., Diller, R., Kim, J., Chu, Y. (July 2002). Teenagers, Health Care & the Law. New York, NY: New York Civil Liberties Union Reproductive Rights Project.