Doctors and teen contraception
By Garth A. Rattray
May is Child Month and, fortuitously, the Caribbean College of Family Physicians - Jamaica Chapter recently staged a continuing medical education seminar on medical ethics covering some of the moral and legal issues encountered when physicians see patients under 16 years of age. One presenter was from the Office of the Children's Registry (OCR) - established under the Ministry of Health in 2007 - and the other was from the legal profession.
The Child Care and Protection Act (of 2004) makes every citizen legally responsible for reporting, to the OCR, any knowledge or suspicion that a child "has been, is being or is likely to be abandoned, neglected or physically or sexually ill-treated". Physicians are among the 'prescribed' persons who, by virtue of their professional responsibilities, have a special duty to report to the OCR and/or to the Centre for the Investigation of Sexual Offences and Child Abuse. Failure to report carries a possible $500,000 fine and/or six months in prison. No one making a report can be prosecuted if the allegation or suspicion turns out to be untrue or unfounded.
If a teenage girl under the age of 16 asks for contraceptive counselling/ treatment (not just general knowledge), physicians must seek to involve her parent(s) or guardian(s). If attempts to secure the permission/involvement of the parent/guardian fail, physicians in Jamaica use their clinical judgement to decide whether or not they will provide contraception counselling.
In the seminar, we learnt that the matter of parental consent came before the House of Lords in 1984 when a Mrs Gillick brought legal action against the West Norfolk and Wisbech Area Health Authority and the Department of Health and Social Security (in England) for guiding clinic doctors to decide for themselves whether to provide contraception advice for underage teens if efforts to convince the teen to involve her parent/guardian failed.
The essence of the argument was that as long as the parent(s) have not abandoned responsibility towards an underage child, abused parental powers or is unavailable, the decision to "provide contraceptive facilities" cannot lawfully be made without the consent of a parent/guardian.
However, questions arose regarding the doctor-patient confidentiality as it applies to underage children and of the greater good - regarding the provision of contraception to a minor (intent on sexual adventure), without the permission of a parent/guardian.
In such matters, the OCR reminds us that children under 16 do not have the capacity to give valid consent for any medical attention without permission from a parent or guardian. That includes contraceptive advice and treatment.
Interestingly, if we are to adhere strictly to the act regarding underage girls, a parent/guardian should never provide or agree to contraception counselling, and a physician should never provide or counsel on contraception, as that could be interpreted as complicity in suspected or likely sexual activity by the underage girl (which is always illegal).
And, whether or not an underage female tells the doctor that she is engaging in sexual intercourse, once there is a reasonable suspicion of sexual activity, it should be reported to the OCR.
I fully understand the intent and, therefore, the guiding principles of the OCR but, in reality, in spite of our best efforts, the average age of sex initiation for Jamaican girls is just over 15 years old.
Between our societal preoccupation with sex and peer pressure, there is real danger that the system, which is designed to protect our children, could end up relegating physicians to sentinels and thus encouraging determined underage girls to seek advice from their peers or act in absolute ignorance - consequent upon which are underage pregnancies and the spreading of sexually transmitted infections.