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Table of Contents
Think
Assess
Patient: Autonomy
Practitioner: Beneficence & Nonmaleficence
Public Policy: Justice
Conclude
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10. Contraception
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The best medical practitioner is the one who is the most ingenious inspirer of hope.
~ Samuel Taylor Coleridge
Deceptive Prescriptions
The Contraception Controversy
Detective Johnson was called to the local clinic after a nurse discovered a disturbing scene in one of the exam rooms. Upon arrival, she found the body of Dr. Samantha Chen, a well-known and respected OB/GYN, lying on the floor. The room was in disarray, with papers and medical equipment scattered across the floor.
As the investigation began, Detective Johnson quickly discovered that Dr. Chen had been working on a controversial case involving a minor seeking contraception without parental consent. Dr. Chen had been a vocal advocate for patient autonomy and had been providing contraceptives to minors who requested them.
However, it appeared that Dr. Chen had encountered resistance from some of her colleagues who believed that minors should not have access to contraceptives without parental consent. The investigation revealed that one of her colleagues, Dr. Jameson, had been particularly vocal in his opposition to Dr. Chen’s approach.
Further investigation revealed that Dr. Jameson had been seen arguing with Dr. Chen in the days leading up to her death. It was also discovered that Dr. Jameson had a financial interest in a company that manufactured a competing contraceptive product, which raised concerns about a conflict of interest.
Despite Dr. Jameson’s initial denials, the evidence against him was overwhelming. He eventually confessed to killing Dr. Chen out of frustration with her approach to providing contraception to minors. He believed that her actions were a violation of the principle of nonmaleficence and posed a risk to the health and safety of minors.
Detective Johnson was appalled by Dr. Jameson’s actions and stressed the importance of upholding the principles of patient autonomy, beneficence, nonmaleficence, and justice in the medical profession. She hoped that Dr. Chen’s tragic death would serve as a reminder of the importance of respecting patients’ rights and providing care in a way that promotes their best interests.
Abstract
In 1977, the US Supreme Court established the constitutional right for all citizens, including minors, to use contraceptives based on the due process clause of the 14th amendment. Patient autonomy is a fundamental right and minors have the right to choose contraception without the need for parental consent. Practitioners have an obligation to respect the minor’s choice and provide contraception in accordance with the principles of beneficence (do good) and nonmaleficence (do no harm). Not providing access to contraception would be a violation of the principle of nonmaleficence. While it is medical best practice to communicate with the minor’s parent(s) about contraceptives, the principle of justice requires fair distribution of benefits and burdens, and denying minors access to contraception would be an unfair burden. Therefore, the correct response for a practitioner regarding contraception or prenatal care of a minor is to provide access and encourage the minor to discuss the matter with their parent(s).
**
Think
[10:1] In 1977, the US Supreme Court affirmed in Carey v. Population Services International the constitutional right for all citizens, including minors, to use contraceptives in all states. The due process clause of the 14th amendment was used to establish the fundamental liberty of the right to use contraception.
[10:2] Fourteenth Amendment Section 1:
… no state shall deprive any person of life, liberty, or property, without due process of law.
[10:3] Minors are considered to be partially emancipated as it relates to contraception, meaning that minors do not need parental consent.
[10:4]
Assess
Patient: 1) Autonomy
[10:5] Patient autonomy is a fundamental right, and whenever there is a right, then by definition, that means that others have an obligation towards those who have the right. There are two categories of rights; negative rights and positive rights. A negative right is when others have an obligation to “not interfere.” This obligation of noninterference is why this right is referred to as a negative right. In the context of autonomy, this means that others have an obligation not to interfere in the minor’s right to choose to have contraception. A positive right is when others have an obligation to “provide” something. This obligation of providing is why this right is referred to as a positive right. In the context of autonomy, others have an obligation to provide the minor with contraception.
[10:6]
Practitioner: 2) Beneficence & 3) Nonmaleficence
[10:7] Professionally, the practitioner must respect the minor’s choice for contraception and provide the minor with the contraception in the same manner as a practitioner would provide an adult with the same request. This respect and provision are based on the professional principles of beneficence (do good) and nonmaleficence (do no harm).
[10:8] Since not allowing minors the choice and access to contraception would increase unwanted pregnancies, which has historically increased high school dropout rates, increased single-mother families, increased unemployment, and increased social welfare spending, and since all of these consequences are considered to be harmful to the patient, it, therefore, follows that not providing access to contraception would be a clear violation of the principle of nonmaleficence (do no harm).
[10:9] However, whenever a practitioner treats a minor patient, it is generally considered medical best practice to communicate to the minor the benefits of having an open and candid discussion about contraceptives with their parent(s). Having such communication, providing access to contraceptives, and helping to prevent unwanted pregnancy are all part of the professional principle of beneficence (do good).
Public Policy: 4) Justice
[10:10] The principle of justice requires the fair distribution of benefits and burdens. To not allow minors access to contraception would be to burden minors unfairly. This is why the Supreme Court affirmed the constitutional right to privacy for a minor to obtain contraceptives in all states. Therefore, as a matter of justice (be fair), practitioners must allow minors the right to choose contraceptives and help provide contraceptive access.
Conclude
[10:11] The correct response regarding contraception or prenatal care of a minor will always be for the practitioner to “provide the access or the care” and “encourage the minor to discuss contraception or prenatal care with the minor’s parent(s).”
[10:12] In summary, when it comes to contraception or prenatal care for a minor, the appropriate response for a medical practitioner is to provide access to care and encourage the minor to discuss the matter with their parent(s). By doing so, practitioners uphold the principles of patient autonomy, beneficence, nonmaleficence, and justice, ensuring a fair distribution of benefits and burdens while promoting open communication between minors and their parents.
**
Circumstances in Which Minors
Do Not Require Parental Consent
- • Emergency care
- • Sexually transmitted infections
- • Contraception
- • Substance abuse (most states)
- • Prenatal care
Medical
- • Homeless
- • Parent
- • Married
- • Military
- • Financially independent
Emancipated
Minor
Civil Rights
- • Obligation of others to Not Interfere
Negative Right
- • Obligation of others to Provide something
Positive Right
10. Review Questions
1. Minors are considered to be partially emancipated when making medical decisions for:
2. A negative right is a right that is wrong
3. Whenever someone has a right, it always means that others have an obligation.
4. A minor’s right to contraception is only a negative right.
5. Whenever treating a minor, it is always important to encourage the minor to discuss their decisions with their parent(s).
**
CORRECT! 🙂
[10:5] Patient autonomy is a fundamental right, and whenever there is a right, then by definition, that means that others have an obligation towards those who have the right. There are two categories of rights; negative rights and positive rights. A negative right is when others have an obligation to “not interfere.” This obligation of noninterference is why this right is referred to as a negative right. In the context of autonomy, this means that others have an obligation not to interfere in the minor’s right to choose to have contraception. A positive right is when others have an obligation to “provide” something. This obligation of providing is why this right is referred to as a positive right. In the context of autonomy, others have an obligation to provide the minor with contraception.
Wrong 😕
[10:5] Patient autonomy is a fundamental right, and whenever there is a right, then by definition, that means that others have an obligation towards those who have the right. There are two categories of rights; negative rights and positive rights. A negative right is when others have an obligation to “not interfere.” This obligation of noninterference is why this right is referred to as a negative right. In the context of autonomy, this means that others have an obligation not to interfere in the minor’s right to choose to have contraception. A positive right is when others have an obligation to “provide” something. This obligation of providing is why this right is referred to as a positive right. In the context of autonomy, others have an obligation to provide the minor with contraception.
Wrong 😕
[10:5] Patient autonomy is a fundamental right, and whenever there is a right, then by definition, that means that others have an obligation towards those who have the right. There are two categories of rights; negative rights and positive rights. A negative right is when others have an obligation to “not interfere.” This obligation of noninterference is why this right is referred to as a negative right. In the context of autonomy, this means that others have an obligation not to interfere in the minor’s right to choose to have contraception. A positive right is when others have an obligation to “provide” something. This obligation of providing is why this right is referred to as a positive right. In the context of autonomy, others have an obligation to provide the minor with contraception.
CORRECT! 🙂
[10:5] Patient autonomy is a fundamental right, and whenever there is a right, then by definition, that means that others have an obligation towards those who have the right. There are two categories of rights; negative rights and positive rights. A negative right is when others have an obligation to “not interfere.” This obligation of noninterference is why this right is referred to as a negative right. In the context of autonomy, this means that others have an obligation not to interfere in the minor’s right to choose to have contraception. A positive right is when others have an obligation to “provide” something. This obligation of providing is why this right is referred to as a positive right. In the context of autonomy, others have an obligation to provide the minor with contraception.
CORRECT! 🙂
[10:5] Patient autonomy is a fundamental right, and whenever there is a right, then by definition, that means that others have an obligation towards those who have the right. There are two categories of rights; negative rights and positive rights. A negative right is when others have an obligation to “not interfere.” This obligation of noninterference is why this right is referred to as a negative right. In the context of autonomy, this means that others have an obligation not to interfere in the minor’s right to choose to have contraception. A positive right is when others have an obligation to “provide” something. This obligation of providing is why this right is referred to as a positive right. In the context of autonomy, others have an obligation to provide the minor with contraception.
Wrong 😕
[10:5] Patient autonomy is a fundamental right, and whenever there is a right, then by definition, that means that others have an obligation towards those who have the right. There are two categories of rights; negative rights and positive rights. A negative right is when others have an obligation to “not interfere.” This obligation of noninterference is why this right is referred to as a negative right. In the context of autonomy, this means that others have an obligation not to interfere in the minor’s right to choose to have contraception. A positive right is when others have an obligation to “provide” something. This obligation of providing is why this right is referred to as a positive right. In the context of autonomy, others have an obligation to provide the minor with contraception.
CORRECT! 🙂
[10:9] However, whenever a practitioner treats a minor patient, it is generally considered medical best practice to communicate to the minor the benefits of having an open and candid discussion about contraceptives with their parent(s). Having such communication, providing access to contraceptives, and helping to prevent unwanted pregnancy are all part of the professional principle of beneficence (do good).
Wrong 😕
[10:9] However, whenever a practitioner treats a minor patient, it is generally considered medical best practice to communicate to the minor the benefits of having an open and candid discussion about contraceptives with their parent(s). Having such communication, providing access to contraceptives, and helping to prevent unwanted pregnancy are all part of the professional principle of beneficence (do good).
10. Clinical Vignettes
1. Ms. Angelica Jackson, a 17-year-old landscape architect presents to the emergency department with severe abdominal pain. The patient reports having unprotected sexual intercourse a week prior. The patient also reports a history of substance abuse and is currently pregnant. What type of medical treatment is appropriate for this patient?
2. Ms. Noelle Harris, a 16-year-old high school student presents to the clinic seeking contraception. The practitioner must consider the patient's negative right to obtain contraception. Which of the following best describes the practitioner's obligation towards the patient?
3. Ms. Eileen Clark, a 26-year-old aerospace engineer visits the clinic for a routine check-up. The patient is in a sexually active relationship and wants to discuss options for contraception. The practitioner discusses the various methods of contraception available, including hormonal methods, barrier methods, and intrauterine devices (IUDs). The patient expresses interest in an IUD, and the practitioner explains the benefits and risks of this method. The practitioner also emphasizes the importance of using contraception to prevent unintended pregnancy and protect against sexually transmitted infections (STIs). If the patient has a right to contraception, what does that socially mean?
4. Ms. Veronica Davis, a 16-year-old high school student presents to the clinic seeking contraception. They express concern about their parents finding out and potentially interfering with their ability to access contraception. What is the patient's right to contraception?
5. Ms. Judith Miller, a 17-year-old high school student visits the clinic seeking information about contraception options. The practitioner has the following options to discuss with the patient:
CORRECT! 🙂
Explanation: he type of medical treatment appropriate for this patient is that minors and practitioners do not require parental consent for emergencies [10:4], treatment for sexually transmitted infections [10:4], treatment for substance abuse [10:4], and prenatal care [10:4]. In most states, minors have the right to consent to their own medical treatment for certain conditions, such as emergencies, treatment for sexually transmitted infections, treatment for substance abuse, and prenatal care [10:4]. These conditions are often considered confidential and protected by law to encourage minors to seek appropriate medical care without fear of judgment or retribution [10:10]. In this case, the patient presents to the emergency department with severe abdominal pain and reports a history of substance abuse and an unplanned pregnancy. The patient also reports having unprotected sexual intercourse a week prior, indicating a risk of sexually transmitted infections [10:4]. Therefore, the patient would require immediate medical attention, and treatment for sexually transmitted infections [10:4], substance abuse [10:4], and prenatal care [10:4], if necessary. Parental consent is not required for these treatments, and practitioners can provide these treatments to minors without fear of legal action [10:4].
Wrong 😕
Explanation: he type of medical treatment appropriate for this patient is that minors and practitioners do not require parental consent for emergencies [10:4], treatment for sexually transmitted infections [10:4], treatment for substance abuse [10:4], and prenatal care [10:4]. In most states, minors have the right to consent to their own medical treatment for certain conditions, such as emergencies, treatment for sexually transmitted infections, treatment for substance abuse, and prenatal care [10:4]. These conditions are often considered confidential and protected by law to encourage minors to seek appropriate medical care without fear of judgment or retribution [10:10]. In this case, the patient presents to the emergency department with severe abdominal pain and reports a history of substance abuse and an unplanned pregnancy. The patient also reports having unprotected sexual intercourse a week prior, indicating a risk of sexually transmitted infections [10:4]. Therefore, the patient would require immediate medical attention, and treatment for sexually transmitted infections [10:4], substance abuse [10:4], and prenatal care [10:4], if necessary. Parental consent is not required for these treatments, and practitioners can provide these treatments to minors without fear of legal action [10:4].
CORRECT! 🙂
Explanation: The practitioner's obligation towards the patient in this situation is to not interfere with the minor's choice to have contraception [10:5]. Minors have the right to access contraception without parental consent in most states [10:3]. The practitioner must respect the patient's negative right to obtain contraception, which means that the practitioner should not interfere with the patient's ability to obtain contraception [10:5]. The practitioner should provide the patient with the necessary information about contraception, its use, and its potential benefits and risks [10:7], but ultimately, it is up to the patient to make the decision regarding their own healthcare [10:5]. Therefore, the correct option is to not interfere with the minor's choice to have contraception [10:11].
Wrong 😕
Explanation: The practitioner's obligation towards the patient in this situation is to not interfere with the minor's choice to have contraception [10:5]. Minors have the right to access contraception without parental consent in most states [10:3]. The practitioner must respect the patient's negative right to obtain contraception, which means that the practitioner should not interfere with the patient's ability to obtain contraception [10:5]. The practitioner should provide the patient with the necessary information about contraception, its use, and its potential benefits and risks [10:7], but ultimately, it is up to the patient to make the decision regarding their own healthcare [10:5]. Therefore, the correct option is to not interfere with the minor's choice to have contraception [10:11].
CORRECT! 🙂
Explanation: If the patient has a right to contraception, it means that others have an obligation to either not interfere or to provide something [10:5]. Socially, the right to contraception implies that individuals have the right to access and use contraception without fear of judgment, discrimination, or interference from others [10:1]. This right is supported by the medical community and many legal frameworks that recognize the importance of sexual and reproductive health for individuals and societies [10:1]. By recognizing this right, others, including healthcare providers and policymakers, have an obligation to support and promote access to contraception, whether by providing information and resources or by refraining from interference [10:5]. Therefore, the correct option is that others have an obligation to either not interfere or to provide something [10:5].
Wrong 😕
Explanation: If the patient has a right to contraception, it means that others have an obligation to either not interfere or to provide something [10:5]. Socially, the right to contraception implies that individuals have the right to access and use contraception without fear of judgment, discrimination, or interference from others [10:1]. This right is supported by the medical community and many legal frameworks that recognize the importance of sexual and reproductive health for individuals and societies [10:1]. By recognizing this right, others, including healthcare providers and policymakers, have an obligation to support and promote access to contraception, whether by providing information and resources or by refraining from interference [10:5]. Therefore, the correct option is that others have an obligation to either not interfere or to provide something [10:5].
CORRECT! 🙂
Explanation: In this scenario, the patient has both a negative and positive right to contraception, meaning that others are obligated not to interfere with their access to contraception, as well as to provide contraception, if necessary [10:5]. Minors have the right to access contraception without parental consent in most states, and healthcare providers are obligated to respect this right and maintain confidentiality, as long as the patient is deemed mature enough to make informed decisions about their own healthcare [10:3]. The patient's concern about their parents finding out and interfering with their access to contraception highlights the importance of protecting the patient's confidentiality and ensuring that they have access to contraception without fear of judgment or interference [10:1]. Therefore, the correct option is the patient has both a negative and positive right to contraception, meaning that others are obligated not to interfere and to provide contraception [10:5].
Wrong 😕
Explanation: In this scenario, the patient has both a negative and positive right to contraception, meaning that others are obligated not to interfere with their access to contraception, as well as to provide contraception, if necessary [10:5]. Minors have the right to access contraception without parental consent in most states, and healthcare providers are obligated to respect this right and maintain confidentiality, as long as the patient is deemed mature enough to make informed decisions about their own healthcare [10:3]. The patient's concern about their parents finding out and interfering with their access to contraception highlights the importance of protecting the patient's confidentiality and ensuring that they have access to contraception without fear of judgment or interference [10:1]. Therefore, the correct option is the patient has both a negative and positive right to contraception, meaning that others are obligated not to interfere and to provide contraception [10:5].
CORRECT! 🙂
Explanation: The most appropriate option for the practitioner to discuss with the patient is to provide information on both the birth control pill and LARC methods and advise the patient to discuss the options with their parent(s) before making a decision [10:7]. This option allows the patient to be fully informed about the available contraception options, which include both short-term and long-term methods [10:7]. The practitioner also recognizes that the patient is a minor and therefore may benefit from discussing their decision with their parent(s) before making a final choice [10:7]. By providing the patient with information and encouraging them to discuss their options with their parent(s), the practitioner can support the patient's right to access contraception while also respecting their family's role in the decision-making process [10:7]. Therefore, the correct option is to provide information on both the birth control pill and LARC methods and advise the patient to discuss the options with their parent(s) before making a decision [10:7].
Wrong 😕
Explanation: The most appropriate option for the practitioner to discuss with the patient is to provide information on both the birth control pill and LARC methods and advise the patient to discuss the options with their parent(s) before making a decision [10:7]. This option allows the patient to be fully informed about the available contraception options, which include both short-term and long-term methods [10:7]. The practitioner also recognizes that the patient is a minor and therefore may benefit from discussing their decision with their parent(s) before making a final choice [10:7]. By providing the patient with information and encouraging them to discuss their options with their parent(s), the practitioner can support the patient's right to access contraception while also respecting their family's role in the decision-making process [10:7]. Therefore, the correct option is to provide information on both the birth control pill and LARC methods and advise the patient to discuss the options with their parent(s) before making a decision [10:7].
**
10. Reflection Vignettes
1. Ms. Ashley Lee is a 16-year-old high school student who has come in for her annual well-patient care with her mother. She is seen by Dr. Maria Rodriguez, a primary care practitioner who specializes in adolescent health. During the private portion of the visit, Ms. Lee expresses to Dr. Rodriguez that she is sexually active and would like to start using contraception. She also requests that Dr. Rodriguez inform her mother that she needs to take the pill to control menstrual flow, rather than revealing the true reason for wanting contraception. Dr. Rodriguez acknowledges Ms. Lee's request and discusses the different types of contraception available, including the pill, condoms, and intrauterine devices (IUDs). She explains the potential risks and benefits of each option and ensures that Ms. Lee fully understands how to use them safely and effectively. Dr. Rodriguez also discusses the importance of open communication and honesty with parents or guardians, emphasizing that they are an important source of support and guidance. However, she recognizes that some teens may not feel comfortable discussing certain topics with their parents or guardians. Dr. Rodriguez respects Ms. Lee's privacy and informs her mother that Ms. Lee is requesting contraception to regulate menstrual flow. She provides Ms. Lee with a prescription for the pill and ensures that she understands how to use it correctly. Dr. Rodriguez also encourages Ms. Lee to return for follow-up visits and to continue to communicate openly about her health and well-being. This scenario highlights the importance of confidentiality and respect for adolescent autonomy in healthcare. It also underscores the need for healthcare practitioners to provide accurate information and support to young people as they navigate their sexual and reproductive health.
Think
Assess
Patient: Autonomy
Practitioner: Beneficence & Nonmaleficence
Public Policy: Justice
Conclude
**
2. Mr. James Brown is a school superintendent who has come in to see Dr. Elizabeth Smith, a primary care practitioner who also specializes in adolescent health. Mr. Brown is interested in discussing the potential benefits and risks of making condoms available to junior high and high school students through vending machines on school grounds. Dr. Smith acknowledges Mr. Brown's concerns and explains that providing access to contraception can have a positive impact on adolescent health and reduce rates of unintended pregnancies and sexually transmitted infections (STIs). She also notes that the American Academy of Pediatrics supports the provision of condoms to adolescents. However, Dr. Smith also discusses the potential challenges and concerns associated with condom vending machines in schools. She acknowledges that some parents and community members may object to the idea and that there may be concerns about student access and safety. Dr. Smith recommends that Mr. Brown consult with a multidisciplinary team, including school administrators, health educators, and parents, to carefully consider the potential benefits and risks of implementing a condom vending machine program in schools. She emphasizes the importance of open communication and collaboration among stakeholders to ensure that any program implemented is appropriate for the school community. Dr. Smith also encourages Mr. Brown to provide comprehensive sexuality education to students, emphasizing the importance of healthy relationships, communication, and informed decision-making. She emphasizes that providing access to contraception is just one aspect of comprehensive adolescent health care. This scenario highlights the importance of open communication and collaboration among stakeholders in addressing complex issues related to adolescent health. It also underscores the need for healthcare practitioners to provide accurate information and support to school administrators as they consider ways to improve adolescent health outcomes.
Think
Assess
Patient: Autonomy
Practitioner: Beneficence & Nonmaleficence
Public Policy: Justice
Conclude
***
