To Tell or Not to Tell

Many health care providers face ethical challenges when preforming abortions to minors. “Ethical challenges are situation in which no clear cut right answer exists and no individual is required to make a choice between two or more equally unfavorable alternatives. ” (McWay 2011) No doctor is obligated to perform an abortion if there is a conflict of his/her conscience. Pro-choice consider it unethical to take away a woman right to decide over her body. Women have rights when it comes to abortions. They have the right to privacy, the right to ownership of one’s body, the right to equal treatment, and the right to self-determination.

This means they have the right to decide about their own future, and that it is morally wrong to force women to bear a child against her will. But what about minors who have an unplanned pregnancy? Legally the parents are the guardian but what if the parents have no clue that the minor is pregnant. Doctors who examine minors usually find that parents come fairly late in the process or not at all. Some teenagers carry their pregnancy to term while others request an abortion in the second trimester. Many states have passed laws about minors either needing or not needing consent of a parent to have an abortion.

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“The Supreme Court has held that if a state requires a minor to consult with a parent before deciding to terminate her pregnancy, the state must offer the minor a judicial bypass. ” (Pennachio 2002) A judicial bypass is a bypass of parental involvement. This is generally done by appearing before a judge to explain her situation. The judge then finds if the minor is mature enough to make an independent decision or that an abortion is in the minors’ best interests which allows the minor to decide whether to end the pregnancy without parents knowing.

The judge usually decides the minors’ maturity level by the evidence presented by the minor’s legal team. Such evidence included the “independence at home, involvement in extracurricular activities, employment, and consultation with medical personnel or clergy about emotional and physical consequences of having an abortion, risk of abuse of family trauma at home, eviction from home or stress of financial situation or educational plans”(Garybill 2002). Pro-lifers consider it unethical to kill a growing life. They consider abortions a form of legalized killing.

There are a lot of younger doctors that decline the will to perform abortions. They do not wish to take the necessary training of abortions due to moral grounds. Others are just not willing to let their friends know that they perform abortions. One doctor explained his experience while preforming an abortion, “Once I tore perfectly formed upper and lower extremities from the fetus’s torso in the uterus, the terrible irrefutable reality struck me that I’m performing abortions, I’d been killing babies for the convenience of parents.

I made a 180 degree turn and have discontinued doing abortions”. (Pennachio 2002) Ethics will always be challenged when dealing with issues as tough as abortions. Confidentiality is another ethical challenge that health care providers face when dealing with minors. In August of 2002, new federal rules took effect that protects the privacy of individuals’ health information and medical records. The rule which is based off of Health Insurance Portability and Accountability Act of 1996 (HIPPA) protects important minor health information as well as a form of defense of the health care provider.

Such provisions are a compromise between the importance of parental access to minors’ health information and confidentiality in children health care services. When minors’ have consent for care, the provider cannot share the minor’s health information with anyone, including the parents of legal guardian, without the consent of the minor, unless there is an exception in the law that allows or require a provider to disclose of information.

Theses exceptions included inpatient mental health treatment, release of records to current health care provider, if the injuries involve a crime, or if child abuse is in play. The fear of disclosure is why many minors do not seek health services. When knowing that providers will keep the information private the adolescent feels a sense of security with the provider.

According to Guttmacher Institute State policies in Brief: Minors’ Access to Contraceptive Services, “21 states and District of Columbia allows all minors to consent to contraceptive services, 25 states permits minors to connect with 1 or more circumstances, 3 states allow minors to connect to contraceptives services if the provider determines that the minor would face a health hazard if not provided, 21 states allow consent if the minor is married, 6 states allow consent if the minor is a parent, 6 states allows consent if the minor has even been pregnant, 11 states allows minor to connect to contraceptives services if the minor meets other requirements which included being a high school graduate, reaching a minimum age, demonstrating maturity or receiving a referral form a specified professional such as physician of a member of clergy. And 4 states have no explicit policy on minor’s authority to consent to contraceptive services” (Guttmacher Institute 2013). By law, clinics that receive federal funding must provide confidential sexual health services to teenagers. “Title X, the only federal funded program that provides family services to low income women and teenagers mandated that providers have to encourage minors to include their parents when seeking contraceptive decisions” (Jones & Boonstra 2004).

In order to limit minors access to contraceptive services, politicians tried to enter into legislation that if clinics, under Title X, wanted to continue to receive funding from the government, that they had to require parental consent for minors seeking contraceptive services. This legislation has so far been unsuccessful. Two states, Texas and Utah, have ended their relationship with state funding in order to be able to provide contraception to minors without parental consent. They believe that if the parents had to know that the child was seeking help, they would not come and seek help at all which could create a bigger issue for the minor. Bottom line is as long as the minor has the trust of the provider; they will almost always seek help when in need.

Ethics will always be challenged when dealing with adolescents. In today’s society, minors deal with a lot of adult issues; drugs, sex, metal disorders. But minors have certain rights just as an adult would have. Providers are required to encourage the child to inform their parents of the decision that they are trying to make for themselves. But where the law is silent, the decision to inform the parents of their child’s need for contraceptive is up to the provider acting in the best interest of the child. WORK CITED Graybill, E. S (2002) Assisting minors seeking abortions in judicial bypass proceedings: A guardian litem is no substitute for an attorney.



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