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Open Collection of Student Writing (OCSW)

Confidentiality for a Sexually-Active Minor

Introduction

Andrea was a fifteen-year old patient who came in at the end of Dr. Nelson’s shift. A week prior, Andrea had an intrauterine-contraceptive device, or IUD, placed by Dr. Nelson because she and her boyfriend had become sexually active. She had come in alone since her father, Frank, strictly prohibited pre-marital sex; he had kicked her sister out when she had become pregnant, so it was a serious thing for him. This week, Andrea was seeing Dr. Nelson for pelvic-inflammatory disease, or PID, a rare complication that the IUD can cause, and Frank is screaming at his daughter, threatening to kick her out since this must mean that she is having sex. Dr. Nelson sees Andrea alone, and Andrea is begging the doctor not to tell her dad the truth.

Andrea lives in a state that allows minors her age to consent to treatment, however Frank will still be paying her medical bills so even if Dr. Nelson lies, he will see the diagnoses and treatments on the bill. Dr. Nelson inquires some of Frank and learns that he does not know about Andrea’s diagnosis yet nor about the IUD. Dr. Nelson tells him that they need to do more testing to confirm anything, and that the sexual activity of his daughter is impertinent to their treatment of her. Further testing of Andrea’s urine shows that she has a urinary tract infection, and when discussing the details with Andrea’s father she focuses on that while skimming over the PID, since urinary tract infections have more causes and she does not want to see Andrea homeless.

Thesis

Dr. Nelson had an ethical battle to consider. She highly respected patient confidentiality because she wanted her patients to have trust in her, including the adolescents. She also knew the laws regarding adolescents limited their autonomy to financial independence, so if a parent is paying for treatment than they have the right to know the condition to at least some extent. On top of all this, Dr. Nelson had to take into consideration Andrea’s case as an individual, including the consequences of Frank learning Andrea’s sexual status. In this paper, it will be shown that Dr. Nelson made the most ethically sound decision she could for all things considered.

Medical Indications

As previously stated, Andrea’s medical problem is Pelvic Inflammatory Disease that resulted from insertion of an intra-uterine device. It is an acute, reversible disease, which means it was quick and harsh in coming (Vorvick 2017) but can also be treated. Clearly, the main objective for Dr. Nelson is to treat Andrea, preferably without relaying Andrea’s sexual activity to her father.

Andrea will greatly benefit from medical care in this situation, as PID is easily treated in its early stages. If Andrea or her father was to refuse treatment, complications could arise for her in the future such as chronic and sometimes severe pelvic pain, and scarring around the ovaries or fallopian tubes that can cause menstruation irregularities or even infertility (CDC Staff 2017). The only circumstance that could potentially lead to a request not to treat would be if Frank knew the true nature of both Andrea’s condition and what brought it on.

Patient Preferences

Andrea is aware of treatment options and has consented under the condition that her complete diagnosis remains secret to her father. While she is certainly mentally capable of choosing treatment, she needs her father’s permission to be treated since she is a minor. She worries he will either refuse treatment on her behalf or even disown her should he know that an IUD and sexual activity brought on her disease. Still, Frank is her guardian and has a right to know what he will be paying for. Andrea is trusting Dr. Nelson to find a way to keep her safe while attempting to explain her condition to Frank.

Quality of Life

With treatment, Andrea will easily return to her normal life. She will know to be more careful with her sexual activity to prevent further incidences, and as long her dad is not aware of her sexual activity she will face no severe repercussions. If her father does happen to find out, he may refuse treatment or cause issues for her at home. If he refuses the treatment, Andrea’s quality of life will take a severe impact as she faces a life of chronic pain and most likely menstruation issues.

Even if Frank learns of the sexual activity, it is unlikely he will refuse treatment since he could be accused of medical neglect of a child and face serious criminal charges (LaMance 2018). However, if even if Frank knows the entire truth and chooses to treat Andrea, she will still face a worsened overall quality of life due to his extreme non-acceptance of extramarital sex. Things will likely get harder for Andrea at home, and she faces potential emotional and verbal abuse from an angry father.

Contextual Features

Frank, Andrea’s father, is extremely important in this situation since she is still a minor. While he has a right to know about Andrea’s condition, her sexual activity is confidential, and Dr. Nelson retains her right to decide how much information is necessary for Frank to know in order to treat Andrea (Hanley 2013). Dr. Nelson’s reason for wanting to limit Frank’s understanding is because she fears for Andrea’s safety. While Frank is legally obligated to care for Andrea until she is either emancipated or an adult of her own (Protecting the Confidentiality 2012), that does not put Andrea out of harm’s way.

It is also important for Dr. Nelson to not retain too much information. Since Frank will be getting the bill from the insurance company, he will see the different treatments. If he feels that he did not have a full understanding of Andrea’s condition either due to quietness on Dr. Nelson’s part or the total cost seeming incongruent with what he thought was Andrea’s condition, he may look deeper into what happened. He may call the insurance company for more information or look up information on the treatments given to Andrea, which can put her in danger.

However, this may also enable Frank to take legal action. Dr. Nelson must protect herself and the hospital as well as Andrea. While she certainly wants Frank to treat Andrea, there is a possibility that he could sue her or the hospital for lying or withholding information. She needs to be blunt in order to assure protection for herself and her workplace, but careful about the words she uses and how she explains things in order to protect Andrea.

Alternative Options

If antibiotic treatment of the PID is not allowed by Frank, Andrea will be given non-steroidal anti-inflammatory medications to relieve the pain caused by PID (Healthwise Staff 2017). It is likely that Dr. Nelson would also recommend cognitive behavioral therapy to deal with the emotional consequences of dealing with the pain and stress of potential infertility. Alternatively, if Frank refuses to treat Andrea the police may be involved, and the hospital may obtain a court order to treat her.

Conclusion

Taking each piece into account, it is clear the Dr. Nelson made the right choice in grazing over the details of Andrea’s condition. The medical indications show the vitality of treatment, which Andrea may not receive should her father know about her sexual activity. Dr. Nelson is thus avoiding harm to Andrea by giving Frank enough details to want to treat Andrea without giving him the opportunity to come to conclusions about the state of the disease’s development. This also falls in place with Andrea’s individual preferences. Dr. Nelson does want to be honest with Frank, but not at the cost of Andrea’s quality of life. In finding this middle ground, she is also giving Frank enough information that he would have no case against herself or the hospital should he learn the complete truth. Dr. Nelson has found the proper middle ground to keep Andrea’s trust as a provider while protecting her both of them from negative repercussions.

References

CDC Staff. (2017, July 10). Pelvic Inflammatory Disease (PID). Retrieved April 28, 2018, from https://www.cdc.gov/std/pid/stdfact-pid.htm

Hanley, R. (2013, December 17). Doctor – Teen Patient Confidentiality: What You Should Know. Retrieved April 28, 2018, from https://www.trustedchoice.com/insurance-articles/life-health/doctor-teen-confidentiality/

Healthwise Staff. (2017, October 6). Pelvic Inflammatory Disease. Retrieved April 28, 2018, from http://www.progressiveurology.net/health-library/hw-view.php?DOCHWID=hw43366#hw43566

LaMance, K. (2018, March 05). Medical Neglect of a Child. Retrieved April 28, 2018, from https://www.legalmatch.com/law-library/article/medical-neglect-of-a-child.html

Protecting the Confidentiality of Sexually Active Adolescents. (2012). Virtual Mentor,14(2), 99-104. doi:10.1001/virtualmentor.2012.14.2.ccas2-1202

Vorvick, L. J. (2017, January 26). Acute vs. Chronic Conditions. Retrieved April 28, 2018, from https://medlineplus.gov/ency/imagepages/18126.htm

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