Young People, Medical Consent and Sexual Health

by Dr Caitriona Henchion, IFPA Medical Director March 2010

The recent publication of the Law Reform Commission’s report on medical treatment for young people is hopefully the beginning of the end of years of profound ambiguity among service providers and young people about access to contraception and sexual health services.

Published last December, the report recommended legislative reforms that would allow for the views of mature teenagers to be taken into account in the context of consenting to medical treatment, including surgery and contraception.

The report highlighted the glaring conflict between Irish laws and the ethical obligations of doctors to provide care in the best interest of the client. Currently the law on prescribing contraception to young people under the age of 16 requires consent from a parent or a guardian – this presents a major dilemma to doctors who are ethically required to provide a confidential service which is in the best interest of their client. This is further complicated by the fact that the age of sexual consent in Ireland is 17.

The current law can give rise to the following scenarios; doctors refusing to provide sexual health services including emergency contraception to young people, doctors violating principles of confidentiality by contacting the parents of the young person against their express wishes and doctors reporting consensual sexual relationships between young people under 17 to the Gardai as a potential criminal act. It is the IFPA’s experience that young people are acutely aware of these scenarios and that some will choose to avoid sexual health services altogether and risk unplanned pregnancies and STIs, rather than consult with their parents on contraception and sexual health services.

The IFPA believes that sexual health services should always be provided on the basis of what is in the best interest of the young person and that doctors have an ethical obligation to provide care to young people that reflects their evolving capacities to make informed decisions about their own health and wellbeing.

The commission’s proposed legislative changes would allow 16- and 17-year-olds to consent to and refuse medical treatment, including surgery and contraception. 14- to 15-year-olds would be able to consent to and refuse medical treatment provided they have the capacity to understand the nature and consequences of the treatment, subject to conditions, according to the consultation paper. These conditions include the provision that the doctor encourages them to inform their parents, the doctor considers the treatment to be in the patient’s best interest and the doctor has due regard to any public health concerns.

The commission also recommended that 12- and 13-year-olds could be treated subject to the condition that the doctor notifies the parents or guardians of the child and takes account of their views. The doctor must also take account of the views of the child in question and consider the best interests of the patient. The doctor must again have due regard to any public health concerns.

In developing best-practice guidelines as recommended by the commission the Government should be guided by the Fraser Guidelines, which have been adopted into Canadian, Australian and UK law.

These guidelines set out criteria by which doctors should assess young people for treatment. These include the condition that the young person understands the advice being given, that the young person cannot be convinced to involve parents/carers or allow the medical practitioner to do so on their behalf, that it is likely that the young person will begin or continue having sex with our without contraception, that the young person’s physical or mental health is likely to suffer and that the young person’s best interests require contraception advice, treatment or supplies to be given to them without parental consent.

March 31 is the final date for submissions to the Law Reform Commission following which a final report will be submitted to the Government.

For more info see www.lawreform.ie