Contraceptives should be prescribed only if medically indicated and desired by
the minor. [ACOG Technical Bulletin 145.
The Adolescent Obstetric- Gyncologic
Patient. September 1990.] Most medical care practitioners worry about the risks
of giving minors prescription contraceptives without parental consent. Parental
pressure to force contraceptives on an unwilling minor is a more subtle
problem. A minor who is forced to use contraceptives by a parent or guardian
cannot be said to have voluntarily assumed the risks. If this minor were to
suffer a stroke or other serious side effect, the medical care practitioner could
be sued for failure of consent. The medical care practitioner should talk to the
minor alone and attempt to determine if she truly wants the contraceptive. If
the minor is reluctant, the medical care practitioner should refuse to prescribe
a contraceptive for her.
Adolescents are at special risk for STDs:
Adolescent contraceptive practices affect the risk of infections. Many
adolescents never use a method or rely solely on the oral contraceptive.
Whether or not oral contraceptives increase susceptibility to certain
infections, they clearly reduce the impetus to use a barrier method or to
involve males in prevention. Adolescents who decide or can be
persuaded to use barrier methods seldom use them consistently and
often use them incorrectly. IUD are rarely advised for adolescents and
should never be considered for those at high risk for infection or for poor
compliance with close follow-up. [Berman SM, Hein K. Adolescents and
STDs. In Holmes, KK, et al, eds.
Sexually Transmitted Diseases. 3rd ed.
New York: McGraw- Hill Professional Publishing; 1998:117–128. ]
Medical care practitioners prescribing contraceptives should provide the minor
with all the information that is usually provided to adult patients. If the
contraceptives are prescribed without parental permission, then it is advised
that additional information be considered and recorded in the medical record:
1. Inquiry should always be made as to the feasibility of parental consent.
2. A full case history, including preexisting sexual activity, should be obtained
and maintained, and it should demonstrate that the medical care practitioner
has considered the “total situation” of the patient.
3. A record should be kept of the “emergency” need and a judgment by the
medical care practitioner that pregnancy would constitute a serious health
hazard, one more serious than the possible disadvantages of the prescription.
4. The minor should be clearly aware of the problems presented and the nature
and consequences of the procedures suggested, including very specific
discussions of the side effects of contraceptive pills if those are to be
prescribed. She should be required to sign a consent form so stating.
5. Where follow-up care is indicated, it should be insisted on. [Holder AR.
Legal
Issues in Pediatrics and Adolescent Medicine. 2nd ed. New Haven, CT: Yale
University Press; 1985.]
To this list and the consent form should be added a discussion of the risks of
STD infection, with particular reference to HIV.
