RUNNING HEAD: ETHICAL DILEMMAS SURROUNDING PATIENT

AUTONOMY IN TEENS
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Michelle Larsen
Salt Lake Community College
Ethical Dilemmas Surrounding Patient Autonomy in Teens
August 6, 2016

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INTRODUCTION
Patient autonomy is the right that each patient has to make their
own decisions regarding their health care. It is each persons individual
right to be informed about all aspects of their health care, and to make
informed decisions in order to provide consent for medical treatment.
When it comes to patient autonomy, it has been decided that parents
of children are responsible for making these health care decisions for
their children until the children have reached the legal age of eighteen.
However, when it comes to teenagers who are only a few short years
away from turning eighteen, privacy can be very important to them,
and ethical dilemmas often inevitably rise up. Privacy in health care for
these teens can be difficult due to the involvement that parents have
in their medical decisions, as well as the involvement that health care
providers allow parents to have regarding a teenagers health.
Suppose that a fifteen or sixteen-year-old girl is visiting a doctor
specializing in obstetrics and gynecology for the first time. Because
she is a new patient, the doctor needs to update her medical history.
The young female hesitates to answer many of the questions regarding
her sexual history specifically because she is worried about her
parents finding out the answers to the questions her physician is
asking her. Of course, the doctor reassures her that everything that is
discussed is completely confidential and that the two of them should
be able to discuss her concerns with no worries regarding the

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information getting out to her parents. The young girl understands and
agrees to share her concerns with her physician.
The doctor goes on to ask this young girl if she is sexually active.
The girl answers that she is and that she is planning on becoming
pregnant within the next year. The doctor then becomes quite
concerned. He is worried about a young teen making the decision to
start having children so early in life but knows that if he tells her
parents about this girls plan, the young girl will feel like she cannot
trust him to be her doctor anymore. However, if he does not tell
anyone, or if he fails to convince her to not make this decision, he risks
watching her go through with something she might regret and risks the
arguments of her parents when they come to find out if he knew about
her plan the entire time.
What the doctor faces is challenging, as it poses many risks
related to this teenagers emerging and developing patient autonomy.
He needs to recognize that she is going to make decisions in her life
and regarding her health, and it is up to him to inform her of proper
ways to avoid risky behavior that could negatively impact the rest of
her life. She has asked him to keep her medical history and medical
concerns private and confidential, and at the time he agreed. By
agreeing to keep her history and concerns private, he was agreeing
that this young girl was mature enough to be a part of her own health
decisions. Part of a physicians duty is to provide care in [a patients]

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best interest until they have the legal right to make decisions for
themselves (Ott, 2014). By allowing the teenage girl to make the
decision to have a child while she is still in high school, he is raising the
question of whether or not this decision is in her best interest as his
patient.
THESIS
Only twenty-six states currently allow minors to consent to
contraceptive care and services, and thirty-two states allow minors to
receive prenatal care (Ott, 2014). This means that if the doctor in the
scenario above decides to support the teenager with any of her health
decisions, including her plan to get pregnant, there is a good chance
that he will not face any legal repercussions. He can continue to
provide her care throughout her pregnancy, and will not be found at
fault for not persuading her to make an alternate decision. Due to the
confidentiality laws, he is most likely safe from any repercussions and
fights from the patients parents, as his agreement to keep her health
confidential means he cannot be discuss anything with the patients
parents. However, despite the fact that a teenager is allowed the right
to have complete patient confidentiality, her doctor should be
informing her of all the risks associated with her behavior, and help
use that information to guide her to make a different decision. Though
a doctor should not force or coerce patients into making one decision
over another, he should be allowing them to exercise their right to

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make their own decisions regarding their health care, regardless of
age. If a person is found to be mature enough to understand the risks
and guidelines that are discussed with his or her physician, then they
have the right to exercise their autonomy and make decisions
concerning their overall health. In this case specifically, the physician
should respect his young patients right to keep her health private and
confidential, and help her with the decision-making process without
disclosing her information he promised her he would keep private.
BODY
There are a few different paths that this doctor can take, but
what is the right thing for the doctor of this young teenage girl do? She
is planning on having a child, without fully understanding the
consequences she might face in the future. The first thing that the
doctor should do in this case is make sure that the girl is mentally
capable of making her own decisions, and making sure that her plan to
become pregnant while she is still a teenager is not a result of another
medical condition. It would be important for him to recognize whether
or not she is mature enough to understand the risks and benefits of
starting a family so young. The best thing for the doctor to do,
however, is make sure that she is capable of making this life-changing
medical decision, and treat her in the best way to make sure that her
concerns are addressed and taken care of and that her health is kept
confidential in any situation.

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Some might say that this doctor could use his knowledge of her
brain development at this stage in life to persuade her into making an
alternate decision. Many studies have found that emotional decisions,
such as those regarding family planning, are more rationally thought
through by adults, while teenagers are simply not equipped to think
things through in the same way (Talukder, 2013.) This means that
when faced with decisions that can be emotionally stressful or difficult,
adults are able to put aside their emotions and make better decisions.
Teenagers are more likely to make decisions based on how it will make
them feel, causing them to lean towards decisions that will make them
happyeven if the happiness is imagined or temporary. Many might
say that this proves that teenagers are not old enough to be allowed
complete confidentiality in their health care, as they are not old
enough to understand all of the risks and implications of any decisions
they might make, and that their parents should be involved to help
prevent regrettable decisions from being made. However, this study
does not take into account each individual teens ability to comprehend
and respond to difficult situations. In situations like this, physicians
should be making sure that their patients are mentally capable of
understanding all of the possible risks and benefits of any medical
treatment or advice they desire. This ensures that the patients
autonomy is honored and that they are not forced to make decisions
they do not agree with. If a doctor finds that a teenager is mentally

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capable of making their own health decisions, then they should not
need to wait until the patient is of legal age to honor their right to
make individual and confidential health decisions.
If the doctor decides to allow this young girl to become pregnant,
there is a chance that her information might not be as confidential as
the teenage girl thought at first. Since she is young, she is still under
her parents health insurance, meaning that they will have access to
certain aspects of her medical care, such as when they receive the bill
for any treatment or testing the doctor provides for their daughter.
Though the physician promised complete confidentiality, there is a
chance that the girls parents could discover some aspects of her
health care. However, if this were the case, he could help provide her
with options that would allow her to receive the confidentiality she
seeks, and avoid any potential legal issues that could present
themselves.
For teenagers, their quality of life is not necessarily best decided
by their parents in all cases. It is the duty of the physician to provide
the child the best medical care possibleand the duty of the parents is
to protect and promote the welfare of their child (Munson, p. 43). In
the case of the teenage girl wishing to become pregnant, her quality of
life would not necessarily be different whether or not she decided to go
through with her plan or not. However, there is a chance that she
would feel less inclined to agree with the course of action that her

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parents might decide for her. Without allowing her to be a part of her
own health, she potentially could feel shut out of her own decisions
and feel resentful towards those making her health decisions for her.
Because a young persons developing and emerging autonomy is
important to them, it is then important to make sure that we allow
them to exercise this autonomy so they can learn and grow from their
decisions.
CONCLUSION
In conclusion, patient autonomy is an important aspect of
medical ethics and health care. It allows patients the right to make
decisions regarding their health care, and can help prevent them from
making decisions about the treatment they might not agree with.
Though it has been decided that parents of children should be the ones
to provide medical consent for their children, this can take away their
developing individual autonomy. As with most ethical dilemmas, things
are best worked out on a case-by-case basis but in the instance of a
teen that is a few short years away from turning the legal age of
eighteen, it would be best if they were treated like any other patient,
with the right to make their own decisions concerning their health care
and the right to keep their medical information confidential. Patient
autonomy is not just for adults, but also for any patient of any age who
feels they have a right to confidential and quality health care.

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Works Cited
Munson,R.(n.d.).Interventionandreflection:Basicissuesinbioethics.pg.43
Ott, M., MD, MA. (2014). Teen Pregnancy and Confidentiality. Virtual
Mentor,

16(11),

884-890.

doi:10.1001/virtualmentor.2014.16.11.ecas3-1411
Talukder, G. (2013, March 20). Decision-making is Still a Work in
Progress for Teenagers - Brain Connection.
http://brainconnection.brainhq.com/2013/03/20/decision-makingis-still-a-work-in-progress-for-teenagers/