56. CASE: Family Friends/ Family Doc

Dr. Jones has been a close friend of the Smith family since coming to town 18 years ago. The Smith’s oldest child, Sally (15 years), has come to the office to have a physical to be on her school’s track team. Her mother has brought her to the office, but as usual, Dr. Jones sees Sally alone.

After taking the history and doing an exam, it is evident that Sally wants to talk about something. In response to a question about whether she has started dating, she explains that she has been dating JJ for the last six months. She says that she really likes him a lot, and although they “haven’t done it yet, they have been thinking about it a lot.” She is wondering if she could start taking birth control pills.

Sally also explains that her parents do not know anything about it. She said that when she has tried to talk with her mother, her mom just, “got weird—talking about babies having babies, and nobody having morals any more.” She says her mother would be very upset if she knew Sally was talking about it, and asks that this information not get back to her parents.

[From Rural Health Ethics: A Manual for Trainers. William Nelson & Karen Schifferdecker. http://geiselmed.dartmouth.edu/cfm/resources/manual/manual.pdf%5D

  • Is it ethical to prescribe birth control without parental permission to a patient who is below the legal age of consent for sexual activity?
  • Should Dr. Jones try to separate her role as Sally’s physician with her role as a friend of her parents?
  • What is the main ethics question in this case? What are the conflicting values?
  • How should Dr. Jones proceed and why?

Some Values and Ethics Issues to Consider

  • Community and family relationships
  • Respect for privacy and confidentiality
  • Patient-provider relationships
  • Professional boundaries
  • Honesty, trust and truth-telling
  • Duty to provide care
  • Overlapping roles and responsibilities

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