Your daughter and contraception...

Imagine that you are the parent of a fifteen-year-old teenager. She’s a bright and energetic girl who is very popular with her friends. Her academic performance at school is good and her school test results regularly place her in the top half of her class. You are quietly satisfied that the family appears to be voyaging successfully through the choppy waters of adolescence without too many emotional squalls.

Your daughter has many positive attributes but you have an ongoing pet hate about her. She never tidies her room. It’s always a mess. To use the colloquial Dublin expression; it looks like a bomb hit it. You contrast the untidiness of her room with her good grooming and fashionable dress sense and question how can someone look that lovely and yet choose to leave her room in such a state? One day annoyance gets the better of you and you decide to take matters in hand and tidy the room when she is out at school.

Discovery

And then it hits you like an exocet missile that you never saw coming! You find a packet of contraceptive pills in her drawer as you are tidying away the clothes that have been strewn about the room. What do you do?

'She could ruin her life if she gets a sexually transmitted disease. How did she get these pills? Surely our GP didn’t give them to her?'

There you are standing in your daughter’s bedroom transfixed by the discovery with so many thoughts rushing through your mind. You start a dialogue in your own head. "Where did her father and I go wrong? She’s only fifteen. Does she not realise the risks she’s running. She’s not ready for a sexual relationship at fifteen. For God’s sake she still sucks her thumb at night when she falls asleep in front of the television. I wonder who is she having sex with.

She could ruin her life if she gets a sexually transmitted disease. How did she get these pills? Surely our GP didn’t give them to her? Aw no, not him, sure he’s known her since she was a baby. We’ve always trusted him. Snake in the grass. I’ll report him. It’s not right. He can’t be allowed to get away with this". So many thoughts, so much emotion and eventually you calm down. Your brain slows down and you try to think yourself through this discovery. What do you do?

Do you try to conceal your intrusion by restoring the room to its former chaos and put the pills back in the drawer where you found them and keep your discovery secret? Maybe you take some comfort from the fact that at least your daughter has protected herself from getting pregnant. You wonder if this is something you should keep entirely to your self and not even tell your partner. You cannot make up your mind what to do and decide to say nothing for the time being.

Confrontation

Or perhaps you are so gripped with feelings of rage and betrayal that the grim continuation of tidying the room keeps you from boiling over. You decide you’re not having this. You decide to challenge her about this as soon as she gets home from school. You also decide to contact your doctor and ask him if he has prescribed the pill for her. The surgery is a 10-minute walk from your home and you arrange an appointment for the same afternoon.

You are consumed with a sense of righteous anger and end up having a totally unproductive meeting with your family doctor. He talks a lot of guff about your daughter’s right to have a confidential relationship with her doctor and you reply that she is under age and in the eyes of the law has been raped. The meeting becomes overheated and you leave abruptly slamming the door behind you.

The unfolding scenario I have just painted is a hypothetical one but it is quite possible that some of our site members have already had to cope with the knowledge that their teenage sons or daughters are sexually active while still under age. Those of you who have never had to face the challenge may well feel relief and privately recite the old refrain: "there but for the grace of God go I".

Doctor's view

Of course it is not only parents that are challenged by these situations. Doctors are too. Doctors are also individuals and each has a right to a conscientious view on this subject. Some doctors will argue that a fifteen-year-old girl is under age, should not be sexually active and consequently they will not prescribe the pill for her. Others will make a different judgement and will prescribe the pill. Those that follow the latter course of action are not feckless and morally irresponsible. Many will be guided in their actions by a decision of the House of Lords in England, which has come to be known as the Gillick judgement. The Gillick case was concerned with the issue of prescribing contraceptives to under age teenagers and the name was derived from Mrs Gillick, the parent that pursued the case right through to an appeal hearing in the House of Lords.

A range of contraceptive devices.

Some of you may well say: what relevance has a decision made in the House of Lords got to do with medical practice in the Republic of Ireland? It is true that the issue of prescribing the pill for girls under the age of sixteen has never been tested in an Irish court and therefore we don’t have legal precedents on this subject in Irish law. However, there is a precedent of Irish judges citing case law from other jurisdictions when reaching their conclusions. Irish GPs who prescribe the pill to under age teenagers do so in the belief that the Gillick principle would be a reasonable defence in an Irish court if they were legally challenged for their actions.

Let us return to the realms of hypothetical scenarios and try to tease out what would happen if your fifteen-year-old daughter sought a prescription for the pill from a GP that applied the Gillick principle.

Informed consent

Essentially the principle is focussed on the concept of informed consent. So the GP would have to be satisfied that the girl understood the advice being given. If she did not have the maturity or intelligence to understand what was being said then he should not issue the prescription. If she did understand the advice the GP should try to persuade her to tell her parents and even offer to help her in that regard. But if he was unable to persuade her he must be of the opinion that intercourse was likely to take place whether or not he prescribed the pill. He must also form a judgement that her health might suffer if she did not have contraceptive protection. Finally the GP must be satisfied that the girl’s best interests would be served by prescribing the pill in the absence of parental consent.

Let us now return to the scenario where the parent has slammed the door as she left the GP’s surgery. Does she then engage in an angry confrontation with her daughter and tell her that she has been down to discuss her discovery with the doctor. Does she take legal advice and take the route that Mrs Gillick took?

Maybe our hypothetical mother put the pills back in her daughter’s drawer and had a little cry at her daughter’s premature loss of innocence. Maybe she did tell her husband of her discovery. Maybe the parents discussed the issue with their daughter some weeks later when they had sorted out their own thinking on the matter. What would you do?

Dr Leonard Condren is the medical editor of irishhealth.com.


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