If under 16, is the patient Gillick competent?
If under 13, is the patient engaging in sexual activity?
Consider patient confidentiality versus parental rights.
Ethical responsibilities if the patient is in an abusive relationship.

Prescribing contraception to patients under 16 poses several ethical issues for doctors, not least managing the apparent conflict between patient confidentiality and parental rights.

Confidentiality

You owe the same duty of confidentiality to a young person as to an adult; however, this may be breached if the patient is at risk of abuse.

Before prescribing

It is important to establish a good rapport with the patient and support them as much as possible.

Try to establish the nature of the sexual relationship if possible. Be alert for indications of an abusive relationship.

Explain the physical implications of sexual activity, including pregnancy and sexually transmitted diseases.

Encourage the patient to tell their parents or a trusted adult.

Under-16s

You must determine whether the patient is Gillick competent – that is, are they capable of giving informed consent to medical treatment without the knowledge or permission of their parents?

Factors that need to be considered when assessing those under 16 include:

the patient understands your advice
they cannot be persuaded to tell their parents or allow you to do so
they are very likely to begin or continue a sexual relationship with or without contraception
their mental or physical health or both are likely to suffer if contraception is not provided
it is in their best interests to be given advice and/or treatment without parental authority.

If you're satisfied a patient under 16 is Gillick competent, you can provide contraception, and sexual and reproductive health treatment.

Under-16s in Scotland

In Scotland, the Age of Legal Capacity (Scotland) Act 1991 applies, which states that:

"A person under the age of 16 years shall have legal capacity to consent on his or her own behalf to any surgical, medical or dental procedure or treatment where, in the opinion of a qualified medical practitioner attending him, he is capable of understanding the nature and possible consequences of the procedure or treatment."

Under-13s

A child under 13 is not considered in law to be able to consent to sexual activity.

If the patient is under 13 and in a sexual relationship, inform your child protection lead.

Abusive relationships

If what the young person tells you in confidence leads you to believe they may be involved in abusive or seriously harmful sexual activity, you must share this information with appropriate people or agencies (eg, police or social services).

Factors suggesting an abusive relationship:

the young person is too immature to understand or consent
there is a big difference in age, maturity or power between sexual partners
the young person's sexual partner is in a position of trust
there is force or threat of force, emotional or psychological pressure, bribery or payment to engage in sexual activity, or to keep it secret
drugs or alcohol are used to influence the young person to engage in sexual activity
the sexual partner is known to the police or child protection as having abusive relationships with children or young people.

Relevant guidance: GMC, 0-18 years, guidance for all doctors (2007)

Prescribing contraception to under-16s

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