The Myth of Moral Neutrality: Parental Consent Part 3

Imagine this story:  A twelve year old girl is having sexual relations with her 37-year-old teacher.  The sexual predator becomes tired of depending on condoms as he assaults this girl, so he looks into a way to provide a different type of contraceptive protection to avoid pregnancy (and detection).  He repeatedly drives her to a "family planning clinic" run by the county health department.  A physician prescribes the injectable contraceptive Depo-provera, and the teacher is able to continue his abuse of this girl for a longer period of time.  The girl was driven to the clinic a number of times by the teacher over the eighteen month relationship.

Imagine that the clinic staff could not by federal law inform the girl's parents that the twelve year old was seeking contraceptives, although a girl that young having sex is illegal in the state.  According to Title X guidelines, any clinic that accepts Title X funds cannot inform a child's parents when they seek "family planning" services.  When the parents of this finally found out about this illicit relationship, they also found out that the county health department (and their tax dollars) provided the means that allowed the abuse to go undetected for 18 months. 

As you may guess, this is not a fictional story.  This actually happened in McHenry County Illinois, a suburb about 45 miles southwest of Chicago in 1997.  You can read about it in this sworn testimony here. 

As a result of this horrible incident, the parents in McHenry county took action.  They decided to reject the federal Title X money that forced them to treat children for "reproductive health issues" without getting consent from the parents.  They passed laws that required that children receive parental consent for non-emergency medical treatment.

One of the most common reasons given for the exception made for parental consent when it comes to oral contraceptives (OCs) and "family planning" is that the treatment given is morally neutral.  In other words, a doctor prescribing OCs does not effect or change the behavior of the child he is treating.  He is merely providing a treatment for the behavior that she has decided to engage in.  If prescribing OCs does not change the behavior of the child, and the child will continue to have sex regardless of the actions of the adults in their life, then isn't it a better thing to have the child take contraception?  Isn't this an effective way to decrease the number of teen pregnancies?  These are the questions I wish to explore.

I believe the story that I detailed above shows that a physician's involvement in a child's care is not morally neutral.  The physician who dispensed the injectable contraceptive to this child helped to enable the abuse she endured.  If the taking of contraceptives did not encourage this abuse, then why did the teacher drive her to the health department for this "care"? 

In almost every other issue imaginable, physicians are taught and encouraged to positively influence and change the unhealthy behavior of their patients.  I receive a number of posters, flyers, and information that is designed to effect a change in my patient's behavior, from anti-smoking to anti-pop drinking.  (The latter paid for by my association dues).  If we believe doctors can have a positive impact on behaviors like smoking and drinking excessive sugar, then why do we believe they have no effect on a more serious issue like teenage sexuality? 

Worse, there is no question in my mind that writing a prescription for OCs is perceived by the child in question as an affirmation of their chosen behavior.  Adolescents are in that horribly awkward season of their lives when they are not yet adults but are also not children.  They have begun the process of leaving their parents and braching out, and are increasingly in a position to make decisions that can effect their future.  For this reason, they are often drawn to behaviors that make them feel "more adult", and I believe that is a significant reason why they become involved in sexual relationships. 

Having a child have the "right" to receive prescription contraceptives affirms their sexual choices by someone in authority.  Instead of feeling that they are engaging in an action that their parents believe is dangerous and immoral, the actions of their doctor implies that they are being responsible and merely making an (adult) choice.  As opposed to their parents, who just don't understand them and impose moral rules on their behavior, the doctor affirms their choices without moral comment and enables their more "adult-like" behavior.  Do we really believe this has no effect on the child's behavior, and their decision to engage in sexual activity?

Lastly, the question that we need to answer is whether or not our culture wishes to treat teen sexuality as an amoral act (devoid of morality) in which personal choice should be honored or whether teen sexuality should be seen as a moral failure and should clearly be discouraged?  Should we implicitly affirm the immoral choices that our children make, and allow the government to play a role in keeping their behavior secret; or should society help children make choices that will best ensure their health, safety, and future. 

I believe we sell our kids short and abdicate our responsibility by allowing the state to provide OCs without parental consent.  The doctor's position is not one of moral neutrality.  He is affirming their behavior and pushing the worldview that sexual decisions are only about personal choice, desire, and hormones.  We can do better.