RECENTLY PUBLISHED research into the issue of prescribing the contraceptive pill to girls under the age of 16 has highlighted legal and ethical dilemmas for both parents and family doctors. A Trinity College Dublin survey reveals significant differences in the views of doctors and parents about what is currently legal when prescribing contraceptives for minors.
One third of parents say that a doctor prescribing the contraceptive pill to girls under 16 risks being sued, while more than half of GPs feel legally exposed when dealing with requests for contraception from those aged 16 and under.
The age of consent for medical treatment in the Republic is 16 years. However the current legal age for sexual intercourse is 17. But general practitioners are frequently consulted by patients aged less than 16 seeking medical care. This legal discrepancy represents a challenge for GPs, especially if the consultation relates to oral contraception or a request for “the morning after pill”. The survey found that 83 per cent of GPs have prescribed the pill to a girl under 16. Yet when asked whether a girl aged under 16 could make her own decision that she needed an oral contraceptive or emergency contraception, only 22 per cent of GPs and 10 per cent of parents selected the option “that depends on the girl’s maturity”.
This “mature minor” rule is the basis for guidelines currently in use in the UK. The so-called Gillick guidelines followed a court ruling which found that “a parental right to determine whether or not their minor child below the age of 16 will have medical treatment terminates if and when the child achieves a sufficient understanding and intelligence to enable him or her to understand fully what is proposed”.
However, these guidelines have no established validity in Ireland. A further complication arises in an ethical guideline to doctors from the Medical Council which advises that they encourage patients under 16 to involve their parents in treatment discussions while also bearing in mind their responsibility to act in the patient’s best interests.
Clearly there is a need for greater clarity around this issue. Any variation in prescribing practices on foot of legal uncertainty is not acceptable. The Law Reform Commission has pointed to the effect of the ambiguity on young people who are reluctant to seek treatment and may be putting their health at risk by engaging in unsafe sexual practices. But the commission has also proposed a solution. Last December, it recommended a change in the law to allow patients aged 14 to 16 to give consent provided they have the capacity to understand the nature and consequences of the treatment being offered to them.
The law must keep pace with the times and reflect the reality that the average age of initial sexual intercourse has fallen sharply in recent times. The Government must take the Law Reform Commission’s advice and legislate to eliminate the current conflict between parent, prescriber and patient.