While the rate of teenage pregnancy has decreased, you will still frequently see sexually active females aged under 16. If you have a child patient who is pregnant, there are medicolegal issues you should consider.
It is important that you are familiar with local child safeguarding policies and familiarise yourself with the GMC’s ‘0-18 years – Guidance for all doctors’. The first step is for you to assess the competence of the child. If she has capacity, then you can proceed with the consultation and explore with her what her options are and signpost to places she can seek advice and assistance. It is important to establish what support network she has and whether it would be in her interests to involve her parents or guardians. If she has capacity and has made a decision about the future of her pregnancy you should usually respect her wishes and maintain confidentiality unless doing so would be detrimental to her interests.
If the child does not have competence, then a suitable adult – usually, though not necessarily the parent – will need to consent to any management. You should consider each case on its own merits, and not contact parents automatically in this situation.
If you believe there is a safeguarding concern, and the issue of statutory rape may have arisen (intercourse with a child under 13) you will likely need to bring this to the attention of the appropriate authorities and follow local safeguarding procedures. If you are in any doubt, consider discussing the case with the local clinical safeguarding lead, taking care not to disclose the identity of the patient. Once the details of the case have been fully appraised, the lead will be able to give advice as to how to proceed. In keeping with good practice this advice and steps taken should be documented.
While you should consider your professional and legal obligations, such as GMC guidance, and local procedures, it is important not to forget the girl’s feelings. It may be that she is confused and frightened, and may be expecting a completely confidential medical service. It is vital these factors are taken in to account. The patient’s confidentiality should be protected as far as possible and should not be breached without a justifiable reason. It is vital to deal with her agenda early and to create a trusting environment. If you feel a breach of confidentiality might be warranted, this would need to be discussed with the patient early on and sensitively. A failure to do so would increase the risk of the patient disengaging with medical services or being reticent to discuss difficult matters. A sensitive approach may go some way to mitigating those risks if disclosure of information to others is needed.
Ultimately, the girl’s interests are paramount and in difficult situations such as this, you should not be afraid to seek advice from colleagues, child protection specialists, or your medical defence organisation.
Dr Dan Kremer is a medicolegal adviser at Medical Protection
