Bioethics Discussion Blog: Adolescent Sexual Activity as a Pervasive Culture: What View Should Doctors Hold and Advise the Teen?

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Wednesday, January 23, 2008

Adolescent Sexual Activity as a Pervasive Culture: What View Should Doctors Hold and Advise the Teen?

One of the areas of medical practice which are introduced to first and second year medical students is how to behave and communicate if a patient is an adolescent. Providing medical care for an adolescent is in some ways more complex than caring for an adult. The doctor is dealing with a patient who is old enough to give assent and even in some jurisdictions able to give consent to various procedures and treatments but still is under the legal and ethical responsibilities of parents. The doctor, therefore, has to be involved not only with the adolescent but also the parents. Also the adolescent is in the dynamic process of maturing, emotionally, physically and intellectually with variations of the degree of maturation based on age, genetic factors and environment. There will be views of the adolescent which will be overturned by the individual when the person is no longer an adolescent.

One of the areas of medical interest regarding adolescents is their understanding of sexuality and their resultant sexual behavior. I received a communication from a medical school teacher who has been involved in teaching medical students about adolescents. She poses the issue as to whether, communicating to teen patients, there was a rationale for physicians to make a point opposing sexual activity by teens. The teacher wrote:

“A student approached me feeling strongly that her classmates and professors were all making comments/jokes about talking to teens about their sexuality and “everyone already has premarital sex anyway" and was there a place for a physician to express a different viewpoint in a society so pervasive with sexuality. How to make a stance for abstinence with a young teen? How should doctors reconcile their own religious and moral beliefs about sexuality if they are different from the pervasive culture?”

In the terms of sexual behavior, do you think it is right to teach medical students that physicians should go against the “pervasive culture” or go with the tide? How would you feel as a teenager if your doctor told you to avoid all sexual contact when you know all your fellow students are engaging in sex? ..Maurice.

6 Comments:

At Wednesday, January 23, 2008 5:08:00 PM, Blogger Karen Rayne, Ph.D. said...

The primary issue when talking with adolescents about sexuality is authenticity. Doctors need to be aware that teenagers are on the leading edge of calling people on their issues, and can smell age-discrimination from miles away. Additionally, most teenagers want physical advice from their doctors - not moral advice. (To be honest, this is what teenagers want from most adults, and very rarely get from any of them.)

What that means is that doctors should generally keep to providing unjudgmental information about sex - STIs, pregnancy, and how to prevent those things (including abstinence, of course). Doctors need to provide this information to all teenage patients. Not in a pushy way, of course, but in a "Here are some pamphlets, I am happy to answer more questions if you have them" way.

If the teenage patient is asking for advice, or seems particularly wrought, the doctor has an opportunity to perhaps provide some guidance. But only in very, very small doses, and only while staying truly authentic and honest.

I am a parent educator on issues of sex and sexuality, and I am currently looking into creating a workshop for doctors on how to talk with teenagers about sex/sexuality. I would love to hear from anyone with expertise on the subject.

Karen Rayne, Ph.D.
www.karenrayne.com
karen.rayne@gmail.com

 
At Wednesday, January 23, 2008 9:05:00 PM, Blogger MY OWN WOMAN... said...

I have taught both of my daughters about the physical aspects of sex and the consequences of such, and the emotional aspects of sex and the consequences of such. I feel, as a parent, it is my resposibility to give good sound information on both the physical and emotional aspects that sex can have on any one individual.

I'm not sure that doctors can teach in one session the "moral" or emotional things related to sex. That is an issue that needs to be started at a young age and built upon.

It kind of bothers me that parents (not all but quite a few) leave it up to the schools or the doctors to give a mini sex education class when the parents have eager ears and can talk at the right time.

Both of my daughters learned about sex from me. Did I put my values into "the speech?" Probably, but I tried very hard to be objective. I must have done something good because they seem to tell me everything....even some things I don't want to hear.

 
At Wednesday, January 23, 2008 10:04:00 PM, Blogger Maurice Bernstein, M.D. said...

My Own Woman, thanks for your comment. As a parent, what do you expect the responsibilities of your adolescent's physician with regard to dealing with matters of sexuality? Is there stuff that is clearly in the realm of the doctor (such as making a clinical diagnosis and advising treatment for sexual related conditions) and is there stuff which you would think is not appropriate for the doctor to deal with or express?

One bit of information all parents should understand is that there is in some states in the U.S. a great deal of rights expressed in state laws that minors can be responsible to exercise in terms of making important decisions totally independent of the knowledge or decision by the parents. For example, in my state of California a minor is explicitly authorized to consent for contraceptive services, prenatal care, sexually transmitted disease and HIV services,treatment for alcohol and drug abuse and outpatient mental health services. There is no law or policy written with regard to abortion services. Interestingly, though parents have the consent responsibilities for their minor's marriage, if their minor gives birth to a child, placing the child up for adoption is also a right given to the minor and without the consent of the minor's parents.

For a complete listing of the current statutes in the various states of the U.S. with regard to the rights of minors to consent to health services, you may go to this link. ..Maurice.

 
At Thursday, January 24, 2008 2:00:00 PM, Blogger MY OWN WOMAN... said...

I think it is the doctor's obligation to question any adolescent patient about sex. The doctor needs to know if the child is sexually active, does he/she practice safer sex, does he/she have multiple partners, etc. In fact, I think the doctor should even question the patient about his/her sexual orientation. I would think that as a adolescent's doctor, you would want to know these things in an effort to keep your patient healthy. Do I think the doctor should be permitted to question the child without the parent present? You bet I do. How else, in most cases, are you going to be able to get the child to admit anything when mom or dad is standing over them.

I'm an ER nurse, often times in triagae, I ask adolescents if they could be pregnant, the answer almost always comes from the parent, "NO! She better not be." Hmm... what a message. I can't tell you how many postive pregnancy tests I've seen on someone who has never had sex before.

There comes a time when parents need to accept the fact that our children don't always do as we'd like them to do, and that our children do not want to hurt us intentionally, so they "leave things out."

I'm sorry for such a long post, and I could go on and on about this subject because it irritates me that parents can't explain to their children about the realities of sex. Sex is natural, sex is good, but sex can kill. Our children need to know.

 
At Friday, February 29, 2008 10:25:00 PM, Anonymous Anonymous said...

I think what makes these questions (i.e. where does the physician draw the line with injection of personal morals) more of an issue today than it has in the past has to do with the demographics.

Go back a couple generations to any western country and the patients would be visiting a doctor from the same religious and cultural background. This scenario makes it incredible easy for the doctor to apply his moral views as they are often the same as the community in general. There wouldn't be much of issue here.
Now fast forward to modern times in a western country. You have a diverse set of races, religions, cultures, political views etc. all with different views on issues of premarital sex, abortion, dating, etc. There will be numerous combinations of cultures where the doctor's views could easily clash with that of the patients family.

If anything these issues have gotten worse. In the end there these views will probably be written as guidelines/laws in the jursitiction the doctor lives in (if they haven't already).


TS

 
At Friday, February 29, 2008 10:44:00 PM, Blogger Maurice Bernstein, M.D. said...

TS, very good point. I think this observation can be extended to advice in many other areas of medicine and including adults. Not only are the doctors from multi-cultural backgrounds and not necessarily of the same culture of their patients but also when the patient is seen in the emergency room or is hospitalized these days, they may meet a new physician with whom they may have never met and communicated with previously. This all adds to the lack of joined views on medical issues between patient and physician. Ethicist Dr. Robert Veatch has argued for similar views between doctor and patient to establish the best and therapeutically most effective relationship. ..Maurice.

 

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