Testing for Pregnancy without Consent
Rosemary FlaniganFebruary 12, 2010
The recent issue of the Hastings Center Report has a case study, the content of which surprised me. And then I knew that, if I offered it to you,, I would learn a lot. So here it is:
Samantha is a pale and withdrawn fourteen-year-old brought to the ER by her mother. She is fatigued, nauseated, and has been vomiting. Her mother tells the physician on call that she’s very worried; Samantha lately refuses to eat, has lost weight, has stopped going to soccer practice, and has missed several days of school.
The doctor examines Samantha and then asks if she may speak to her alone. Samantha and her mother agree; her mother leaves the room.
In response to the doctor’s questions, Samantha says that she first menstruated at age eleven, that her periods have been regular, and that she last had one four weeks ago. When the doctor asks whether she is sexually active, she admits that she had her first sexual contact right before her last period. She says it was consensual and that her partner used a condom.
She says she knows she’s not pregnant—she took a home pregnancy test the day before, and the results were negative.
The doctor asks if she can test Samantha again, and Samantha starts to cry. “I already told you, the test said I’m not,” she says. "I’m not pregnant!”
The question for us, of course, is whether or not the physician, who strongly suspects pregnancy, can test again as part of her workup.
And I shall argue (remember, it’s been a long time since I was 14) that if the physician fears the young woman will walk out of the ER without any tests, then the physician should talk fast about the need for blood tests to check for diabetes and a urine test to check for an infection.
Of course, the tests will also make clear whether or not she is pregnant (won’t they?) But I would risk not getting explicit informed consent if I could get consent for the other tests. It’s not ideal, but I can justify it.
Am I going to be lambasted??????? HELP!!!
posted by Practical Bioethics at
9:38 AM
5 Comments:
It does not seem urgent to me that she have a pregnancy test in the ER unless an ectopic pregnancy is suspected, which does not seem to be the case here. Harm is done to force such a test against her will. As an aside, she seems well informed. It is not unusual these days for a 14 year old to be having consensual sex. Advising her to retest at home in another week, or see the family doctor would be more advisable.
As a PCP, I would not test without consent because the therapeutic value of my relationship with the patient outweighs the need for immediate information.
In the ER, the relationship balance shifts, although I think testing without consent would damage this young woman's trust in her physicians in the future, too.
I think it's time to slow down, not speed up, and spend some time listening to Samantha talk about her concerns and what she thinks is going on. I think it's entirely possible that Samantha would agree to re-testing if the doc can build a relationship with her. If not, the ER doc needs to call the family doc directly and pass on her concern.
Everyone normally goes for tests in pregnancy, among of you if anybody having no pregnancy then tubal reversal is a surgical procedure which gives woman a chance to pregnant again.
I think that the mother deserves to be asked if she can approve a pregnancy test for her daughter, after all she is only 14.
Excellent material. Very insightful.
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