Ethics Forum: Prescribing Teratogenic Medications to Adolescents Can Raise Confidentiality, Ethical Concerns

Justice would also support equal access to treatment, which is not attained when treatment is determined by a patient’s age, gender and geography. Continuation of mycophenolate mofetil treatment while warning the patient to be consistent with use of barrier contraception is similarly unsatisfactory. The annual typical-use failure rate of condoms is about 15%, exposing the patient to an unacceptable risk of serious complications that violates the principle of non-maleficence.⁶

Among rheumatologists, contraceptive access for young people is not generally considered an issue of central importance. This case illustrates the challenge of caring for adolescents with medical conditions in which teratogenic medications are indicated.

Recently, contraceptive care has raised political controversy, exemplified by a movement to defund Planned Parenthood (a major provider of Title X family planning services). National health organizations, such as the Society for Adolescent Medicine, have emphasized the importance of eliminating barriers to contraceptive care for adolescents.⁷ This clinical vignette demonstrates that availability of confidential family planning services is a necessary prerequisite that can allow physicians of all specialties to provide outstanding, evidence-based care for women and girls of childbearing age while also maintaining the highest ethical standards.

Karen B. Onel, MD, is section chief of pediatric rheumatology and associate professor of pediatrics at the University of Chicago. She is a member of the ACR’s Committee on Ethics and Conflict of Interest.

Melissa Tesher, MD, is assistant professor of pediatrics and program director for the pediatric rheumatology fellowship training program at the University of Chicago.

References

1. English A, Ford CA. The HIPAA Privacy Rule and adolescents: Legal questions and clinical challenges. Perspectives on Sexual and Reproductive Health. 2004 Mar/Apr;36(2):80–86. https://www.guttmacher.org/about/journals/psrh/2004/hipaa-privacy-rule-and-adolescents-legal-questions-and-clinical-challenges#24a.
2. Tebb K, Sedlander E, Pica G, et al. EOB Policy Brief: Protecting adolescent confidentiality under health care reform: The special case regarding explanation of benefits (EOBs). Philip R Lee Institute for Health Policy Studies and Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of California: San Francisco: June 2014.
3. Hasstedt K. Title X: An essential investment, now more than ever. Guttmacher Policy Review. 2013 Summer;16(3):14–19.
4. Fowler CI, Gable J, Wang J, et al. Family Planning Annual Report: 2014 National Summary. Research Triangle Park, N.C.: RTI International, 2015 Aug.
5. Ponticelli C, Moroni G. Immunosuppression in pregnant women with systemic lupus erythematosus. Expert Rev Clin Immunol. 2015 May;11(5):549–552.
6. Whitaker AK, Gilliam M. Contraceptive care for adolescents. Clin Obstet Gynecol. 2008 Jun;51(2):268–280.
7. Society for Adolescent Health and Medicine, et al. Sexual and reproductive health care: A position paper of the society for adolescent health and medicine. J Adolesc Health. 2014 Apr;54(4):491–496.

Editor’s note: If you have comments or questions about this case, or if you have a case that you’d like to see in Ethics Forum, email us at [email protected].