A rock and a hard place? Ministry of Defence | Defence News | MOD confirms loss of recruitment data
James Cox
ukcrypto at chiark.greenend.org.uk
Wed, 30 Jan 2008 11:13:24 +0000
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On 30 Jan 2008, at 09:09, Ian Batten wrote:
>
> On 30 Jan 08, at 0820, James Cox wrote:
>
>> When it comes to more traditional electives- fixing minor heart
>> defects, dealing with sports injuries, etc - again i'd be hard
>> pushed to imagine a parent choosing to refuse such a course of
>> action, where a doctor believes it is safe to go ahead.
>
> Jehovah's Witnesses? Christian Scientists?
>
They probably wouldn't be going down the elective path anyhow;
electives are for treatments that are life improving but not strictly
required. A doctor is not going to waste their time forcing a
treatment on a JW when it's not life threatening!
> And what's the MMR vaccination rate looking like today?
Again, sensationalism - show me a one year old who's capable of
forming clearly definable sentences, and i'll give them the right of
proxy over _my_ treatment. As you noted below, individual treatment
consent kicks in at about 16 (and that's really not a hard defined
line)... anything before, you really gotta demonstrate competence, and
that's hard.
>>
>> Interestingly the one other elective treatment that may cause
>> contention is where we started: abortion. If i remember correctly,
>> a doctor may not be permitted to involve a parent in an abortion
>> without the patient's consent, however prescription of birth
>> control pills still seems to involve parental notification for
>> minors.
>
> If it does, it's not consistent. A friend of ours was prescribed
> them in the 80s, and the lack of knowledge by her parents meant that
> the vital fact that several of her mother's relatives had had DVTs
> wasn't communicated. She had a DVT in her early twenties.
>
No kidding. the lack of consistency is a problem - there are more than
a handful of GPs who believe that once they exit medical school, they
believe that their training is done. It's shocking in fact...
> From http://cks.library.nhs.uk/contraception_emergency/in_depth/management_issues
> :
>
> Consent to medical treatment
> In the UK, people over the age of 16 years are presumed to be
> competent to consent to medical treatment. In contrast, competence
> to consent to medical treatment must be demonstrated in children
> under the age of 16 years [FFPRHC, 2004a].
> In England and Wales, it is lawful to provide contraceptive advice
> and treatment to young people without parental consent, provided
> that the practitioner is satisfied that the Fraser criteria for
> competence are met [Teenage Pregnancy Unit, 2001; FFPRHC, 2004a;
> Wheeler, 2006]. The criteria are that:
> The young person understands the practitioner's advice.
> The young person cannot be persuaded to inform their parents, or
> will not allow the practitioner to inform the parents, that
> contraceptive advice has been sought.
> The young person is likely to begin or to continue having
> intercourse with or without contraceptive treatment.
> Unless she receives contraceptive advice or treatment, the young
> person's physical or mental health (or both) are likely to suffer.
> The young person's best interest requires the practitioner to give
> contraceptive advice or treatment (or both) without parental consent.
Interesting - but if you read between the lines here, the clause
exemption for contraceptive advice basically is about the following-
that in first preference, parental advice is preferred (some
practitioners will require a minor to go home and book another
appointment with a parent, period (the more conservative types),
refusing to treat. still today.)... where the minor chooses not to
inform parents (seriously, who would ?? :)) then it's all about
dealing with the resulting problem - teen pregnancy. There's a reason
we're still consistently near the top of the developed world in teen
pregnancy rates - we have a prudish attitude to sex and sexual health-
which is systemic through the education system, the nhs and so on... i
certainly have no idea where my nearest family planning clinic would
be- if it even exists anymore!
These clauses are really just about placating an outdated ideal that
kids don't have pre-marital/adult sex. We should just accept that's
not true and focus on providing the best healthcare - to better
ensure the protection of our teenage population. By the way - as an
aside: if a twelve year old came into a GP's practice and demonstrated
a desire to begin a sexual relationship, that they had knowledge etc,
but were insistent not to discuss with their parents - what would you
do as the GP? (personally, i think a psychiatric referral isn't too
far out of the question - which conveniently makes it somewhat easier
to tell the parents...).
This has all been getting way off topic (though i have enjoyed it) -
to tie it in a bit more: i think it's a fair argument to make (legally
and morally) that once you express desire to engage in sexual
activity, that you learn about the risks and rewards and show the
appropriate maturity to handle that, then anything that becomes of
that part of your life is your own - and not your parents. This leads
through to abortion or any other procedure- if you choose not to
involve your family, well - that's your choice. If a clinic chooses to
ignore your preference and contact them anyhow, then they are behaving
negligently and therefore the finding in NY would seem to be
appropriate, and i hope the clinic changes their standards to better
protect patient confidentiality.
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<html><body style=3D"word-wrap: break-word; -webkit-nbsp-mode: space; =
-webkit-line-break: after-white-space; "><br><div><div>On 30 Jan 2008, =
at 09:09, Ian Batten wrote:</div><br =
class=3D"Apple-interchange-newline"><blockquote type=3D"cite"><div =
style=3D"word-wrap: break-word; -webkit-nbsp-mode: space; =
-webkit-line-break: after-white-space; "> <br><div><div>On 30 Jan 08, at =
0820, James Cox wrote:</div><br =
class=3D"Apple-interchange-newline"><blockquote type=3D"cite"><div>When =
it comes to more traditional electives- fixing minor heart defects, =
dealing with sports injuries, etc - again i'd be hard pushed to imagine =
a parent choosing to refuse such a course of action, where a doctor =
believes it is safe to go ahead.</div></blockquote><div><br =
class=3D"webkit-block-placeholder"></div><div>Jehovah's Witnesses? =
Christian =
Scientists?</div><div><br></div></div></div></blockquote>They probably =
wouldn't be going down the elective path anyhow; electives are for =
treatments that are life improving but not strictly required. A doctor =
is not going to waste their time forcing a treatment on a JW when it's =
not life threatening!<br><br><blockquote type=3D"cite"><div =
style=3D"word-wrap: break-word; -webkit-nbsp-mode: space; =
-webkit-line-break: after-white-space; "><div><div>And what's the MMR =
vaccination rate looking like =
today?</div></div></div></blockquote><div><br></div><div>Again, =
sensationalism - show me a one year old who's capable of forming clearly =
definable sentences, and i'll give them the right of proxy over _my_ =
treatment. As you noted below, individual treatment consent kicks in at =
about 16 (and that's really not a hard defined line)... anything before, =
you really gotta demonstrate competence, and that's hard.</div><div><br =
class=3D"webkit-block-placeholder"></div><blockquote type=3D"cite"><div =
style=3D"word-wrap: break-word; -webkit-nbsp-mode: space; =
-webkit-line-break: after-white-space; "><div><blockquote type=3D"cite"> =
<div><br></div> <div>Interestingly the one other elective treatment that =
may cause contention is where we started: abortion. If i remember =
correctly, a doctor may not be permitted to involve a parent in an =
abortion without the patient's consent, however prescription of birth =
control pills still seems to involve parental notification for =
minors.</div> </blockquote><br></div><div>If it does, it's not =
consistent. A friend of ours was prescribed them in the 80s, and =
the lack of knowledge by her parents meant that the vital fact that =
several of her mother's relatives had had DVTs wasn't communicated. =
She had a DVT in her early =
twenties.</div><div><br></div></div></blockquote><div><br =
class=3D"webkit-block-placeholder"></div>No kidding. the lack of =
consistency is a problem - there are more than a handful of GPs who =
believe that once they exit medical school, they believe that their =
training is done. It's shocking in fact...<br><br><blockquote =
type=3D"cite"><div style=3D"word-wrap: break-word; -webkit-nbsp-mode: =
space; -webkit-line-break: after-white-space; "><div><div>From <a =
href=3D"http://cks.library.nhs.uk/contraception_emergency/in_depth/managem=
ent_issues">http://cks.library.nhs.uk/contraception_emergency/in_depth/man=
agement_issues</a>:</div><div><br =
class=3D"webkit-block-placeholder"></div><div><ul> <li style=3D"margin: =
0.0px 0.0px 0.0px 0.0px; line-height: 16.0px"><font face=3D"Verdana" =
size=3D"3" color=3D"#212121" style=3D"font: 11.0px Verdana; color: =
#212121"><b>Consent to medical treatment</b></font></li> <ul> <li =
style=3D"margin: 0.0px 0.0px 0.0px 0.0px; line-height: 16.0px"><font =
face=3D"Verdana" size=3D"3" color=3D"#212121" style=3D"font: 11.0px =
Verdana; color: #212121"></font></li> <li style=3D"margin: 0.0px 0.0px =
0.0px 0.0px; line-height: 16.0px"><font face=3D"Verdana" size=3D"3" =
color=3D"#212121" style=3D"font: 11.0px Verdana; color: #212121">In the =
UK, people over the age of 16 years are presumed to be competent to =
consent to medical treatment. In contrast, competence to consent to =
medical treatment must be demonstrated in children under the age of 16 =
years [<a =
href=3D"http://cks.library.nhs.uk/contraception/in_depth/references#A18109=
"><font color=3D"#0056c2" style=3D"color: #0056c2"><u>FFPRHC, =
2004</u>a</font></a>].</font></li> <li style=3D"margin: 0.0px 0.0px =
0.0px 0.0px; line-height: 16.0px"><font face=3D"Verdana" size=3D"3" =
color=3D"#212121" style=3D"font: 11.0px Verdana; color: =
#212121"></font></li> <li style=3D"margin: 0.0px 0.0px 0.0px 0.0px; =
line-height: 16.0px"><font face=3D"Verdana" size=3D"3" color=3D"#212121" =
style=3D"font: 11.0px Verdana; color: #212121">In England and Wales, it =
is lawful to provide contraceptive advice and treatment to young people =
without parental consent, provided that the practitioner is satisfied =
that the Fraser criteria for competence are met [<a =
href=3D"http://cks.library.nhs.uk/contraception/in_depth/references#A10955=
"><font color=3D"#0056c2" style=3D"color: #0056c2"><u>Teenage Pregnancy =
Unit, 2001</u></font></a>; <a =
href=3D"http://cks.library.nhs.uk/contraception/in_depth/references#A18109=
"><font color=3D"#0056c2" style=3D"color: #0056c2"><u>FFPRHC, =
2004</u>a</font></a>; <a =
href=3D"http://cks.library.nhs.uk/contraception/in_depth/references#A24628=
"><font color=3D"#0056c2" style=3D"color: #0056c2"><u>Wheeler, =
2006</u></font></a>]. The criteria are that:</font></li> <ul> <li =
style=3D"margin: 0.0px 0.0px 0.0px 0.0px; line-height: 16.0px"><font =
face=3D"Verdana" size=3D"3" color=3D"#212121" style=3D"font: 11.0px =
Verdana; color: #212121">The young person understands the practitioner's =
advice.</font></li> <li style=3D"margin: 0.0px 0.0px 0.0px 0.0px; =
line-height: 16.0px"><font face=3D"Verdana" size=3D"3" color=3D"#212121" =
style=3D"font: 11.0px Verdana; color: #212121">The young person cannot =
be persuaded to inform their parents, or will not allow the practitioner =
to inform the parents, that contraceptive advice has been =
sought.</font></li> <li style=3D"margin: 0.0px 0.0px 0.0px 0.0px; =
line-height: 16.0px"><font face=3D"Verdana" size=3D"3" color=3D"#212121" =
style=3D"font: 11.0px Verdana; color: #212121">The young person is =
likely to begin or to continue having intercourse with or without =
contraceptive treatment.</font></li> <li style=3D"margin: 0.0px 0.0px =
0.0px 0.0px; line-height: 16.0px"><font face=3D"Verdana" size=3D"3" =
color=3D"#212121" style=3D"font: 11.0px Verdana; color: #212121">Unless =
she receives contraceptive advice or treatment, the young person's =
physical or mental health (or both) are likely to suffer.</font></li> =
<li style=3D"margin: 0.0px 0.0px 0.0px 0.0px; line-height: 16.0px"><font =
face=3D"Verdana" size=3D"3" color=3D"#212121" style=3D"font: 11.0px =
Verdana; color: #212121">The young person's best interest requires the =
practitioner to give contraceptive advice or treatment (or both) without =
parental consent.</font></li> </ul> </ul> =
</ul></div></div></div></blockquote></div>Interesting - but if you read =
between the lines here, the clause exemption for contraceptive advice =
basically is about the following-<div><br =
class=3D"webkit-block-placeholder"></div><div>that in first preference, =
parental advice is preferred (some practitioners will require =
a minor to go home and book another appointment with a parent, period =
(the more conservative types), refusing to treat. still =
today.)... where the minor chooses not to inform parents =
(seriously, who would ?? :)) then it's all about dealing with the =
resulting problem - teen pregnancy. There's a reason we're still =
consistently near the top of the developed world in teen pregnancy rates =
- we have a prudish attitude to sex and sexual health- which is systemic =
through the education system, the nhs and so on... i certainly have no =
idea where my nearest family planning clinic would be- if it even exists =
anymore!</div><div><br class=3D"webkit-block-placeholder"></div><div>These=
clauses are really just about placating an outdated ideal that kids =
don't have pre-marital/adult sex. We should just accept that's not =
true and focus on providing the best healthcare - to better =
ensure the protection of our teenage population. By the way - as an =
aside: if a twelve year old came into a GP's practice and demonstrated a =
desire to begin a sexual relationship, that they had knowledge etc, but =
were insistent not to discuss with their parents - what would you do as =
the GP? (personally, i think a psychiatric referral isn't too =
far out of the question - which conveniently makes it somewhat =
easier to tell the parents...).</div><div><br =
class=3D"webkit-block-placeholder"></div><div>This has all been getting =
way off topic (though i have enjoyed it) - to tie it in a bit more: i =
think it's a fair argument to make (legally and morally) that once you =
express desire to engage in sexual activity, that you learn about the =
risks and rewards and show the appropriate maturity to handle that, then =
anything that becomes of that part of your life is your own - and not =
your parents. This leads through to abortion or any other procedure- if =
you choose not to involve your family, well - that's your =
choice. If a clinic chooses to ignore your preference and contact =
them anyhow, then they are behaving negligently and therefore the =
finding in NY would seem to be appropriate, and i hope the clinic =
changes their standards to better protect patient =
confidentiality.</div><div><br =
class=3D"webkit-block-placeholder"></div><div><br =
class=3D"webkit-block-placeholder"></div><div><br =
class=3D"webkit-block-placeholder"></div><div><br =
class=3D"webkit-block-placeholder"></div></body></html>=
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