Sexual health guidance could undermine trust

This summer, the London Child Protection Committee issued draft guidance for people working with sexually active children and young people that caused something of a commotion among doctors.

They were particularly worried by its suggestion that anybody under the age of 13 who was sexually active should be reported to the police. It also said that whenever doctors were aware that someone under 16 was having sex, a check should be made with the police as to whether his or her sexual partner was known to them.

The guidance threw out current practice and rode roughshod over doctors’ discretion, preventing them from making decisions in the best interests of young people.

Doctors have worked hard to secure the confidence of young people. At a time when sexually transmitted infections and underage pregnancy are on the increase, the guidance could effectively destroy trust in health services and turn young people away in droves.

It is important to get worries about the guidance into perspective. Both the doctors’ regulatory body, the General Medical Council, and its professional trade union, the British Medical Association, say that doctors must always look after the best interests of young people. All health professionals have to keep information they get from their patients confidential and they can and will be disciplined if they do not.

This does not mean, however, that they are unaware of the need to protect children and vulnerable young people from getting hurt. Where there is any reason to suspect that young people are being harmed, confidential information can be given to the police or social services.

In the BMA’s view, doctors should always talk this over with the young person first so that they understand and agree to the information being passed on. Persuading young people why they should involve social services or the police can take time – young people may take a while before they come to trust their doctor. Forcing doctors to tell the police would leave no room for manoeuvre and young people could end up not talking to the very people who can help them.

Doctors are also well aware of the health risks for young people of starting sex too early. Looking after them may mean encouraging them to wait a while. Doctors will also try and get them to talk about the issues with their parents. But when young people are already sexually active in a mutually agreed relationship with someone of a similar age, looking after them properly can include providing sexual health advice or contraception.

It is clear that patients’ lifelong view of doctors can also be influenced by how they are treated when they are young. Passing on information without their agreement should only happen when it is absolutely necessary and never as a matter of routine.

Doctors are also aware that the younger the patient, the greater the need to ensure they are not being forced or coerced into sexual relationships, or otherwise abused. They need to be especially careful with young people who appear particularly vulnerable. Doctors are agreed that the very young would always fall into this category – but this is not the same as saying that they should always be reported to the police.

In the BMA’s view, the London Child Protection Committee guidance should be withdrawn. It is likely to create confusion as to whether doctors can talk about sexual health or give contraceptives to some young patients even where they consider this to be the best thing. It will not help doctors and other health professionals to make difficult decisions about how best to look after children and young people. In the end, the guidance could wind up hurting those children and young people it was designed to help.

Dr Vivienne Nathanson is head of science and ethics at the British Medical Association

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