Section 2 Confidentiality conundrums
Make me a champion MDU advice
A GP registrar saw a 14-year-old girl who attended The MDU adviser discussed with the doctor the need to
with a friend and asked for a prescription for oral balance the potential harm that may come from disclosing
contraceptives. The girl was physically mature and information, primarily the possibility of the patient losing
appeared to have a good understanding of the trust in doctors, against the potential harm that may
advice the doctor gave about contraception. She flow from a failure to disclose. The adviser referred the
said she was determined to avoid getting pregnant doctor to the GMC guidance in the publication entitled
because it would ruin her chances of becoming an ‘0-18 years: guidance for all doctors’,(2007) which states
athlete. She said that her boyfriend was fully that doctors should consider each such case on its merits,
supportive of her ambitions. taking into account the potential vulnerability of the
The doctor could not persuade the girl to tell her parents
young person, and must protect young people who are
herself, or to allow the doctor to tell them, about the
involved in seriously harmful or abusive relationships by
prescription. The doctor came to the view that the girl
sharing relevant information with appropriate agencies,
had sufficient capacity to make an informed decision on
such as police or social services, quickly and professionally.
taking contraceptives. The doctor was confident that the risk of a failure to
Furthermore, the doctor was familiar with the Gillick
disclose information about the relationship outweighed
judgment* and felt justified in providing advice and a
the possible harm that could come from it. On the basis
prescription for the pill without the authority of the girl’s
of her fears that the coach was manipulating the girl, the
parents because it was in her best interest and because
GP registrar felt she would be able to justify a disclosure
her mental health was likely to suffer without treatment
to the police.
as she was anxious to avoid pregnancy. The MDU adviser suggested that it would be helpful to
The doctor also feared that the patient might begin to
discuss the case with the doctor’s supervising GP, and the
have sex with or without the oral contraceptive and
child protection lead at the PCT on an anonymised basis
might therefore be dependent on her partner to exercise
at first. The doctor was also advised to seek the girl’s
responsibility.
consent to disclose the information, and only if this was
withheld to disclose the minimum information necessary
As the doctor was preparing the prescription the friend, in the public interest.
who until then had been silent, said to the girl ‘Aren’t
you going to tell her, then?’ The patient looked
The girl should be told subsequently that a disclosure had
embarrassed and the doctor waited while the two girls
been made and what information had been disclosed.
had a whispered conversation and then asked what it
The adviser also recommended that the doctor keep clear
was she needed to know. It transpired that the patient’s
notes regarding her assessment of the girl’s capacity, the
boyfriend was in fact her athletics coach, aged 27.
reasons for disclosure, and what information had been
On further questioning about the relationship, the doctor
disclosed and to whom.
began to fear that this was an abusive relationship, The doctor again sought the consent of the girl to
especially after the girl confided that the coach had disclose information about her contraception and the
promised to ‘make her a champion’ if she slept with him. relationship she was having, but again the girl refused.
The doctor rang the MDU advice line to ask whether or
As a result, the doctor, having discussed the situation
not she would be justified in disclosing information
further with her supervisory GP and with the child
about the relationship without the consent of the girl
protection lead at the PCT, felt she had no option but to
and, if so, to whom disclosure should be made.
tell the police about her concerns. The police took action
immediately. They interviewed the athletics coach,
decided to bring charges against him, and he was
successfully prosecuted for having sex with a minor.
*Gillick v West Norfolk and Wisbech AHA (1985)
“…the patient’s boyfriend was in
fact her athletics coach, aged 27.”
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