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• cannot be persuaded to tell their parents or to allow you to tell them


• in relation to contraception and STIs, is very likely to have sex with or without such treatment


• is likely to suffer physical or mental health problems unless they receive such advice or treatment.


Consultations involving sexual activity in minors should always raise certain questions in your mind even if a patient is judged to be competent to consent. The GMC advises that if a “child or young person is involved in abusive or seriously harmful sexual activity, you must protect them by sharing relevant information with appropriate people or agencies, such as the police or social services, quickly and professionally”. You should usually share information about sexual activity where a patient is under the age of 13. Some patients may refuse to name the sexual partner and that in itself may be a cause for concern. The MDDUS is frequently asked about the fact that


sexual activity under the age of 16 is illegal. We advise that the full circumstances of each individual case need to be considered. In general there is no automatic requirement to involve other agencies and due regard must be paid to the young person’s capacity, the ages of those involved and the circumstances of the relationship. In any complex case you should seek advice from a suitable colleague, such as an adviser at MDDUS.


What’s best for Mary? In Mary’s case we would advise the GP to carefully check through the relevant clinical aspects, for example the duration of the pregnancy, how the pregnancy was confirmed and the patient’s general health. Clearly, Mary would also need to be advised about the medical aspects of her request for a termination of pregnancy. She is obviously very young at 14 and whilst she has a


supportive older sister, it would be helpful if Mary could discuss matters with her mother. Her sister has indicated that their father would be very angry but it should be explained to the patient that there are advantages of


informing at least one of her parents. In cases where the family is known to a practice it can be helpful to have prior knowledge of how parents might react in these circumstances. Mary has also indicated that she “could not face Dr Jones”, but she should be made aware that it is essential that relevant information about the consultation is shared and available in her records. It is essential that during the consultation the doctor


forms a clear view about the patient’s capacity. If there is any doubt that she is not sufficiently mature and lacks capacity, this will have to be explored with the patient and further steps taken to liaise with a parent. The involvement of the 17-year-old sister is helpful, but she would not be a valid proxy in circumstances where the 14-year-old lacked the capacity to make decisions on her own behalf. If the 14-year-old is deemed capable of making her own decisions the sister can certainly provide valuable support. In circumstances where the patient is deemed


competent and is insistent on referral for termination of pregnancy, having been fully advised of the likely procedures and their risks, an appropriate referral should be made. In view of the patient’s young age it would be helpful to speak to one of the local gynaecologists/family planning doctors directly to be aware of their own procedures and protocols and the patient advised accordingly. A range of practical aspects will also need to be


considered such as transportation to and from hospital, time away from the family, etc. Quite often young patients do not fully appreciate that it can be difficult to attend other facilities without the knowledge of at least one parent.


Seek further advice Situations such as these are complex and unique, and each case has to be assessed very carefully on its individual features. It is important to remember that your decisions may be called into question by subsequent events and complaints and you must be prepared to justify your actions. In all cases where there is any difficulty we advise members to discuss a case with colleagues and to seek our input for detailed advice.


Dr Gail Gilmartin, medico-legal adviser, with Jim Killgore, editor MDDUS Summons


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