Refuse to prescribe Sarah the Pill, and ring her parents to advise them of the consultation?
Sarah explains to Dr Williams that she wants to go on the contraceptive pill. She has discussed this with her boyfriend, but her parents are unaware of her visit.
Sarah is 15 years old. She has come alone to the GP surgery seeking advice about contraception.
Have you tried talking to your mum or dad about this Sarah? They could be supportive. They were your age not so long ago after all.
No way! They'd go mad! They still think I'm their little girl. And they don't even like Paul - they think he's a bad influence. They don't understand how we feel about each other.
And how about Paul - does he know you're here? Is he the same age as you?
No, he's 19 but...what difference does that make? Look, Dr Williams - I'm trying to be responsible here! We're having sex. I know about the risks of the pill, I know I should still use condoms, but I know they're not as reliable and I just don't want to risk getting pregnant. I do know what I'm doing.
Dr Williams prescribes Sarah the Pill, because she judges that she understands her advice and the implications of the treatment and that it is in her best interests. She discusses the benefits of condom use and tries to persuade Sarah to speak to her parents, or to allow her to speak to them. Sarah is adamant that she cannot talk to her parents so Dr Williams decides in the end that Sarah's best interests are served by prescribing without their knowledge. She asks the receptionist to arrange another appointment with Sarah so she can review the situation.
A confidential sexual health service is essential for the welfare of children and young people. Concern about confidentiality is the biggest deterrent to young people asking for sexual health advice 27. That in turn presents dangers to young people's own health and to that of the community, particularly other young people.
(0-18 years: guidance for all doctors, paragraph 64)
27. Best Practice Guidance for Doctors and other Health Professionals on the provision of Advice and Treatment to Young People under 16 on Contraception, Sexual and Reproductive Health (Department of Health, 2004).
You have the same duty of confidentiality to children and young people as you have to adults. But parents often want and need information about their children's care so that they can make decisions or provide care and support. Children and young people are usually happy for information to be shared with their parents. This sharing of information is often in the best interests of children and young people...
(0-18 years: guidance for all doctors, paragraph 21)
You can provide contraceptive, abortion30 and STI advice and treatment, without parental knowledge or consent, to young people under 16 provided that:
(a) they understand all aspects of the advice and its implications
(b) you cannot persuade the young person to tell their parents or to allow you to tell them
(c) in relation to contraception and STIs, the young person is very likely to have sex with or without such treatment
(d) their physical or mental health is likely to suffer unless they receive such advice or treatment, and
(e) it is in the best interests of the young person to receive the advice and treatment without parental knowledge or consent.31
(0-18 years: guidance for all doctors, paragraph 70)
30. The Abortion Act 1967 does not extend to Northern Ireland and the grounds on which abortion may be carried out are more restrictive than in the rest of the UK.
31. Gillick v West Norfolk and Wisbech AHA  AC 112. See also R (on the application of Sue Axon) v The Secretary of State for Health & Anor  EWHC 37 (Admin),  1 FCR 195 and Best Practice Guidance for Doctors and other Health Professionals on the provision of Advice and Treatment to Young People under 16 on Contraception, Sexual and Reproductive Health (Department of Health, 2004).