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Chapter 22 The Physician and Teenage Sexuality A few facts should set the stage for the question I want to raise in this chapter. Every year in the United States, more than a million teenagers become pregnant.1 Of this number, 30,000 are under fifteen years of age. The United States leads nearly all developed countries in pregnancies in the age group fifteen to nineteen. Around 45%of the pregnancies end in abortion . Of those that end in childbirth, more than half are illegitimate, and that figure is considerably higher in many areas. Behind such figures we will find what will surprise no one: a change in attitudes toward sexual conduct, unwed motherhood etc. Fully 20% of fifteen-year-old girls admit to having had sexual intercourse. The figure climbs to around 45% for seventeen-year-olds. Of teenagers who are sexually active, only around 30%use some form of contraception and many of those who do are poorly informed about methodology. Of the abortions now performed in the United States, nearly 30% are performed on teenagers. From figures such as these we can draw two easy conclusions: (1) There is an enormous problem. (2) This problem is not going away and is not likely to do soin the immediate future. I say "problem" because teenage pregnancies are associated with all sorts ofproblems: abortion, high divorce rates, financial dependence, school dropoutage, attempted suicide, underprivileged and uncared-for children, increased medical risk. It is widely agreed that the overall consequences of adolescent child-bearing are adverse. There are many aspects ofthis phenomenon that could be addressed in a useful way. In this chapter I want to relate it rather narrowly to the physician's possible role in facing it. I say "narrowly" because I want to 390 / Richard A. McCormick, S.J. raise a single practical question: should or may the physician ever givecontraceptive information (or, for that matter, natural family planning information ), and indeed, contraceptive devices to so-called "sexually active" teenagers? The question may appear somewhat quaint. After all, in a poll done by Yankelovich, Skelly and White, Inc., for Time magazine, 78%of Americans answered yes to the question: "Do you favor sex education in the schools, including information about birth control?"2 Furthermore, in some places on-campus health clinics that offer contraceptive information and dispense contraceptives have been established. So, what is so problematic about an individual physician, in the privacy of her/his office, prescribing a contraceptive on an individual basis? I raise this question for two reasons, both methodological in nature. First, it concerns the always thorny problem of cooperation in evil and as such it may be useful in lifting out the structural approach to such problems . Second, it may throw light on the physician's role insofar as this role demands of a physician that he/she practice medicine in accord with the dictates of conscience. To the question as put, I suspect that there would be two spontaneous but opposite answers. The first would say: "Whyjyes, .of course. This is the best and apparently the only way to prevent teenage pregnancy and its terrible consequences." This is especially the case ifthe spontaneous responder abhors abortion. There are two sorts ofdata that tend to indicate that at least very many would respond in this way. One is the Yankelovich poll cited above. Seventeen years ago(1972), a Gallup poll yielded similar results. It revealed that 75% of the American people believed that "birth control information, services and counselling should be made available to unmarried teenagers who are sexually active."3 Second, "numerous national physician and health organizations have endorsed the physician's right to exercise his medical judgment, free of legal barriers, in the provision of contraceptive care for the best interests of his minor patients."4 Included are: AMA, American College of Obstetricians and Gynecologists, American Academy of Pediatrics, American Health Association and others. The second spontaneous answer to the question raised is a firm and final "no." Provision ofsuch information and services encourages, is a contribution to further sexual license, and a betrayal ofthe physician's responsibility for the overall health of his patient. After all, it would be argued, the physician is not just an animated tool responding to those desires and demands. She, too, has a conscience, and her conduct must reflect that. The Utah Supreme Court seems to support this approach. A trial court had ruled that the requirement of parental consent for contraceptive services to...

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