California's Prop 4 Jeopardizes Doctor-Patient Relationship

Election '08
Editor's Note: Proposition 4 is the ballot initiative that would amend the California Constitution to require parental notification for teenagers obtaining abortions. One of its least discussed aspects of the proposition is that a teen who refuses to have her parents notified may choose to have another adult relative informed, but the young woman must file a written report detailing a pattern of "abuse" at the hands of her parents, which the doctor must immediately send to either Child Protective Services or the police, and must inform the substitute adult relative about the report to law enforcement as well as the teen's abortion. Otherwise, the teen must personally appear in court to obtain a waiver from a judge. This piece draws on an interview of Dr. Eleanor Drey by Carole Joffe about this aspect of Proposition 4. Drey is a UCSF obstetrician-gynecologist and a former high school teacher who also is the medical director of Women's Options Center, an abortion clinic at San Francisco General Hospital.

I'm a doctor, not a cop. But if Proposition 4 should pass, the burden of determining whether a teen is falsely representing herself and her family will fall on me, as a physician. It would entirely shift the relationship between me and my teenage patients.

I don't want to have to ask my patients questions like,"Is that really your mother?" or "Have you given us the correct address for your aunt?"

Many people don't realize that as a health care provider, I am already a mandated reporter for abuse and rape. If there is reason for suspicion, I ask my patients, "Are you safe at home?" and "Were you forced to have sex with someone or otherwise abused?" It will be harder to build the trust to ask these sensitive questions if teens see meas a police investigator who has to verify the identities of those who came with them to the clinic. In cases of rape, we already help a patient to report the case and then work with detectives to obtain evidence.

Although it is unfortunate, I do not think that it necessarily means a teen is "abused"if she does not feel able to tell her parents about her pregnancy. Forcing her to file a write a narrative claiming a pattern of abuse by her parents that I then must file with authorities will almost certainly ruin her relationship with them-and she very likely does not want that relationship destroyed.

We do all we can at Women Options Center to encourage a teen to involve her parents in a pregnancy decision. And in most cases, teens do inform their parents, even when it is very hard for them to do so. Sometimes the positions are reversed -- parents will insist on an abortion for their 14-year-old, which the teen will not want. We then have to explain to the often desperate and sometimes furious parents that we cannot perform an abortion on anyone if it is not what she in fact wants.

Decisions about becoming sexually active, and continuing or terminating an unplanned pregnancy obviously can raise very difficult issues for teens and their families. What I have learned working at Women's Option Center is that there are no easy or one-size-fits-all solutions to these problems. If Prop. 4 passes, turning me and my colleagues into cops only will erode the trust between us and our younger, teenage patients.

We already know from what has happened in other states with these laws that these well-intentioned measures drive teens away from care. In those states, teens present later for abortions or travel out of state, both of which increase their medical risks. Moreover, some teens will take matters into their own hands to end an unwanted pregnancy, and I hate to think of the consequences. Prop 4 is truly misguided public policy that unfortunately will endanger California teens. That's why professional organizations that understand the complex lives and choices faced by teens oppose Prop. 4, including the California Medical Association, California Nurses Association, American Academy of Pediatrics, California Academy of Family Physician, Society for Adolescent Medicine and my own professional organization, the California chapter of the American College of Obstetricians and Gynecologists. We adults are supposed to protect teens, not endanger them at the ballot box or take away their ability to obtain safe medical care before they can even vote for themselves.

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