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  5. Contraception abortion and sexually transmitted infections STIs

0–18 years: guidance for all doctors

Contraception, abortion and sexually transmitted infections (STIs)

63

You can provide contraceptive, abortion35and STI advice and treatment, without parental knowledge or consent, to young people under 16 provided that:

  1. they understand all aspects of the advice and its implications
  2. you cannot persuade the young person to tell their parents or to allow you to tell them
  3. in relation to contraception and STIs, the young person is very likely to have sex with or without such treatment
  4. their physical or mental health is likely to suffer unless they receive such advice or treatment, and
  5. it is in the best interests of the young person to receive the advice and treatment without parental knowledge or consent.36 
35

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.

36

Gillick v West Norfolk and Wisbech AHA [1986] AC 112. See also R (on the application of Sue Axon) v The Secretary of State for Health & Anor [2006] EWHC 37 (Admin), [2006] 1FCR 175 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 (DH, 2004).

64

You should keep consultations confidential even if you decide not to provide advice or treatment (for example, if your patient does not understand your advice or the implications of treatment), other than in the exceptional circumstances outlined in paragraphs 46 to 52 and paragraphs 57 to 62.

46

If a child or young person does not agree to disclosure there are still circumstances in which you should disclose information:

  1. when there is an overriding public interest in the disclosure
  2. when you judge that the disclosure is in the best interests of a child or young person who does not have the maturity or understanding to make a decision about disclosure
  3. when disclosure is required by law.
47

You can disclose, without consent, information that identifies the child or young person, in the public interest. A disclosure is in the public interest if the benefits which are likely to arise from the release of information outweigh both the child or young person’s interest in keeping the information confidential and society’s interest in maintaining trust between doctors and patients. You must make this judgement case by case, by weighing up the various interests involved.

48

When considering whether disclosure would be justified you should:

  1. tell the child or young person what you propose to disclose and why, unless that would undermine the purpose or place the child or young person at increased risk of harm
  2. ask for consent to the disclosure, if you judge the young person to be competent to make the decision, unless it is not practical to do so.
49

If a child or young person refuses consent, or if it is not practical to ask for consent, you should consider the benefits and possible harms that may arise from disclosure. You should consider any views given by the child or young person on why you should not disclose the information. But you should disclose information if this is necessary to protect the child or young person, or someone else, from risk of death or serious harm. Such cases may arise, for example, if:

  1. a child or young person is at risk of neglect or sexual, physical or emotional abuse (see paragraphs 56 to 63)
  2. the information would help in the prevention, detection or prosecution of serious crime, usually crime against the person27 
  3. a child or young person is involved in behaviour that might put them or others at risk of serious harm, such as serious addiction, self-harm or joy-riding.
50

If you judge that disclosure is justified, you should disclose the information promptly to an appropriate person or authority and record your discussions and reasons. If you judge that disclosure is not justified, you should record your reasons for not disclosing.

51

Children will usually be accompanied by parents or other adults involved in their care, and you can usually tell if a child agrees to information being shared by their behaviour. Occasionally, children who lack the capacity to consent will share information with you on the understanding that their parents are not informed. You should usually try to persuade the child to involve a parent in such circumstances. If they refuse and you consider it is necessary in the child’s best interests for the information to be shared (for example, to enable a parent to make an important decision, or to provide proper care for the child), you can disclose information to parents or appropriate authorities. You should record your discussions and reasons for sharing the information.

52

You must disclose information as required by law. You must also disclose information when directed to do so by a court.28 

57

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.32 That in turn presents dangers to young people’s own health and to that of the community, particularly other young people.

58

You can disclose relevant information when this is in the public interest (see paragraphs 47 to 50). 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.

59

You should consider each case on its merits and take into account young people’s behaviour, living circumstances, maturity, serious learning disabilities, and any other factors that might make them particularly vulnerable.

60

You should usually share information about sexual activity involving children under 13, who are considered in law to be unable to consent.33 You should discuss a decision not to disclose with a named or designated doctor for child protection and record your decision and the reasons for it.

61

You should usually share information about abusive or seriously harmful sexual activity involving any child or young person, including that which involves:

  1. a young person too immature to understand or consent
  2. big differences in age, maturity or power between sexual partners
  3. a young person’s sexual partner having a position of trust
  4. force or the threat of force, emotional or psychological pressure, bribery or payment, either to engage in sexual activity or to keep it secret
  5. drugs or alcohol used to influence a young person to engage in sexual activity when they otherwise would not
  6. a person known to the police or child protection agencies as having had abusive relationships with children or young people.34 
62

You may not be able to judge if a relationship is abusive without knowing the identity of a young person’s sexual partner, which the young person might not want to reveal. If you are concerned that a relationship is abusive, you should carefully balance the benefits of knowing a sexual partner’s identity against the potential loss of trust in asking for or sharing such information.

Conscientious objections

65

If carrying out a particular procedure or giving advice about it conflicts with your religious or moral beliefs, and this conflict might affect the treatment or advice you provide, you must explain this to the patient and tell them they have the right to see another doctor.37 You should make sure that information about alternative services is readily available to all patients. Children and young people in particular may have difficulty in making alternative arrangements themselves, so you must make sure that arrangements are made for another suitably qualified colleague to take over your role as quickly as possible.