Dr Idara

 ABORTION  CONTRACEPTION  STERILIZATION  MINORS  DONATION OF SPERM AND EGGS

Abortion is legal in some US states. In some states, parental notification is needed if a minor seeks an abortion. There is no agreement in all US states. For minors, on the examination, there is a clear cut standard, you do not report to their parents; you encourage the minor to have a discussion with her parents.

An adult woman has an unrestricted access to abortion through the end of the first trimester Women do not need the approval or consent of anyone else to obtain a first-trimester abortion.

In the second trimester, the decision is between a woman and her physician, but the ease of a second trimester abortion is still not clear as states may regulate it when necessary to protect the life or health of the mother. Second trimester abortion is however still performed at the patient’s discretion.

Third-trimester abortions are not freely available, because the fetus is potentially viable. Third-trimester abortions are clearly restricted. Consent by the father for an abortion is not required. The fetus is considered as a part of the woman’s body and does not have a right until after birth.

There is no compulsion on the part of the physician to perform an abortion if performing this procedure is ethically unacceptable to the physician. You should simply refer the patient to another physician. The patient has a right to have an abortion, but they don’t have a right to force you to do it, if it is objectionable to you. It is considered unethical for a patient to seek an abortion for the purposes of gender selection

 There is no limitation on the access to contraception for either a man or a woman.  It is entirely at the discretion of the patient and equally true for minors.  Parental consent is not necessary to obtain contraception in minors.

 Both men and women have free access to sterilization.  Consent is only necessary from the patient.  Spousal consent is not required for sterilization  All reproductive issues can be performed over the objection of the spouse.

There is no limitation on a patient’s permissibility to donate sperm and unfertilized eggs. Payment may be received for sperm and unfertilized egg donations. In other words, there is no legal or ethical contradiction to selling sperm and unfertilized eggs. There is however, a prohibition against selling fertilized eggs. Fertilized eggs may be donated but not sold.

You are the general internist in a large, multispecialty physician group. The office-based pregnancy test on your patient has just become positive and you estimate the gestational age of the fetus at eight weeks. You are a very deeply religious person in a conservative, Midwestern city and you are opposed to abortion because you believe life begins at contraception. After extensive discussion about the options, your patient asks to be referred for an abortion. Which of the following is the most appropriate response?

a. “ I am pro-life and so I can’t help you” b. “ I will refer you to another doctor” c. “ I can no longer be your physician” d. “ patient’s like you make religious people very unhappy” e. “ keep the pregnancy, give – up the infant for adoption”

A 34-year-old female who you have treated in your office for years presents for an annual physical exam. During your interview with her, she states that she would like to undergo a bilateral tubal ligation as she does not wish to have children and she is tired of using oral contraceptives. You know that she has been in a relationship with and lived with her boyfriend for over ten years, but the couple have never been married. What is the best way to address this situation?

A. refer the patient to a gynecological surgeon for her procedure B. inform the patient that sterilization is against your beliefs and educate her about options such as adoption if she were to become pregnant C. review the risks and benefits of this procedure and ask the patient if she has discussed this issue with her significant other D. tell the patient that you can not make a referral until she brings her significant other to the office so all three of you can discuss this together E. tell the patient to wait for menopause as she will likely start to undergo that process within the next five years

1. Parental consent is not necessary for either contraception or prenatal care 2. The rules on parental consent in the case of abortion are less clear and vary from state to state 3. USMLE requires you to still encourage discussion with parent concerning the issue of abortion.