- Email: [email protected]
AGE OF CONSENT TO ABORTION
1418 to further
State control of all life-social, financial, and political and destroy the family as a social and political force. In the 1980 presidential election, the voters endorsed overwhelmingly the profamily philosophy. The "statists" are now attempting in all ways possible to frustrate the will of that majority, and your correspondent seems determined to aid and abet them. There can be no question that there is a large amount of teenage sexual activity, and also a large number of illegitimate pregnancies, with or without abortion. Fordecade, Federal, State, and local governments have been giving out contraceptives of one sort or another as they would candy. This has made no inroad into the problem. More of the same will hardly solve it. The "statists" contend that the problem is not the responsibility of the teenagers’ parents. However, the law still gives to the parents the greatest responsibility for the teenager-for instance, who pays for property damage or personal liability incurred by a teenager in a motor
obtained but their refusal should not be allowed to prevent a lawful termination to which the patient herself consents and which is considered to be clinically necessary. Conversely a termination should never be carried out in opposition to the girl’s wishes even if the parents demand it." (Medical Defence Union. Consent to Treatment, 1974.)
to
,
vehicle accident? The Reagan Government in simply making the not unreasonable regulation that parents be informed if their minor children are dispensed contraceptives at a tax-supported clinic. There is a lot of evidence that many teenage females have pregnancies to satisfy peculiar psychological yearning of their own and not as a result of lack of sex education. For many years, there have been certain groups in United States society with high rates of illegitimate births. This was always accepted as a "fact of life" and little commented on. Now these figures are carefully compiled to make a point. These groups will not be affected by further contraceptive dispensation. Also, the Government rewards illegitimate births with their financial aid to dependent children. Many people have reported in interviews that they have one illegitimate pregnancy after another to increase the aid-to-dependent-children payments. Many are teenagers and will be little influenced by contraceptive availability until the "gain in illness" is reduced. We are drowning in a sea of contraceptives and sex education. It is time we got the government and the "statists" out of the teenage sex business. Breaching the confidentiality of the doctor-patient relationship is a ludicrous argument. Teenagers do not go to private physicians on their own because they cannot afford it. For the few who do, the failure of the teenagers’ parents to pay the bill, will quickly overcome the physician’s scruples about the doctor-patient
relationship. Scottsdale Memorial Hospital, Scottsdale, Arizona 85251, U.S.A.
JOHN F. CURRIN
AGE OF CONSENT TO ABORTION
SIR,-In commenting (May 22) on the case of the 15-year-old girl whom Mrs Justice Butler-Sloss allowed to have an abortion despite the parents’ objections, Mrs Brahams does not raise the question of the ability of a girl under 16 to give her own valid consent to medical treatment. It is generally recognised that in exceptional cases where a doctor considers contraception to be in the best interests of a patient aged under 16, but is unable to obtain parental consent, he may decide that the patient is capable of understanding and giving consent herself (British Medical Association Handbook of Medical Ethics, 1981). The same principle would seem to apply in abortion, although, fortunately, the occasions when the question would arise in practice are even more rare. In this particular case, because the girl was both in care and a ward of court, the local authority may have considered it necessary, in accordance with their general duty, to bring all major decisions back to court. However, this cannot and should not override, irrespective of whose care she is in, the girl’s common law right to give her own ’
consent.
In this respect, the
Children’s Legal Centre, 2 Malden Road, London NW5 3HR
MADELEINE COLVIN
Brook Advisory Centres, 153a East Street, London SE17 2SD
CAROLINE WOODROFFE
ROLE OF THE CLINICAL GENETICIST
SIR,-I was very impressed by your editorial on regional genetic services (March 20, p. 633). As a former paediatrician, recruited to clinical genetics, permit me to make some observations. Prof. Alan Emery has an admirable quotation from The Duchess of Malfi, featured prominently in his department and in some of his
publications: "Past sorrows, let us moderately lament them, For those to come, seek wisely to prevent them."
This embodies the main aim of medical genetics. However, a very dimension is missing-the present. Your editorial does refer to the possibility of the geneticist, according to his background and interests, joining colleagues in treatment and management. In some instances he should take the lead. Partly this is to establish the natural history of individually rare disorders; then there is a direct treatment aspect, and this is likely to become more important in the future. It is not good enough merely to establish the presence of an eventually lethal or severely handicapping genetic condition. Genetic counselling, with parents deciding to limit their families or with abortion on the basis of a high risk figure or antenatal diagnosis, is a second best alternative. If we could offer cure of a condition such as cystic fibrosis, then the genetic aspects would become relatively unimportant-witness the position as it applies to phenylketonuria. Of course, in the absence of cures then the best that we can do is to offer accurate genetic information. We have read recently of reversal of clinical features in an infant with Hurler’s disease treated by bone-marrow transplant.There are a host of metabolic disorders which might benefit from such an
important
approach. Zatz et awl. have described an unusually benign course in a boy with Duchenne muscular dystrophy and incidental growth hormone deficiency. On the basis of this report, Zatz and FrotaPessoa3 wonder whether treatment with a growth hormone inhibitor might ameliorate the course of this dreadful disease. There are very few loci thus far assigned to chromosome 21, the smallest chromosome with a large heterochromatic (non-coding) region. Children with Down syndrome have a 11/2-fold increase in the enzyme superoxide dismutase.4,5 Could the dose effect of this enzyme be sufficient to account for the tragic effects of trisomy 21? Often progress in early infancy has led the unwary to predict a better mental outcome than that eventually achieved. The brain in Down syndrome shows premature onset of senile dementia. Discovery of the switch for superoxide dismutase could allow normal mental
development. Professor Lejeune (Jan. 30, p. 273) hypothesises on the possible of the fragile X syndrome by administration of monocarbon donors. Recruitment to clinical genetics of someone with training in paediatrics, general medicine, or obstetrics wastes this background if he plays no part in the treatment process. Because of the full range treatment
disease
2.
following references may be helpful:
"The preferred view is that a minor’s competency [to give consent to medical treatment] depends on whether he or she can comprehend what is involved in the procedure in question; there are no fixed rules based upon age, legal status medical condition." (Gostin L. Int J Law Psychiat, 1979.) "When the girl is under 16 her parents should always be consulted unless she forbids the practitioner to do so. The written consent of the parents should be
JR, Hugh-Jones K, Barrett AJ,
et al. Reversal of clinical features of Hurler’s biochemical improvement after treatment by bone-marrow transplantation. Lancet 1981; ii: 709-12. Zatz M, Betti RTB, Levy JA. Benign Duchenne muscular dystrophy in a patient with growth hormone deficiency. Am J Med Genet 1981; 10: 301-04. Zatz M, Frota-Pessoa O. Suggestion for a possible mitigating treatment of Duchenne muscular dystrophy. Am J Med Genet 1981; 10: 305-07. Sichitiu S, Sinet PM, Lejeune J, Frezal J. Surdosage de la forme dimerique de l’indophenoloxydase dans la trisomie 21, secondaire au surdosage genique. Humangenetik 1974; 23: 65-72 Feaster W, Kwok L, Epstein CJ. Dosage effects for superoxide dismutase-1in nucleated cells for chromosome 21. Am J Hum Genet 1977; 29: 563-70.
1. Hobbs
3. 4.
or
5.
and
State control of all life-social, financial, and political and destroy the family as a social and political force. In the 1980 presidential election, the voters endorsed overwhelmingly the profamily philosophy. The "statists" are now attempting in all ways possible to frustrate the will of that majority, and your correspondent seems determined to aid and abet them. There can be no question that there is a large amount of teenage sexual activity, and also a large number of illegitimate pregnancies, with or without abortion. Fordecade, Federal, State, and local governments have been giving out contraceptives of one sort or another as they would candy. This has made no inroad into the problem. More of the same will hardly solve it. The "statists" contend that the problem is not the responsibility of the teenagers’ parents. However, the law still gives to the parents the greatest responsibility for the teenager-for instance, who pays for property damage or personal liability incurred by a teenager in a motor
obtained but their refusal should not be allowed to prevent a lawful termination to which the patient herself consents and which is considered to be clinically necessary. Conversely a termination should never be carried out in opposition to the girl’s wishes even if the parents demand it." (Medical Defence Union. Consent to Treatment, 1974.)
to
,
vehicle accident? The Reagan Government in simply making the not unreasonable regulation that parents be informed if their minor children are dispensed contraceptives at a tax-supported clinic. There is a lot of evidence that many teenage females have pregnancies to satisfy peculiar psychological yearning of their own and not as a result of lack of sex education. For many years, there have been certain groups in United States society with high rates of illegitimate births. This was always accepted as a "fact of life" and little commented on. Now these figures are carefully compiled to make a point. These groups will not be affected by further contraceptive dispensation. Also, the Government rewards illegitimate births with their financial aid to dependent children. Many people have reported in interviews that they have one illegitimate pregnancy after another to increase the aid-to-dependent-children payments. Many are teenagers and will be little influenced by contraceptive availability until the "gain in illness" is reduced. We are drowning in a sea of contraceptives and sex education. It is time we got the government and the "statists" out of the teenage sex business. Breaching the confidentiality of the doctor-patient relationship is a ludicrous argument. Teenagers do not go to private physicians on their own because they cannot afford it. For the few who do, the failure of the teenagers’ parents to pay the bill, will quickly overcome the physician’s scruples about the doctor-patient
relationship. Scottsdale Memorial Hospital, Scottsdale, Arizona 85251, U.S.A.
JOHN F. CURRIN
AGE OF CONSENT TO ABORTION
SIR,-In commenting (May 22) on the case of the 15-year-old girl whom Mrs Justice Butler-Sloss allowed to have an abortion despite the parents’ objections, Mrs Brahams does not raise the question of the ability of a girl under 16 to give her own valid consent to medical treatment. It is generally recognised that in exceptional cases where a doctor considers contraception to be in the best interests of a patient aged under 16, but is unable to obtain parental consent, he may decide that the patient is capable of understanding and giving consent herself (British Medical Association Handbook of Medical Ethics, 1981). The same principle would seem to apply in abortion, although, fortunately, the occasions when the question would arise in practice are even more rare. In this particular case, because the girl was both in care and a ward of court, the local authority may have considered it necessary, in accordance with their general duty, to bring all major decisions back to court. However, this cannot and should not override, irrespective of whose care she is in, the girl’s common law right to give her own ’
consent.
In this respect, the
Children’s Legal Centre, 2 Malden Road, London NW5 3HR
MADELEINE COLVIN
Brook Advisory Centres, 153a East Street, London SE17 2SD
CAROLINE WOODROFFE
ROLE OF THE CLINICAL GENETICIST
SIR,-I was very impressed by your editorial on regional genetic services (March 20, p. 633). As a former paediatrician, recruited to clinical genetics, permit me to make some observations. Prof. Alan Emery has an admirable quotation from The Duchess of Malfi, featured prominently in his department and in some of his
publications: "Past sorrows, let us moderately lament them, For those to come, seek wisely to prevent them."
This embodies the main aim of medical genetics. However, a very dimension is missing-the present. Your editorial does refer to the possibility of the geneticist, according to his background and interests, joining colleagues in treatment and management. In some instances he should take the lead. Partly this is to establish the natural history of individually rare disorders; then there is a direct treatment aspect, and this is likely to become more important in the future. It is not good enough merely to establish the presence of an eventually lethal or severely handicapping genetic condition. Genetic counselling, with parents deciding to limit their families or with abortion on the basis of a high risk figure or antenatal diagnosis, is a second best alternative. If we could offer cure of a condition such as cystic fibrosis, then the genetic aspects would become relatively unimportant-witness the position as it applies to phenylketonuria. Of course, in the absence of cures then the best that we can do is to offer accurate genetic information. We have read recently of reversal of clinical features in an infant with Hurler’s disease treated by bone-marrow transplant.There are a host of metabolic disorders which might benefit from such an
important
approach. Zatz et awl. have described an unusually benign course in a boy with Duchenne muscular dystrophy and incidental growth hormone deficiency. On the basis of this report, Zatz and FrotaPessoa3 wonder whether treatment with a growth hormone inhibitor might ameliorate the course of this dreadful disease. There are very few loci thus far assigned to chromosome 21, the smallest chromosome with a large heterochromatic (non-coding) region. Children with Down syndrome have a 11/2-fold increase in the enzyme superoxide dismutase.4,5 Could the dose effect of this enzyme be sufficient to account for the tragic effects of trisomy 21? Often progress in early infancy has led the unwary to predict a better mental outcome than that eventually achieved. The brain in Down syndrome shows premature onset of senile dementia. Discovery of the switch for superoxide dismutase could allow normal mental
development. Professor Lejeune (Jan. 30, p. 273) hypothesises on the possible of the fragile X syndrome by administration of monocarbon donors. Recruitment to clinical genetics of someone with training in paediatrics, general medicine, or obstetrics wastes this background if he plays no part in the treatment process. Because of the full range treatment
disease
2.
following references may be helpful:
"The preferred view is that a minor’s competency [to give consent to medical treatment] depends on whether he or she can comprehend what is involved in the procedure in question; there are no fixed rules based upon age, legal status medical condition." (Gostin L. Int J Law Psychiat, 1979.) "When the girl is under 16 her parents should always be consulted unless she forbids the practitioner to do so. The written consent of the parents should be
JR, Hugh-Jones K, Barrett AJ,
et al. Reversal of clinical features of Hurler’s biochemical improvement after treatment by bone-marrow transplantation. Lancet 1981; ii: 709-12. Zatz M, Betti RTB, Levy JA. Benign Duchenne muscular dystrophy in a patient with growth hormone deficiency. Am J Med Genet 1981; 10: 301-04. Zatz M, Frota-Pessoa O. Suggestion for a possible mitigating treatment of Duchenne muscular dystrophy. Am J Med Genet 1981; 10: 305-07. Sichitiu S, Sinet PM, Lejeune J, Frezal J. Surdosage de la forme dimerique de l’indophenoloxydase dans la trisomie 21, secondaire au surdosage genique. Humangenetik 1974; 23: 65-72 Feaster W, Kwok L, Epstein CJ. Dosage effects for superoxide dismutase-1in nucleated cells for chromosome 21. Am J Hum Genet 1977; 29: 563-70.
1. Hobbs
3. 4.
or
5.
and