What Are the Legal Considerations in Giving a 13-Year-Old Medroxyprogesterone (Depo-Provera)?

Marilyn W. Edmunds, PhD, NP

Disclosures

October 30, 2001

Question

A mother brought her 13-year-old daughter to our clinic, requesting that the child be given medroxyprogesterone (Depo-Provera). The child stated that she is not sexually active and does not want the medication. What are the health and legal issues relevant to this situation?

Response from Marilyn W. Edmunds, PhD, NP

While there is much in the ethical and legal arenas to guide a primary care provider in the care of a minor child who wishes to obtain confidential family planning services, the situation you describe is without legal precedent. Clearly, this situation speaks loudly about the problems inherent in a family dynamic that does not include trust between parent and teen. It appears that this mother is not willing to accept her daughter's claim that she is not sexually active. This needs to be explored with both individuals. Was this mother a teenage parent and is she concerned that the same thing will happen with her daughter? Can the NP facilitate an open discussion in this family that concludes with an agreement that the daughter will speak with the mother if she is contemplating becoming sexually active? Is the mother's concern masking the existence of sexual abuse in the home? All of these issues need to be explored with the family.

Let's start with the easy part of your question -- the health issues. Obviously, whether a teen receives medroxyprogesterone (Depo-Provera) at her own request or by way of her parent, the health issues are the same. Medroxyprogesterone, a synthetic injectable progestin-only contraceptive, is a very effective product administered via injection every 3 months. Medroxyprogesterone is a popular choice in teens because of the ease of administration and efficacy rate of 99.7%. Since the product does not contain any estrogen, estrogen-related side effects such as weight gain, nausea, breast tenderness, and hypertension are avoided. However, like all hormonal products, it requires that the teen be well educated about its use and the expected, common side effects. Most upsetting to teenagers can be the amenorrhea that frequently occurs with this product. In the situation you describe, it is reasonable to educate both the mother and daughter about this product, including contraindications to use, expected side effects, and benefits. Be certain that the teenager's rejection of this product is not due to fear of injection or misperceptions about side effects.

The legal issues are less defined. A query of several legal experts reveals that there is no clear, statutory law in this area. Melanie Goodman PNP, JD recommends that nurse practitioners (NPs) be familiar with child abuse statutes in their state, since forced administration of a drug that is not necessary could be considered abuse. The NP could explain to the mother that she/he cannot give this drug to the child without the child's permission as mandated by law. Administration of the medication could be considered assault and battery and the NP would be the one committing the battery (an offensive touching or use of force on a person without the person's consent). Both the mother and the NP could be construed to be breaking the law and could be held criminally liable. If the mother states that she will go somewhere else, the NP should consider filing a child abuse report.

It would be prudent to discuss this situation separately with both parent and child. The mother needs to be aware of the potential legal and ethical concerns with this demand. The child needs to know that the NP is a confidential source of information. Probably the best outcome would be an agreement between the child and the NP that the teen will present immediately if she is contemplating becoming sexually active. The parent must be reassured that the NP will be available to both of them but that interaction between provider and child is confidential.

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