Approaches to Health Management: Sexuality

• "If you have specific concerns about your child's safety or well-being, please share those with me, and I can address them within the bounds of confidentiality and the law. I can also offer resources for both of you on adolescent development, sexual health, and communication."
• To the 17-year-old (if they are my patient): If the child has discussed sexual activity with me, I would:
  • Reinforce the importance of safe sex practices, including contraception and STI prevention.
  • Provide information and resources on sexual health.
  • Encourage open communication with their parent(s) or a trusted adult, while respecting their autonomy.
  • Assess for any risk factors, such as coercion or exploitation.
  • Explain the limits of confidentiality, especially regarding potential harm to themselves or others.

If the child is 14 years old:

• To the Father: My response would be very similar to when the child is 17, emphasizing patient confidentiality and encouraging open communication with the child. I would also highlight the legal implications of sexual activity at this age due to Florida's age of consent being 18.
• To the 14-year-old (if they are my patient):
  • I would address the information with even greater emphasis on the legal aspects of sexual activity and the potential risks involved, including STIs, unintended pregnancy, and exploitation.
  • I would strongly encourage them to talk to a trusted adult, which ideally would be their parents, but could also be another family member, school counselor, or another healthcare professional.
  • Given their age, I would be more inclined to explore the reasons for their sexual activity and assess for any underlying issues or vulnerabilities.
  • I would also discuss the importance of healthy relationships and consent.

If the child is 11 years old:

• To the Father: "It is understandable that you are concerned about your child. However, at 11 years old, sexual activity is developmentally very concerning and could indicate potential issues such as sexual abuse or exploitation.
• "Due to patient confidentiality, I cannot confirm or deny any information about your child's private matters. However, if you have specific reasons to believe your 11-year-old is sexually active, it is crucial to address this immediately.
• "I strongly recommend having a gentle and age-appropriate conversation with your child to understand what is happening. It's important to create a safe and supportive environment where they feel comfortable sharing.
• "I also want to emphasize that sexual activity involving an 11-year-old is illegal in Florida and could be a sign of abuse. If you have any suspicion of abuse, it is your legal and ethical responsibility to report it to the appropriate authorities, such as the Department of Children and Families or law enforcement. I am also obligated to report any suspicion of child abuse."
• To the 11-year-old (if they are my patient):
  • If an 11-year-old disclosed sexual activity, my primary concern would be their safety and well-being.
  • I would need to assess the situation carefully to determine if they are being harmed or exploited.
  • Due to their age and the potential for harm, the principle of confidentiality would likely be overridden by the need to protect the child. I would need to inform Child Protective Services and potentially their parents about the disclosure, explaining the reasons for this breach of confidentiality to the child in an age-appropriate manner.
  • I would provide support and resources to the child and their family as needed.

Florida Law Regarding Parental Notification:

As mentioned earlier, there is no specific Florida law that mandates parental notification solely based on a minor being sexually active. However, there are laws regarding parental consent for certain medical procedures, like abortion.

Ethical Considerations:

In all these scenarios, I would be guided by the following ethical principles:

• Beneficence: Acting in the best interest of the child.
• Non-maleficence: Avoiding harm to the child.
• Autonomy: Respecting the child's right to make decisions, to the extent they are capable. This is a developing capacity in adolescence.
• Justice: Ensuring fair and equitable treatment.

Balancing the father's concern with the child's right to privacy and my ethical and legal obligations is crucial. Open communication within the family is ideal, and I would encourage that while respecting the child's confidentiality within legal and ethical boundaries. In cases of suspected harm or illegal activity, my duty to protect the child would take precedence.

It's important to approach this situation with sensitivity and prioritize the well-being and privacy of the child. My response will differ based on the child's age, keeping in mind ethical considerations and Florida law.

General Principles for All Ages:

• Focus on the Child: My primary concern is the health and safety of the child.
• Confidentiality: As a healthcare provider, I have an ethical obligation to maintain the confidentiality of my patients, especially minors. This confidentiality is not absolute and has exceptions, particularly when there is a risk of harm.
• Therapeutic Relationship: My goal is to build a trusting relationship with the child to provide appropriate care and guidance.
• Age of Consent: In Florida, the age of consent for sexual activity is 18 years old. This means that any sexual activity with a minor under 18 is considered illegal, regardless of consent (with some limited exceptions for minors close in age).
• Florida Law on Parental Notification for Abortion: While not directly about sexual activity, Florida law regarding abortion provides some insight into parental involvement for minors' healthcare decisions related to reproductive health. Florida Statute § 390.01114 requires parental consent for a minor to have an abortion, with a judicial bypass option. There is no specific Florida law mandating parental notification solely based on a minor being sexually active.

Specific Responses Based on Age:

If the child is 17 years old:

• To the Father: "I understand your concern for your child. As a healthcare provider, my priority is to have an open and honest relationship with my patients to ensure their health and well-being. Due to patient confidentiality, I cannot confirm or deny your child's sexual activity to you.
• "However, I strongly encourage you to have an open and supportive conversation with your child about relationships, sexual health, and responsible decision-making. Creating a safe space for them to talk to you is crucial.