Monday, July 20, 2009

Irresponsible and noncompliant

It's Friday morning, I went into work ready for my week to be over. It was a typical Friday, quite a few people were still scrambling to raise money for their 2 or 3 day procedure that had to start on Friday or would increase in price again, by as much as $300 or $400.

A seventeen-year-old young woman came in for the second time in hopes of getting her abortion. The first time she showed up, she was unaware of parental consent requirements and she was sent home because she didn’t have a parent with her. She was given the information about parental consent and judicial bypasses, a means of getting a court order stating a minor is mature enough to have an abortion without the consent of her parent. It is then up to her to find a way to communicate with her parents or begin the process of getting a judicial bypass.

This patient showed up with out any parent or anyone for support and was at least 13 weeks pregnant. At that point she was told, you can’t do this on your own, state law mandates that you go through extra hoops because you are a few months shy of legal adulthood. Now as she sat in the waiting room one of the clinic staff members, who had to communicate with me about financial assistance for the abortion, made a couple very disturbing comments. I talked to him about her total cost and if we should wait on the ultrasound before completing financial assistance.

“She’s really rather irresponsible.” The staff member rattled this statement as he described her first visit to the clinic alone. I was quite taken aback and told him I would talk to her once he completed the ultrasound. I planned to try and step in and help counsel her through the remaining steps to prepare for her procedure. He then told me, “well, she’s really not going to be very compliant.” I didn’t know how to respond to my colleague. I was appalled and yet in the moment there was nothing I could say. I quickly set up the financial assistance without the ultrasound and told him to let me speak directly to her if anything changes.

In my mind, this young woman is 17 and pregnant and what a mind-boggling situation to be in. Especially if she doesn’t want to stay pregnant and now she’s under time constraints to maneuver through laws, regulations, and counseling appointments. She was told, you're running out of time but you still have to talk your parent into supporting your decision or else talk to a judge.

The word "compliance" infers that the woman is weak and subservient. The idea that she needs to be compliant, or yield to those in authority is ridiculous. I realize my colleague is probably exhausted and burnt out, but patients must be treated as human beings. Patients need to be empowered to understand how to access health care that is dictated by laws and policies mandating parental consent and 24 hour waiting periods. Our patients are confused, angry, sad, relieved, broke, burnt out, tired, they are a lot of things, but noncompliant and irresponsible are not accurate descriptors.

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