Ethical, legal and professional issues of contraception and sexual health'

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Ethical, legal and professional issues of
contraception and sexual health.

• Enid W. Egginton

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Keeping up with the times!

• Sexual health care is for healthy people having
  sex, sexy people having health
• Joan Walsh
• Health Policy/Research Officer, FPA

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Ethical issues

• Right

• Wrong

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Legal issues
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Professional issues
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Ethical Theories

• Utilitarian
• Consequences
• The end justifies the means

• Deontology
• Duty is important
• Never treat people as a means to an end
• Respecting the individuals autonomy

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Bioethical Principles

• Autonomy
• Beneficence
• Non-maleficence
• Justice

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Is there an ethical issue?

• Christian philosophers of the middle ages
  (Augustine and Aquinas) developed theories of
  sexuality which confined sex to heterosexual
  genital intercourse within monogamous marriage
  (Primoraz 1999 p5)

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What about the past?

• Then Judah said to Onan lie with your brothers
  wife and fulfil your duty to her as a brother in
  law to produce offspring for your brother. But
  Onan knew that the offspring would not be his

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• So whenever he lay with his brothers wife, he
  spilled his seed on the ground to keep from
  producing offspring for his brother. What he did
  was wicked in the Lords sight, so he put him to
  death also.
• Genesis 38 v 8

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Choice?

• Abstinence
• Potions, contraptions, herbs and incantations
• Abortion
• Infanticide

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Advancement

• 1841 Fruits of Philosophy. Charles Knowlton
• 1886 The Wifes Handbook. Dr Arthur Albutt.
• 1924 Marie Stopes
• 1939 Margaret Sanger

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Advantages

• Limit the number of children
• Improve quality of life
• Maternal health
• Maintain a career

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Are some forms of contraception more ethical than
others?

• Why?

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Global issues

• Individual control of lives is seen as good.
• What about when control is taken away and the
  government dictates?
• Situation in China

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Is there now a question of right or wrong?

• Utilitarian argument
• The end justifies the means.
• Consequences that are important.

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Legal issues

• USA State tried to control the use of
  contraceptives Griswold v Connecticut 1965
  a law forbidding the use of contraceptives by
  married couples was overturned.

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Sharia law

• The word sharia means path to a watering hole
• Hadd offences carry specific penalties
• Unlawful sexual intercourse (outside marriage)
• Adultery

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Female Genital Mutilation

• Social acceptance, especially for marriage
• Hygiene and cleanliness
• Family honour
• Sense of belonging
• Fear of social exclusion
• Enhancing fertility?

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UK Law

• Prohibition of Female Circumcision Act 1985
• Female Genital Mutilation Act 2003

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• We are quick to criticise other cultures and
  traditions, but how do they view our customs here
  in the West?

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Sexually Transmitted Infections

• Increase in
• Chlamydia
• Gonorrhoea
• Genital herpes
• Genital warts

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The Gillick case

• She challenged the guidance issued by the DHSS
  that a GP could give contraceptive advice and
  treatment to a child without parental consent
  provided the child had sufficient understanding.

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Mrs Axons case

• A doctor is under no obligation to keep
  confidential such advice and treatment he
  proposed to provide in respect of contraception,
  sexually transmitted infection and abortion to a
  child under 16.

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Professional response

• .I am relieved that Sue Axon lost her case. It
  would be disastrous to take away confidentiality
  from young people regarding their sexual
  health.young people have somewhere safe to go

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Professional issues

• Paternalism
• Evidence based information
• Reaching targets

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What influences us?

• First we must know where we are coming from and
  what our own values are.
• As professionals what influences the way we
  discuss sexual issues and the advice we give?

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References

• Campbell, A. (1999) Childfree and Sterilized.
  London Cassell.
• Department of Health (2004) Best practice
  guidance for doctors and other health
  professionals on the provision of advice and
  treatment to young people under 16 on
  contraception, sexual and reproductive health..
  DH London.
• Evans, D.T. (2007) Promoting sexual health to
  young people to reduce STIs. Nursing Times, 102
  (30) 25-26.
• Gillick v West Norfolk and Wisbeck AHA and the
  DHSS (1985) 3 All ER 402.
• Hairon, N. (2007) NICE guidance on prevention of
  STIs and teenage pregnancies. Nursing Times, 103
  (11) 23-24.

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• Nicoll, A., Catchpole, M., Cliffe, S., Hughes,
  G., Simms, I., Thomas, D. (1999) Sexual health of
  teenagers in England and Wales analysis of
  national data. British Medical Journal, 318
  (7194) 1321-1322.
• Potts, M., Shouse, N. (1999) International
  aspects of ethical problems in obstetrics and
  gynaecology. Baillieres Clinical Obstetrics and
  Gynaecology, 13 (4) 559-570.
• Primoratz, I (1999) Ethics and Sex.London
  Routledge.
• R. (Axon) v Secretary of State for Health (2006)
• Vincenti, A. (2005) A Womans Right to Choose.
  Womens Health Newsletter, 64 15-17.