"Informed" Consent?

A smart phone app that is garnering more media attention, due to its expanding market, is Nurx. The app allows women to order and obtain contraceptives through the app, which are then delivered right to their door. Women can pick a contraceptive of their choosing (or get a doctor’s recommendation), then answer a “few health questions” and the process is completed. This process also applies to minors looking to obtain birth control. Nurx’s website claims that age requirements vary by state, however, the website for the Center for Reproductive Rights claims that there are no current federal or state laws requiring minors to have their parent’s consent to obtain contraception.
As a registered nurse, this is concerning on many levels. Any time a physician orders a new medication or performs a procedure or test, they are required to delineate all the benefits, risks and alternatives of whatever it is that they are getting consent for, a process called “informed consent.” Additionally, there are four elements of a valid consent, two of these include the patient’s ability to adequately comprehend the information presented and the patient having the capacity or ability to make the decision to accept or deny the treatment the physician is explaining.
Whether this conversation is taking place in a doctor’s office or through the digital communication of an app, as women helping to nurture and raise the next generation of females, are we certain these young girls are getting adequate information to truly make an informed decision regarding contraceptives? Are they even able to make a truly informed decision, even when they are given all pertinent information? If we question a 14-year old’s ability to remember to make her bed every morning, are we certain she understands the implications of taking or not taking her birth control pill? What about teens who may struggle with learning disabilities. Are they able to understand the risks, inherent to taking synthetic hormones, on their long-term health and relationships? Is the information concerning the risks of contraceptives delivered in a manner that they can comprehend, especially through an app?
Even in the context of women over the age of 18, how often are physicians truly obtaining informed consent from these patients? As a registered nurse, I have given presentations to college-aged women on contraceptives and each time have been alarmed at how many of these women have no information on how contraceptives actually work and some of the basic risks that come with taking them. They are unaware that hormonal contraceptives can cause very early miscarriages of their unborn children and blood clots, mood disorders or other health complications for themselves. The average woman today makes every effort to avoid synthetic hormones in the meats they eat and the plastic products they use, and yet willingly take a daily hormone pill. Have they full consented to this? Do women truly understand?
As a nurse, a young mother and a woman I fear that our culture has simply accepted the “fact” that all teens are having intercourse, or want to be having intercourse, and therefore we must do whatever possible to “protect them,” regardless of the secondary risks that this “protection” may carry. If we believe that teens are mature enough to be making these huge decisions regarding their sexuality, then why not be certain that they understand the risks and the alternatives? Why are we not teaching women, both young and not-so-young, that their fertility is a sign of health and wellness, something to treasure and appreciate, rather than something to suppress and poison? The desire to keep women and girls “safe” comes from a good place, but we can’t truly be helping anyone by only giving them half of the information they need to truly make an informed decision.

Janet Garcia

Janet Garcia

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