Ethical dilemmas: responses to emails

Hello everyone,

I have received several emails of concern about my sending as an addendum, without comment, an email from a teacher detailing the teacher's method of working with pregnant girls. It has been pointed out to me--and on reflection I agree--that there are "liability issues" in what the teacher said. (The addendum is reprinted below with my comments.)

I said in my main email yesterday that teachers are not qualified to give medical advice. I must reiterate that. If I could emphasize it in such a way that no one ever attempted it again, I would.

As teachers, we are NOT authorized to give medical advice to students. If a girl comes to you for advice on her pregnancy and you give it, you have overstepped the bounds of your licensure. It doesn't really matter if you think the nurse will not give adequate advice, or that the nurse lacks a close relationship with the student, you are not authorized to give such advice. (I am perfectly aware that there are former medical doctors among us, and they may be qualified; however, if their license to practice medicine is still valid, they must still have authorization from the state and the school district to practice medicine in a school context, which is unlikely to happen given the risk of malpractice to the district. There is no question whatsoever about the rest of us. We may not give medical advice.)

If you are working with a student who needs competent medical advice, you should urge the student to get it from a qualified medical practitioner, including the school nurse. You should not give it yourself.

The same applies to legal advice. Teachers may teach about biology or law, but teachers are not authorized to give advice on how to medicate or how to act in a legal situation. The best advice in medicine and law is "see your doctor" or "see your attorney." There is nothing wrong with saying, "I am not competent to advise in this."

Let me use a metaphor, if I may. Every decision that a girl makes, after she finds that she is pregnant, is like trying to cure a tumor with a knife. You may cut the tumor out, but you have to CUT. There is always a cut, and the cut always hurts. Sometimes the cut gets infected. If the girl keeps the baby, marries the father, doesn't marry the father, aborts, doesn't abort, or puts the baby up for adoption, there is always a hurt. You cannot advise anything without giving a hurt, and as soon as you advise, you give a hurt for which you are always liable. If you try to give advice without all the details, you leave the girl unable to make a personal decision as to what hurt she wants, and how much of the hurt she is willing to accept. Leave it to the experts.

Keep in mind especially that sexual discourse is subject to all sorts of regulations and qualifications in the schools. Giving medical or legal advice in sexual issues is like playing with land mines. You might survive, but you're not smart to try it. Best to give it to the bomb crew.

Jeff Combe

I include some overdue comments in CAPS with the reprint of the "addendum" below.


From: Combe, Jeffery
Sent: Wed 3/19/2008 3:14 PM
Subject: Daily email: Ethical dilemmas, part 2--addendum

Hello everyone,

I got this comment from a teacher after I sent the previous email, and I wanted to forward it for your consideration.

I have a comment about what we say when a girl reveals that she is pregnant. I usually start by asking her how she feels about this and how her partner feels about this.

THIS MAY SEEM LIKE CASUAL CONVERSATION, BUT YOU OUGHT TO BE AWARE OF THE POTENTIAL DANGER THAT COMES IF THE GIRL REPORTS THAT SHE TALKED WITH HER TEACHER ABOUT HER PREGNANCY. JUST IMAGINE, FOR EXAMPLE, WHAT COULD HAPPEN IF SHE REPORTED INACCURATELY THAT YOU HAD HAD A DISCUSSION WITH HER ABOUT THE SEX SHE AND HER BOYFRIEND HAD AND HOW SHE FELT ABOUT IT.

I also ask if she's spoken to her parents.

A GOOD IDEA. IF SHE HASN'T, I BELIEVE YOU SHOULD RECOMMEND FOR HER TO DO IT.

I then ask if she knows what options she has and if not, I lay them out for her (keeping the child, adoption, morning after pill, abortion, etc.)

THIS IS BEYOND YOUR AUTHORITY. YOU'VE CROSSED THE LINE HERE AND COULD GET YOURSELF INTO BIG PROBLEMS BECAUSE OF THIS. YOU SHOULD RECUSE YOURSELF IMMEDIATELY AT THIS POINT.

and where she might go to investigate these resources.

ACCEPTABLE IF YOU ARE ABSOLUTELY CONFIDENT THAT YOU KNOW EVERY SINGLE POSSIBLE SOURCE SHE COULD GO THROUGH. IT'S BEST TO SEND HER TO THE AUTHORIZED SOURCE OF INFORMATION ON CAMPUS WHO KNOWS THE ACCEPTABLE AGENCIES THE SCHOOL HAS THE RIGHT TO REFER TO (THE NURSE) OR SIMPLY RECOMMEND THAT SHE SEE HER DOCTOR IMMEDIATELY. I SEE NO PROBLEM WITH EMPHASIZING THE NEED FOR EARLY CARE AS LONG AS YOU AREN'T ADVISING WHAT THE CARE SHOULD OR SHOULD NOT BE.

I try VERY hard to keep my own feelings out of these exchanges,

I'M NOT SURE IF YOUR FEELINGS ARE AS DANGEROUS AS YOUR ADVICE. AS A TEACHER, I AM CAPABLE OF SAYING SOMETHING LIKE, "I AM SORRY YOU HAVE GOTTEN YOURSELF IN SUCH A DIFFICULTY. MAYBE WE NEED TO WORK SOMETHING OUT SO THAT YOU CAN FINISH YOUR CLASSWORK BEFORE THE BABY IS DUE." IN FACT, IT IS DESIRABLE FOR YOU TO WORK OUT WAYS FOR HER TO ACCOMPLISH HER EDUCATION, IF POSSIBLE, DESPITE THE MEDICAL DIFFICULTIES SHE WILL FACE. THERE IS NOTHING WRONG WITH FEELING BAD THAT HER SITUATION IS SUDDENLY VERY DIFFICULT. IF YOU ARE TRYING TO WITHHOLD YOUR FEELINGS ABOUT WHETHER OR NOT AN ABORTION IS APPROPRIATE, THAT'S ANOTHER ISSUE. THOSE ARE THE SORTS OF FEELINGS I THINK YOU SHOULD CONSCIOUSLY SUPPRESS IF YOU CAN.

but I also know that often we have more of a relationship with these girls then the school nurse and that they may not be aware of all of their choices.

THE CLOSE RELATIONSHIP IS NOT A LEGAL QUALIFICATION TO GIVE MEDICAL ADVICE, HOWEVER, AND I SHOULD HAVE MADE THIS MORE EXPLICIT YESTERDAY. BY ALL MEANS, USE THE CLOSE RELATIONSHIP AS A WAY OF HELPING THE GIRL HAVE AS MUCH ACADEMIC SUCCESS AS POSSIBLE GIVEN HER PROBLEMS, OR AS A WAY OF URGING HER TO GET IMMEDIATE PRENATAL CARE, OR TO TALK TO HER PARENTS, BUT DON'T PRESUME TO BE THE ONE TO GIVE HER MEDICAL OPTIONS.

Jeff Combe