California’s Prop 4 Jeopardizes the Doctor-Patient Relationship

Editor’s Note: Proposition 4 is the ballot initiative that would amend the California Constitution to require parental notification for teenagers obtaining abortions. One of its least discussed aspects  of the proposition is that a teen who refuses to have her parents notified may choose to have another adult relative informed, but the young woman must file a written report detailing a pattern of "abuse" at the hands of her parents, which the doctor must immediately send to either Child Protective Services or the police, and must inform the substitute adult relative about the report to law enforcement as well as the teen’s abortion. Otherwise, the teen must personally appear in court to obtain a waiver from a judge.  This piece draws on an interview of Dr. Eleanor Drey by Carole Joffe about this aspect of Proposition 4.   Drey is a UCSF obstetrician-gynecologist and a former high school teacher who also is the medical director of Women’s Options Center,  an abortion clinic at San Francisco General Hospital.


I’m a doctor, not a cop. But if Proposition 4 should pass, the burden of determining whether a teen is falsely representing herself and her family will fall on me, as a physician.  It would entirely shift the relationship between me and my teenage patients.

I don’t want to have to ask my patients questionslike,"Is that reallyyour mother?" or "Have you given us the correct address for your aunt?"

Many people don’t realize that as a health care provider, I am alreadya mandated reporter for abuse and rapeIf there is reason for suspicion, I ask my patients, "Are you safe at home?" and "Were you forced to have sex with someone or otherwise abused?"   It will be harder to build the trust to ask these sensitive questions if teens see meas a police investigator who has to verify the identities of those who came with them to the clinic.  In cases of rape, we already help a patient to report the case and then work with detectives to obtain evidence.

Although it is unfortunate, I do not think that it necessarily means a teen is "abused"if she does not feel able to tell her parents about her pregnancy.  Forcing her to file a write a narrative claiming a pattern of abuse by her parents  that I then must file with authorities will almost certainly ruin her relationship with them-and she very likely does not want that relationship destroyed.

We do all we can at Women Options Center to encourage a teen to involve her parents in a pregnancy decision. And in most cases, teens do inform their parents, even when it is very hard for them to do so.  Sometimes the positions are reversed–parents will insist on an abortion for their 14-year-old, which the teen will not want. We then have to explain to the often desperate and sometimes furious parents that we cannot perform an abortion on anyone if it is not what she in fact wants.

Decisions about becoming sexually active, and continuing or terminating an unplanned pregnancy obviously can raise very difficult issues for teens and their families.  What I have learned working at Women’s Option Center is that there are no easy or one-size-fits-all solutions to these problems.  If Prop. 4 passes, turning me and my colleagues into cops only will erode the trust between us and our younger, teenage patients.

We already know from what has happened in other states with these laws that these well-intentioned measures drive teens away from care. In those states, teens present later for abortions or travel out of state, both of which increase their medical risks.  Moreover, some teens will take matters into their own hands to end an unwanted pregnancy, and I hate to think of the consequences. Prop 4 is truly misguided public policy that unfortunately will endanger California teens.  That’s why professional organizations that understand the complex lives and choices faced by teens oppose Prop. 4, including the California Medical Association, California Nurses Association, American Academy of Pediatrics, California Academy of Family Physician, Society for Adolescent Medicine and my own professional organization, the California chapter of the American College of Obstetricians and Gynecologists.  We adults are supposed to protect teens, not endanger them at the ballot box or take away their ability to obtain safe medical care before they can even vote for themselves. 

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  • invalid-0

    Making sure parents know when their teenager daughter is having surgery violates the doctor patient relationship?

    And if you were performing a tonsillectomy or removing a teen’s appendix you would be fine if the young girl’s parents had no idea she would be having the surgery? What makes abortion different?

    The fact remains that teenagers (and adult women) do not have a prior relationship with the doctor doing the abortions. Most abortions are done at freestanding abortion centers and the family practitioner that any teen or her mom and dad normally see for routine medical care is NOT the person who will do the abortion.

    Or perhaps you suggest that young girls and women should have a relationship with Howard Pfupajena of the Clinica Medica Para La Mujer abortion center in Santa Ana who allegedly assaulted a pro-life advocate?

    Maybe they should have a relationship with Shelley Sella, who stands accused of killing a baby who apparently was born alive following a failed abortion procedure. (

    Or perhaps they should have one with Bertha Bugarin and her sister Raquel — who put women’s health at risk by doing abortions despite not having a medical license. (

    And then there is California abortion practitioner Laurence Reich, who has been charged with practicing medicine without a license. Reich lost his medical license in 2005 after he was convicted of molesting women during physical exams.

    Oh yes… let’s make sure parents are kept in the dark and young women have relationships with these anti-woman people.

  • moiv

    when you draw the anti-choice pros out of the woodwork.


    As Mr. Ertelt surely is aware, abortion is the only pregnancy-related
    health care for which minors are required to have any parental
    involvement, let alone consent.


    A minor female is the sole person entitled to consent to any other
    health care related to her own pregnancy or delivery. She alone can
    provide legal consent even for an entirely elective C-section — a
    medically unnecessary procedure which would place her at an increased
    risk of complications during every future pregnancy she might have.


    Should her child be born with any number of serious and complicated
    health conditions, she alone is entitled to assess the possible risks
    and benefits of all the treatment options available, and to provide
    informed consent for her child’s treatment.


    In fact, the only choice regarding her own pregnancy or maternity
    that Mr. Ertelt and his ilk seek to deny her is that of deciding for
    herself that she is not yet ready for motherhood at all.


    Thanks to Carole Joffe and to Dr. Drey for raising their voices of
    sweet reason amid the howling mob that is today’s professional
    anti-choice movement.


  • paul-bradford

    …that a seventeen year old girl who isn’t pregnant isn’t allowed to make health care decisions for herself but her fifteen year old sister who is pregnant can.


    It seems to me that the whole idea of giving control to the parents is predicated on the assumption that minors aren’t mature enough to make their own health care decisions.  Do we also assume that pregnant teenagers are more mature than their non-pregnant peers?


    Paul Bradford

    Pro-Life Catholics for Choice

  • invalid-0

    How it is that some third party deserves the right to make a medical decision for someone’s child while the parent is denied such choice is beyond me. How a minor child can sign a legal contract to have major surgery escapes me too. I was under the impression that minors cannot legally sign contracts; guess I was wrong. But then if they CAN sign contracts, then why can’t they even consent to taking an aspirin? Strange, strange, strange indeed.

    These abortionists are truly perverts messing around with some girl’s body in secrecy! What’s even sicker are all the whacko people who voted to allow this abhorrent behavior to continue.

    I say that any parent that’s good enough to provide food, clothing, and shelter for their child is good enough to make ALL medical decisions for them! Especially when the parent is SOLELY responsible for any consequences arising from such medical care; and they are.

  • invalid-0

    Okay this “doctor” really begin this proposterous proposal by stating that the first reason (and what appears to be the general idea throughout)that a parent should not be notified about their child’s abortion is because it violates the doctor/patient relationship? At least I guess I can respect this person for their honesty that their first motives our selfish and to protect their rights. “I have to fill out all this paperwork…wah…wah…wah.” I think our next prop should demand more of these ‘alleged doctors’ who are selfish and lazy. These days they shove birth control pills down every girl/woman’s throats without explaining how it’s a drug that messes with their emotional, physical, psychological and metabolic development! Forget the teenagers and their parents for one second. How come these doctors never have to stand trial, just because they had to go to college for twice as long as the rest of us? Even though they get paid twice as much as the rest of us, I guess they earn it by filling out all this tideous paperwork! Gimme a break, teachers have an abundance of paperwork and do they suggest against parental permission slips? I’m ashamed that all of these women doctors who should be making us girls look smart, instead make us look victimized!

  • invalid-0

    I agree , this is a very dangerous Proposition , the pregnant teen is under an enormous amount of stress and I don’t think she needs more interrogation and pressure. More often than not these medical professionals provide guidance and a sense of security for them and to require these professionals to probe and investigate these already rattled young women will only drive them away and even force them to turn to unscrupulous people and put their lives in jeopardy.

    -Dino Delellis

  • invalid-0

    I don’t like this , this will add unwanted pressure on the teen , pressure that they don’t need. It may seem wrong to some people but these clinics are serve as one of the places these teens run to for help , this is where many of them feel safe because they know that their privacy will be respected.

    However if this law will be passed that privacy will be jeopardized and thats not good because this will cause the teens turn away from these clinics and they could end up in illegal clinics that will end up endangering even killing them.