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. . . NO, TEEN HAS RIGHT TO REFUSE DRUG TEST

SHARE . . . NO, TEEN HAS RIGHT TO REFUSE DRUG TEST

Imagine yourself in your doctor's office. You made the appointment because you've been feeling poorly for a week. Like patients before you for 2,000 years you trust your doctor to tell the truth, and not to reveal confidential information to others.

After a careful history and physical examination, he suggests a urine test to "rule out mononucleosis." He emerges from the lab and announces he has tested the urine for illicit drugs, discovered traces of cocaine, and he is going to disclose this information to your family and perhaps the police.What's wrong with this picture?

If you are a red-blooded, flag-waving adult American you would be entitled to outrage for at least three reasons.

Your physician has violated your privacy, the right Louis Brandeis called "the most comprehensive . . . and most valued by civilized men." He has violated the nearly absolute right of American patients to decide for themselves what shall be done to their own bodies. And perhaps worst of all, he has lied to you.

There should be little disagreement that such conduct is unethical, probably illegal, and possibly grounds for review by the licensure board.

Why, then, should such behavior be condoned if the patient is 17 years old, or 15?

Children are not small adults, but they are people, entitled to respect and honesty. They are wronged as surely as older patients when they are deceived, when their privacy is violated without their consent.

In American society, adolescents are increasingly entitled to participate in decisions about their own health care as they come to resemble adults in their capacity to understand the consequences of their decisions.

This is not just to promote their own welfare, but because of the public interest in encouraging all patients to seek assistance for drugs and other problems.

We do not need Hippocrates to tell us that adolescents, like their parents, are unlikely to seek medical care if they cannot trust the doctor to be truthful and to respect confidentiality.

Some argue that the end justifies the means - that cutting a few ethical corners is acceptable if it is intended to help, or results in benefits for the adolescent patient.

I question the assumptions of this claim. Neither good intentions nor good results justify actions. Involuntary drug screening might help the patient at hand, but many others who might have sought help will be frightened away as the news spreads that doctors cannot be trusted.

And even if the benefits outweighed the harm, doesn't it follow that doctors are justified in deceiving all their patients, regardless of age, if only they can show health benefits?

Deceptive screening for illicit drugs is only slightly more objectionable than coercive screening in the schools, most commonly as a condition of athletic competition.

Adolescents are less likely than adults to seek health care for sensitive issues in the best of circumstances. There should be no surprise when unconsented, embarrassing, deceptive and possible punitive drug testing drives them further and further away from those who have the potential to offer caring, trustworthy support and treatment.