Ignorance Is Not Bliss

In her article, "Adolescent Sexuality and Public Policy," Lainie Friedman Ross (1996) has posed precisely the dilemma under which we operate: How do we protect the rights of children while attempting to strengthen or, at the very least, support the responsibilities of the parents? The hypothetical family, the Joneses, are presented as quite attentive parents who are involved in their child Jane's life, and have given her clear limits within which to live. It is important to note that the parents are assumed to live within these limits as well. In short, they are presumed to be good parents, but at a time of most intense need, Jane is unable to go to them for information and guidance about issues of sexuality. Her family has cautiously withheld information about sex, but Jane may seek contraceptives and treatment from her physician without her parents' knowledge or consent. Her physician, who has cared for her all of her life, has not discussed sexuality with her and her parents; and now, when Jane needs help, the physician is concerned about deceiving her parents, not about providing optimal care of the patient. While statistics on adolescent sexuality and its severe consequences and rates of sexual abuse of children are controversial, and disputed by some experts, the effects on our children and their future cannot be ignored. Most cases of sexual abuse never come to the attention of authorities, because outward physical signs of abuse may be absent. Incest generates intense shame, and often becomes an entire family 's unspoken secret. Introducing the idea of incest and rape into this discussion of the hypothetical Jane's life may elicit strong emotion, moral outrage, and perhaps denial in us (Allen and Pothast, 1994). Disputed statistics, shame, emotion, and moral outrage notwithstanding, we cannot legitimately ignore the plight of the thousands of adolescent Janes who are now being sexually molested? and often molested by a family member. The United States Department of Health and Human Services reported that the substantiated claims for sexually abused children in 1992 totaled 129,982, up from the two previous years. And we must remember that most of the incidents go unreported. In the Crime Data Brief of June 1994, from the U.S. Department of Justice (Langan and Harlow, 1994), 12 states reported that 51% of female rape victims were juveniles under the age of 18, while females under 18 comprised 25% of the 1992 U.S. female population. These numbers representing real Janes can no longer be ignored by a society that claims to care for its children. What is Jane to do? Can she go to her parents, who have not protected her as they should? Can she ask the one who rapes her to provide proper health care with a doctor? Jane is at the mercy of a family and a society that allows her to remain ignorant about her body, and then denies her medical treatment for the results of that ignorance. If the world were the way it ought to be for children, we might reasonably rely on the decision-making of the parents, since it would be safe. Sadly, however, the world in which we actually live has not reached that level of development. The function of government may also be considered. Does the government have authority to protect children? If it does, how far can it intrude into the private lives of families? In earlier years, this question was posed to ponder if men had the right to kill their wives under certain circumstances, or to beat them and their children. Mores change, and what we expect from our government likewise changes with time. Ross accepts the idea of taking the physician out of the picture for Jane's treatment (thus avoiding deception of one adult by another) and allowing Jane to get her birth control by purchasing it from a drug store (thereby making her the only one deceiving her parents). This idea is good in some respects, in that Jane is not completely bereft of options, but it does not solve all of her problems. If Jane is unable to contact a health professional, she may not realize all of her options and the associated risks. Ross, as Jane's pediatrician, had 10 to 12 years to counsel Jane and her parents about sexuality, but did not. Jane did not receive health education through school, church, or community. Now we want to blame Jane for what we did not do. Ross's article suggests that adolescents are not mature enough to make health decisions on their own. Taking health professionals out of the picture and having young women pick and choose for themselves from the shelves of stores M. Joycelyn Elders is Professor of Pediatrics, Division of Endocrinology, University of Arkansas Medical Sciences Center, Arkansas Children's Hospital, 800 Marshall Street, Little Rock, AR 72202-3591, USA. She is author or coauthor of hundreds of professional publications in the areas of pediatrics, endocrinology, and public health. She is the former Surgeon General of the United States (1993-1994) and an outspoken advocate for children's health. Prior to her stint in Washington, she was Director of the Department of Health for Arkansas and served as President for the Directors of Health of the United States. She presently serves on the hoards of numerous organizations and is a member of many. These include, among others, the ACLU, Institute of Medicine, Drug Policy Foundation, Advocates for Children, American Pediatrie Research Society, and the Endocrine Society.