" The best interest of the adolescent " : Exploring doctors ' decision to proceed with treatment of sexual reproductive health without parental consent

Adolescents below the age of majority require parental consent for treatment or else the treating doctor may be liable for trespass and assault. This creates a dilemma for frontline doctors, as involving parents in the discussion could add yet another barrier to the existing barriers for adolescents in terms of access to healthcare services. This paper seeks to explore doctors' treatment decisions made without parental consent when managing adolescents presenting with sexual and reproductive health issues. Based on a qualitative approach, in-depth interviews with 25 doctors throughout Malaysia were conducted. All audio-recorded interviews were transcribed verbatim and analyzed using a thematic approach. Generally, doctors weigh any decision by examining the health risks and benefits involved. While fear of litigation influences treatment decisions, a strong adherence to the ethical duty of 'do no harm' outweighs other considerations. When all options are risky, choosing what is considered 'the lesser of two evils,' i.e., what is perceived to be in the best interest of the adolescent, is adopted. The complexity of a medical decision related to adolescent SRH issues is increased further when legal requirements are not in synch with the ethical and personal values of doctors. The laws relating to parental consent should be promulgated with a provision allowing doctors to exercise discretion in terms of treating specific SRH issues without parental consent.