A. Know the UN Convention on the Rights of the Child and European Convention on Human Rights.

• basic premises
• comparison of the above two documents
• country-specific applications and interpretations

*Throughout the teaching of other modules participants should be asked to examine how the Convention might affect what they are being taught. For example, how does it apply to module B4?

Different countries will have different approaches to the Convention on the Rights of the Child. Participants should be asked to find out how the Convention is applied to adolescents in their own countries. If several countries are represented in the audience, a short discussion comparing the methods of applying the document would be informative.

Different countries will also have different ideologies concerning individual rights against societies’ rights, and these should be shared and discussed (i.e. political and legal issues). If possible, get participants to voice which legal structures in their countries they think may impinge on the rights of the adolescent (Use these ideas in advocacy section, Goal III).

Class discussion

Case studies

Discuss why young people need rights.

Discuss the implications of the cultural, ethnic, ethical, legal and moral issues as well as how war, poverty, education, exploitation, labor, family demands and expectations, and migration may also impinge on a young person’s rights.Guidance should be given that participants understand the complexities inherent in the issues concerned, underlining the importance of treating cases individually.

Case study
A 15 year-old immigrant Muslim girl from Pakistan attends your clinic asking for contraception. What specific factors would you discuss concerning her rights to this, in light of her cultural and educational background?

Case study
A 10 year-old girl with a mother with breast cancer asks to be tested to see if she is carrying the gene.

Small groups reflect on questions:

1. In what specific ways do you think that your own medical practice with adolescents will need to be changed in light of the UN Convention on the Rights of the Child?
2. In what specific ways do you think that the Convention might actually impede (legal and practical issues) the way that you deliver your services to adolescents?

D. Address the specific requirements of Article 12 of the UN Convention:

“States Parties shall assure to the child who is capable of forming his or her own views the right to express those views freely in all matters affecting the child, the views of the child being given due weight in accordance with the age and maturity of the child.’’

Handout of UN article 12

Focus groups withinvolvement of young people

The goal of the focus group is that participants understand why they should seek the opinion of young people, by finding out

• what young people consider their major health problems,
• how easy young people find accessing medical facilities, and
• how young people want health related information provided for them.

Questions for participants:

1. What questions would you specifically want to ask the adolescents in your practices about the services you provide?
2. How could you best involve young people in answering these questions?

A. Define ‘confidentiality’ between practitioner and adolescent, and discuss potentially problematic issues

• basic philosophy
• issues of legal structure, ethics, family issues, culture, patient maturity, medical teamwork

Background research

Group discussion

To the extent possible, participants research the legal structures in their own countries that impact confidentiality for adolescents. In class discussion, participants discuss how circumstantial factors can alter the basic philosophy that “the professional should not disclose anything learned from a person who has consulted them, or whom he or she has examined or treated – without that person’s agreement.” Discussion points should include,

The rights of the parents to know,

The rights of the child not to have others know,

The rights of a school to know about a child who might have an infectious disease such as AIDS.

Dilemma question: how should the issues be prioritized?

Refs 1- 6

Websites 3, 4, 5

C. Discuss, and place in context, ‘medical consent’ for adolescents

• working definition
• legal basis
• country-specific regulations
• issues stemming from terms such as  ‘informed’, ‘maturity’, and ‘on behalf of’.

Short lecture by a lawyer knowledgeable in the issues concerning ‘consent’

Group discussion

Small group work/role play

Lecture addresses such points as what medical consent for young people actually entails, what are the legal issues, who can give it and when (according to the specifics of the host country). How does consent relate to procedures, investigations, or treatments?

Class discusses questions that arise in the individual application of the concept of consent for young people such as determination of maturity, the practicalities of ‘informing’, what the true meaning is of ‘informed’ in relation to consent, and how consent can be influenced by the setting.

Case studies

1. A 14 year-old with leukemia that has relapsed several times wants to cease his treatment. Who can give consent to this and how much does the patient’s opinion have to be taken into account? What is the medical practitioner’s specific role in obtaining consent and why?
2. Parents who are Jehovah’s witnesses refuse to allow their daughter who has been in a severe accident to have a blood transfusion. How should you as the child’s medical practitioner approach this? What legal actions will you have to go through to override the parent’s wishes?

Refs 1- 6

Websites 3, 4, 5

Class discuss the following premises that form a rationale for advocacy:

1. Young people do not have the right to vote and therefore lack political power.
2. Adolescents are inexperienced at promoting their needs in an effective way and may lack the appropriate language.
3. A myth exists that adolescents are healthy compared with other age groups, and do not need the same level of services.
4. The media is antipathetic and critical of adolescent behaviours.

Get participants to describe an occasion where they have acted as an advocate for an individual adolescent.

What are the limits to one’s professional ‘obligation’?

Website 6

Module C3

Participants discuss case studies in small groups with the aim of identifying for themselves their personal attitudes about advocacy. Questions to be kept in mind include,

1. Whose specific interests are you representing?
2. Is your advocacy free from financial concerns?
3. What is the specific aim of your advocacy?
4. Does your advocacy have legal implications?
5. How would your status as a parent influence your advocacy in individual cases?

Case study: A teenage couple consults you. The girl is 15 and pregnant. The father, aged 17, wants her to keep the child; the girl wants an abortion.
Whom are you advocate for? – The mother, the father, the unborn child or for the principles concerned? And what is behind your advocacy?

In preparation, participants are asked to privately consider the question, “Should you be broadening your advocacy to include a whole client group, such as all young people in your practice with disabilities?” Follow with open class discussion of what conditions must be present for participants to agree to take up a community or national advocacy role in relation to adolescent health. Use case studies to encourage the individual participant’s involvement in discussion.

Case studies

1. You have been consulted by a boy at your local school who is being bullied for being a homosexual. How do you provide advocacy on his behalf at the school and in the community as a whole? How might you take it up as a national issue?
2. The national government proposes to stop providing free contraception to anyone under the age of 18. How do you advocate against this move on behalf of adolescents?

Using participants’ examples from Goal I objective A, discuss becoming involved to change legal structures which impinge on adolescents’ rights