“I’m 16 and pregnant — I want a termination, and I don’t want my mum told”

A 16-year-old requesting an abortion is an ethics-under-warmth station where the tone is the test: provide non-judgemental, patient-centred care with zero editorialising about abortion, her age or her decision, centring her autonomy whatever your private views. Assess and affirm competence — at 16 she is presumed able to consent to her own treatment (Family Law Reform Act 1969 s8), and Gillick competence is the test for under-16s (the Fraser guidelines apply only to contraception advice) — so answer her fear ("am I too young?") clearly: she can decide without parental consent if competent. Respect confidentiality, which is hers: encourage but do not force involving a parent or trusted adult, and explain that confidentiality is breached only for a serious safeguarding/risk concern, proportionately and ideally with her knowledge — this builds the trust that makes care possible. Crucially, weave in a safeguarding screen sensitively — the father’s identity and age (an adult or large age gap raises child-sexual-exploitation/abuse concern), whether sex was consensual, coercion/CSE/grooming indicators, and any pressure about the pregnancy decision — not to block her choice but to ensure she is safe. Give balanced information on all options (continuing, adoption, abortion) without steering, refer promptly to abortion services or give the self-referral route (NICE NG140; time-critical, earlier is simpler; NICE QS199: the abortion offered within 1 week of assessment; early medical abortion at home up to 9 weeks 6 days), address contraception and STI screening, and safety-net for ectopic pregnancy; a doctor with a conscientious objection must not obstruct — tell her she can see another doctor and make sure she can access care without delay (GMC). The hidden agenda is fear of being judged, controlled or refused and fear of her mother; make her feel safe, believed and in control, weave in safeguarding without policing, and ensure she leaves with a clear plan and trust — never a moral lecture or a breach of confidence.