What is the most appropriate approach for a married adult female patient with capacity who wishes to continue taking oral contraceptive pills (OCPs) despite her relative's desire for her to stop?

Patient Autonomy in Contraceptive Decision-Making

The patient's consent alone is sufficient and necessary to continue oral contraceptive pills—no consent from her relative is required or appropriate. This is a fundamental principle of medical ethics and contraceptive care for competent adult patients.

Core Principle: Individual Autonomy

• An adult woman with decision-making capacity has the sole right to make contraceptive choices without requiring permission from family members, including spouses. 1
• Healthcare practitioners should practice active listening and self-reflection to ensure their biases do not cloud their ability to provide neutral counseling, and should speak with a judgment-free and respectful tone. 1
• The patient's understanding of the most important information about her chosen contraceptive method should be documented in the medical record, but this documentation replaces—not supplements—the need for any third-party consent. 1

Appropriate Clinical Approach

The correct answer is A: Patient consent is enough.

What Should Actually Happen

• Confirm the patient's understanding of her contraceptive method through the teach-back method, asking her to repeat back information about typical effectiveness, correct use, protection from STDs, warning signs for adverse events, and when to return for follow-up. 1
• Assess whether the patient has any concerns with her current method and evaluate any changes in her medical history, including risk factors and medications that might affect safe use. 1
• Provide ongoing contraceptive supplies if the patient is using the method correctly and consistently with no medical contraindications. 1

Cultural Sensitivity Without Compromising Autonomy

• Healthcare practitioners should be aware of the patient's cultural background and how that may impact her preferences regarding shared decision-making, including involving support individuals in the discussion process—but this involvement is at the patient's discretion, not a requirement. 1
• Many factors contribute to decisions women make about contraception, including factors outside their control, and healthcare practitioners should allow time for patients to process information and consult with their support system if the patient chooses to do so. 1

Critical Pitfalls to Avoid

Reproductive Coercion

• It is essential to provide balanced information about all contraceptive options to reduce the likelihood of reproductive coercion. 1
• The relative's desire for the patient to stop OCPs, when the patient wishes to continue, represents a potential form of reproductive coercion that must not be enabled by requiring or even suggesting joint consent.

Confidentiality Concerns

• Follow-up discussions should ensure confidentiality can be assured, whether through in-person visits, telephone, email, or text messaging. 1
• The patient's contraceptive choices and medical information should not be shared with relatives without her explicit permission.

Medical Eligibility Considerations

The only legitimate reasons to reconsider OCP use involve medical contraindications, not family preferences:

• Blood pressure should be measured before continuation of combined hormonal contraceptives. 1
• Assess for any changes in medical history that might affect the U.S. Medical Eligibility Criteria classification for her contraceptive method. 1
• If medical concerns arise, discuss alternative contraceptive options with the patient, presenting the most effective options first. 1

Under no circumstances should a competent adult patient's contraceptive access be contingent on approval from family members. This principle protects patient autonomy, prevents reproductive coercion, and upholds the ethical foundation of modern contraceptive care. 1