Anchorage lost its only pediatric gastroenterologist a few years ago. The physician still comes up periodically to do some work but it has left a significant void in the services that can be provided locally.

Pediatrics is a far different world. Developmental issues are critical to the practice. Only the naive would think it is the "medicine of little people." Some of that development is the ability to come to decisions with regards to medical care.

I was trained mainly on patients older than 18. There was one rotation where we followed around a pediatric gastroenterologist. That served mainly to educate us on how different the practice was from the rest of our training.

For some time now I have seen patients older than 16 on a limited basis at the request of a primary care provider. It has been a small attempt to fill part of the hole present in the community. It is not ideal but there is nothing magic about an 18th birthday. 16 year old patients face similar gastrointestinal issues to adults even though they still have developmental issues.

I explain to every minor patient and their parent that I am an adult gastroenterologist and give them the choice as to whether they wish to utilize my care.

I do a handful of endoscopic procedures on patients under the age of 18. Every time I do one of these procedures I need to get parental consent. I am yet to come across any parent that does not discuss the care with their child and let them make the decision.

The Anchorage School District recently sent out consent forms for swine flu vaccinations. No child received that vaccine without parental consent.

There are plenty of issues that physicians discuss with minor patients every day that remain part of the physician-patient relationship. However, when it becomes a question of treatments that have risks and benefits it becomes crucial to involve parents.

Why should the decision to terminate a pregnancy be any different?

The answer it is it should not. This is not about the legality of pregnancy termination. This is about the rights of parents.

The devil is always in the details. The argument lately has been one of consent vs. notification. It has been whether or not such a law is constitutional.

The debate has also been bogged down in all of the special cases. Incest, rape and difficult parent-child relationships are the ones most people talk about.

There are always exceptions and problem cases with laws. So, anticipate them and write the law to address those concerns. Let the provider or the young woman petition the court if it needs to happen. Do not create a situation that is not ideal for the vast majority of cases.

For the record, I am not ethically comfortable with the procedure. I also believe it should and will remain legal. That is not the issue here.

It is a slippery slope argument that parental notification or consent laws will lead to outlawing the procedure. There are plenty of things that are legal that cause ethical issues for segments of the population. Do we really think the parental consent laws for tattoos will lead to them being outlawed?

We do not trust people under 21 to drink alcohol. We do not trust people under 18 to give consent for swine flu vaccinations. We do not give minors the right to vote. Most of this is to protect youths from making bad decisions.

Just like every other decision right or wrong for a minor, the parents should be involved. Otherwise, the slippery slope we may slide down will be one where parents are not entitled to know anything.