Defining the Problem
As a health professional, Sam is finding it difficult to accept Jessica’s decision to be so negligent in the domain of pregnancy. He thus feels responsible and compelled to do what is best for Rachael and her health. On the other hand, Sam would like to respect Jessica’s wishes but he is not comfortable with letting Jessica take decision on her own health care. Thus the main ethical issue is confidentiality. Jessica is 15 years old so ethical concern of confidentiality is limited in majority of the domains as per NSW Ministry of Health (2005). Adolescence is a time of intense development (McCracken & Loveless, 2014). At 14 to 15-year of age, adolescents make health-related decisions similar to those of adults and when adolescent are treated with confidentiality, it increases with overall participation in care (Erdmans & Black, 2015). From this point Sam’s thought of abiding ethical principal of confidentiality is justified. Moreover, NMBA (code 4) also supports respect to dignity and belief of people. However, Jessica lacks clear idea regarding pregnancy and its aftermath. So taking the well-being of Jessica into consideration it is would be wise for Sam in knowing how to act in Jessica’s best interest while respecting Jessica’s decisions.
- Ethical principle that can be drafted from the case study includesbeneficence, non-malfeasance and autonomy. Beneficence involves balancing the overall benefits of the treatments against the possible risks and costs involved. Non-malfeasance significances avoidance of causing harms.Respecting the principles of beneficence and non-malfeasance might harm an individual’s autonomy (Schaffer &Mbibi 2014). However, if the decision underscores the overall harm cost to the client then principle of autonomy can be over-ruled(Meneses&Saratan2015). In case of Jessica, the ethical principle of autonomy can be bridged ina single ground. Jessica has no clear concept of pregnancy. Informing her mother about the present mind set of Jessica will help to reduce the overall harm to the Jessica and thus will go in favour of both beneficence and non-malfeasance(Meneses&Saratan2015).
- According to the Office of the Australian Information Commissioner, Government of Australia (2015) the Health Information Privacy is required to be maintained if it is the best interest of the child not to tell his or her parents or if the child is capable to making his or her own decision or the attending doctor thinks that the child understands the benefits and risks associated with the condition. However, if there is a single good reason to believe that the teenager or the child might harm themselves or others then it is the duty of the doctor to inform the concern to the parents. Jessica is unsure about her pregnancyand her current health condition is not stable as her haemoglobin level is low, she has fainted during a school event and her mother reported that Jessica was experiencing fatigue for the past few days along with stomach upset. Legally, Sam is obligated to provide the best care and treatment possible for Jessica.Moreover, NMBA code 1 states that nurse must practice in a safe and competent manner.
- According to the International Council of Nurses (ICN) Code of Ethics for Nurses (2012), it is the duty of the nursing professional to hold in confidence personal information and uses judgement in sharing this information. So, it will be the duty of Sam to use proper judgement in sharing the information to Mrs Wilson. Cascading the information to Mrs Wilson in absence of Jessica will help retain the trustworthiness in front of Jessica and at the same time informing her mother will be help to draft a proper therapy plan for Jessica encompassing proper sex education (Erdmans& Black 2015).
- ICN code of Ethics for Nurses (2012), states that the nurse is required to demonstrate professional values like respectfulness, responsiveness, compassion, integrity and trustworthiness. In relation to the case study, it will be the duty of Sam to first develop a therapeutic relationship with Jessica. According to East and Hutchinson (2013),development of therapeutic relationship via effective communication helps in the generation of trustworthy relationship with the client. Developing trustworthy relationship will help in exercising compassion, respectfulness and responsiveness. This will help will help Jessica to discuss her concern openly with Sam. Upon knowing her concern, Sam may discuss how informing the concern to her mother will be helpful in the process of care. In doing this, the ethical issue of autonomy and informed consent will not be bridged.
I think option B is the more appropriate to address Jessica’s problem. The approach of Option B helps to avoid paternalism ethics as it helps service Jessica’s best interest in the foreground, and ensures good health and wellbeing as a consequence. The option B mainly follows the ethical principle of utilitarianism which maximizes the best action. Moreover the ethical principle of utilitarianism states that rightness and wrongness of action should be judged by its consequences. If I follow, option A, then I might end up losing Jessica’s trust and bridging the nursing code of ethics which states that it is the duty of the nurses to treat personal information obtained from the patient in a private and confidential manner. NMBA code of conduct 4 highlights, nursing professionals must respect the dignity, ethical values and beliefs of patient receiving care. So if I notify Mrs Wilson via keeping Jessica in dark, then I will bridge code 4 of NMBA conduct. Moreover, since Jessica is 15 years old, she has right to indulge into her decision making process. So notifying her mother in absence of her consent is not ethically permissible. Thus option A does not follow the ethical principle of utilitarianism as the legal and ethical rule of Jessica is coming at stake. So B is the best suitable options in this case.
Ethical and Legal Principles
In practising, Option B of therapeutic relationship, I will fist develop a trustworthy relationship with Jessica. Practising therapeutic relations will help gain patient trust and confidence (East & Hutchinson 2013). This will help me to understand why Jessica is thinking she is pregnant and the degree of sex education she has. Knowing the issue in detail will help me to draft the care plan for Jessica. Moreover, during the course of developing therapeutic relationship I will also make her understand that her mother is not her enemy and notifying the issue will help her overcome the entire situation. Taking Jessica’s consent before informing Mrs Wilson will also help me to ensure the ethical issue of informed consent and autonomy is not bridge while avoiding the ethical concept of paternalism. Moreover, Jessica also suffers from lack of proper sex education. So it also important to educate Jessica about the concept underlying pregnancy and social responsibilities associated with it. This education session if done in present of her mother, will help to reduce the communication gap between Jessica and Mrs. Wilson. At the same time, it will help to avoid any similar complications in the future. Moreover knowing that her mother is supportive should provide her the encouragement and confidence to discuss her situation in details with her mother. This option would benefit Jessica’s primary health and wellbeing. Overall, it might seems that option B is reducing Jessica’s autonomy and increasing paternalism, but overall, benefit of Jessica’s health will help to over-rule other issues (Atkins et al. 2017).
References
Atkins, K., De Lacey, S., Britton, B. & d Ripperger, R., 2017, Ethics and law for Australian nurses, 2nd end, Cambridge University Press, Cambridge.
East, L. & Hutchinson, M., 2013, ‘Moving beyond the therapeutic relationship: a selective review of intimacy in the sexual health encounter in nursing practice’, Journal of clinical nursing, vol. 22, no. 23-24, pp.3568-3576
Erdmans, M.P. & Black, T., 2015, On becoming a teen mom: Life before pregnancy, 2nd end. Univ of California Press, California.
International Council of Nurses 2012, The ICN Code of Ethics for Nurse, Viewed: 1st September 2018. Retrieved from: https://www.icn.ch/nursing-policy/international-nursing-review
McCracken, K.A. & Loveless, M., 2014, ‘Teen pregnancy: an update’, Current Opinion in Obstetrics and Gynecology, vol. 26, no. 5, pp.355-359.
Meneses, J.D. & Saratan, C.T., 2015, ‘Antecedents and consequences of teenage pregnancy: A phenomonological study’, International Journal of Medicine & Health Research, vol. 1, no. 1, pp.1-5.
NSW Government Ministry of Health, 2005, Consent to Medical Treatment – Patient Information. Access date: 7th September, Retrieved from: https://www.health.nsw.gov.au/legislation/Pages/consent-to-treatment.aspx
Nursing and the Midwifery Board of Australia 2012, Code of Professional Conduct for Nurses. Access date: 7th September 2018. Retrieved from: https://www.nursingmidwiferyboard.gov.au/codes-guidelines-statements/professional-standards.aspx
Office of the Australian Information Commissioner, Government of Australia., 2015, Fact sheet: Privacy and your health information, Viewed: 1st September 2018. https://www.oaic.gov.au/engage-with-us/consultations/health-privacy-guidance/fact-sheet-privacy-and-your-health-information
Schaffer, M.A. & Mbibi, N., 2014, ‘Public health nurse mentorship of pregnant and parenting adolescents’, Public Health Nursing, vol. 31, no. 5, pp. 428-437.
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