Introduction
The case study is of a minor young girl who does not want her parents to know that she has become pregnant. She is considering an abortion and has already decided that whatever be her medical condition, she would provide consent on her own without any consultation with her parents.
According to the Health Practitioner Regulation National Law (WA) Bill 2010, a minor is a person who is less than 18 years. The client in question, Chin Lee is a minor since she is only 15 years old. However, there are separate rules and regulations for minors living in Western Australia. In this state, minors need parental consent for abortion. In this case even the clause for “informed consent” does not hold good as Chin Lee is less than 16 years old.
However, Chin Lee has clearly informed that she does not want to involve her parents. The normal procedure would be to arrange a discussion with her parents and take their consent. Since, Chin Lee does not want to inform her parents about her pregnancy and her decision to abort the unborn child, it is best to seek the advice of an additional counselor or an external party and also determine the legal aspects in this issue.
Chin Lee can approach the Children’s Court and seek an order not to disclose the information of her pregnancy and decision to abort the child to her parents. The medical practitioner needs to be involved and provide a letter which evaluates her level of maturity and her social circumstances. Chin Lee has already informed that her parents are extremely strict and did not have a notion of her being sexually active with another individual. Moreover if the news of her pregnancy was disclosed then it would considerably embarrass her family and her (Government of Western Australia Department of Health, 2012).
If the Magistrate decides that custodial parent should not be informed about a minor’s pregnancy and subsequent decision to abortion then informed consent can be given by the women.
The nurses and midwives have certain ethical code of conduct and supreme among them is that they should provide the utmost priority to determine the needs and values of their clients’ and should not conduct any discrimination on the basis of ethnicity, gender, economic or social status, age or religion of the client (ANMC, 2012). Also the nurses and midwives should abide to the confidentiality clause and should not disclose information relating to the health of the client which has been shared in the course of caring for the patient (Singapore Nursing Board, 2006). In this case the nurses and midwives have a greater duty since the client is a minor and she does not have parental support.
The Gillick Competency Principle is in effect in Australia since 1992 and deals with parental guidance and information with respect to minors’ use of contraceptives and decisions with respect to abortion and pregnancy. This first came into effect in England when Mrs. Gillick, a social activist filed a case with the Department of Health and Social Services over the family planning guidelines formulated. According to this directive, minors had full right to use contraceptives without the consent of parents. The final decision on this case was given from the House of Lords. The final guidelines were provided with Lord Fraser and Lord Scarman with respect to instances when a minor could use contraceptives without parental knowledge. In this case, the landmark judgment made was that a minor is capable of providing informed consent only when the individual “achieves a sufficient understanding and intelligence to enable him or her to understand fully what is proposed”.
In this case, the ethical dilemma is presented with the context to maintain confidentiality. Moreover there is no comprehensive list as to the elements which may be reflected to determine sufficient maturity. This is an area which is left to the judgment of the medical practitioner.
The nurses and midwives should adhere to the confidentiality and privacy clause while providing care. Even in this case, without the consent of the client, they cannot contact the client’s parents, guardians or any concerned person. Also they cannot divulge details of this case to anyone else without getting consent from the client (ANMC, 2012).
The case presents itself with an ethical dilemma wherein the nurse or the medical practitioner has to decide whether informed consent may be provided to Chin Lee. Hence, the national principles should be referred to before taking any decision. The principles do mention that nurses are responsible for making certain professional judgments when a certain task is beyond their own capacity. Also nurses can consult other members of the health care team whom they think will be able to provide rational and suitable advice with respect to a certain case. The principles also mention that a registered nurse is again responsible for taking certain decisions about the most appropriate person who can conduct a particular task in the nursing care. In this case, the decision to provide informed consent should be taken by the nurse or medical practitioner by consulting with experts and peers in the health care domain under the clause of utmost confidentiality (Australian Nursing and Midwifery Council, 2007).
Roles and responsibilities of nurses
Healthcare and medical aid is a constantly changing domain wherein a sizeable sum of money is spent annually towards aiding sophisticated and high quality research. There are a lot of new medicines, clinical processes and medical tools which are frequently invented in this domain. The main goal of all medical practitioners including nurses, midwives, doctors and other hospital staff is to provide best possible treatment and care to the clients.
As children start growing up, parents and elders start providing them with certain responsibilities and also allow them to take certain decision on their own. This is their preparation stage to be an adult when they will be fully able to take decisions on their own. However, the period of adolescent lie between the periods of childhood and adulthood. Hence, during this period, parents and elders should be extra sensitive towards children as this is their growing period but not necessary every child in their adolescent is mature enough to understand certain situations. Most adolescents do not have the qualities of moral responsibility and experience and may not be able to weigh the outcome of their actions and decisions. This situation related to the case study as Chin Lee is a minor and did not realize the consequence of her actions. She does maintain that she comes from a household wherein her parents are strict and her getting pregnant will result in a lot of issues for her. In this case, the medical practitioner may take an informed consent only when the following criteria are fulfilled.
- The medical professional should ensure that the information provided to the client has been lucid and the client has completely understood the data provided to her. In this case, the nurse should hold a frank discussion with Chin Lee informing her about her medical condition and provide her options for possible treatments.
- The patient should be properly counseled with certain consequences as a result of her decisions. In other words, Chin Lee should be informed about the advantages and disadvantages of option for a particular line of treatment.
- Before obtaining consent from Chin Lee with respect to a particular line of treatment, certain risks (if at all present) should be disclosed to her.
- Finally, if the medical practitioner wants to opt for informed consent in this case, then relevant discussion and the consent of the patient concerned should be documented and recorded (Government of Western Australia Department of Health, 2012).
In the above case, Chin Lee needs to be counseled to first consult her parents before taking certain decisions with reference to her medical ailment. Also since, she is not wishing to contact her parents or guardians; the nurse should provide alternative solutions to Chin Lee which may involve legal consultation with experts or possible solutions which may help in the best interest of the patient.
The nurse should also consider the certain professional boundaries which are present in this case. In nursing, professional boundaries may be explained as maintaining certain limits protecting the space between the vulnerability of the client and the power of the nurse. In this case, Chin Lee is minor and is extremely vulnerable as her case contains confidential and sensitive information. The nurse should have empathy for the patient and preserve the dignity of the client by practicing respect and kindness for the client’s vulnerability (Australian Nursing and Midwifery Council, 2010).
The ANMC has provided a nursing summary guide which aids and assists nurses to take certain decisions. The outlined steps for ethical decision making process are as follows:
- The client’s need needs to be recognized. In this case, the nurse needs to provide adequate counseling and care to Chin Lee in order to find out the actual need of the client.
- The next step is to reflect on the scope and standards of nursing practice and accordingly ascertain whether Chin Lee’s case needs any legal consultation or falls under the scope and practice of nursing. In this case, a legal advice should be taken as the girl is a minor and does not want to involve her parents/guardians.
- The next step may be dwelling on whether the case needs organizational support or the context of practice. In Chin Lee’s case, the nurse needs to consider certain sanctions like whether the organization supports the practice of providing legal consultation and/or the decision for informed consent since the client is a minor. The nurse needs to find out whether certain potential risks have been recognized, whether relevant parties have been contacted for consultation – in this case it will be supervisors and legal consultants.
- The next step is to choose a competent individual who may be able to perform relevant tasks. The nurse needs to consider certain responsibilities and roles and find out whether the person performing the activity has the required knowledge, authority, ability and skills with supervision, education and support. Also the required level of education, support and supervision needed for handling this case has to be determined. The nurse needs to ensure that delegation of authority is properly conducted and the individual who is assisting in the case of Chin Lee has understands the accountability and responsibility towards the client.
The ANMC’s ethical decision making model outlines the above mentioned steps and if all the above mentioned steps have been adequately followed then the activity needs to be either performed by the nurse or be delegated to a competent individual. The next step is to document the decision taken and the tasks that followed. Lastly, the outcomes of the decision and action need to be evaluated for future reference and study. If any one of the above mentioned steps cannot be followed then the nurse needs to take advise from other health professionals or collaborate or refer the client to someone else or if necessary then plan for an integrated method or a change in practice. The same needs to be documented and monitored and ascertain whether the modification is still aspired in this case and again start the decision making process (Australian Nursing and Midwifery Council, 2007).
Conclusion
Nursing itself is a dynamic field wherein a lot of skills, knowledge and counseling are required which may help to influence the client in an ethical yet positive manner. It is the nurse’s sole concern to ensure the well being of the patient and hence the decisions made should keep in consideration the health and well being of the patient. In this case, the nurse needs to thoroughly know and understand certain ethical codes, practices and standards for nursing. The nurse should have clear understanding of certain ethical principles related to beneficence and autonomy. Also ethical principles should be used in fostering an environment wherein a lot of respect, care, honesty and openness. In this case, the concerned nurse manager should facilitate discussion with other staff nurses wherein a lot of support and encouragement is provided to formulating ethical principles for treating medical patients.
The case of Chin Lee is a very sensitive case especially because she is a minor and is totally vulnerable at this moment. The nurse should take a lot of care and display professional and ethical standards while providing treatment to her. Certain code of ethics and professional code lay down by the Australian Nurses and Midwifery Counsel should be followed while solving this case. Also the national framework for decision making laid down by the Australian health department should be consulted and accordingly certain ethical steps must be followed keeping in mind the well being of the client in particular.
References:
Australian Nursing and Midwifery Council (2007). National framework for the development of decision-making tools for nursing and midwifery practice. Retrieved December 11, 2012 from
Australian Nursing and Midwifery Council (2007). Nursing practice decision summary guide. Retrieved December 20, 2012 from
Australian Nursing & Midwifery Council (2008). Code of ethics for nurses in Australia. Retrieved December 12, 2012 from
Australian Nursing and Midwifery Council. (2010). A nurse’s guide to professional boundaries. Retrieved December 11, 2012 from
ANMC (2012). Code of professional conduct for nurses in Australia. Retrieved December 11, 2012 from
ANMC (2012). National Competency Standards for the Registered Nurse. Retrieved December 11, 2012 from
Government of Western Australia Department of Health (2012). Informed consent. Retrieved December 12, 2012 from
Government of Western Australia Department of Health (2012). Termination of pregnancy: information and legal obligations for medical practitioners. Retrieved December 11, 2012 from
Health Practitioner Regulation National Law (WA) Bill (2010). Health Practitioner Regulation National Law (WA) Bill 2010. Retrieved December 11, 2012 from
Singapore Nursing Board (2006). Code of ethics and professional conduct. Retrieved December 11, 2012 from
