Ethical Issues in Adolescent Confidentiality: A Case Study

Answer 1
Jessica Wilson who was a minor was supposedly pregnant and does not want Sam to reveal her
suspicion of pregnancy to her mother. In this case scenario, Sam is facing the ethical issue
adolescent confidentiality and her own conscience in order to accommodate Jessica’s choice
while providing healthcare services. Pregnancy in a minor age is a sensitive issue which requires
early intervention but the concerns of adolescents regarding their confidentiality can act as an
obstruction in their accessibility of the health services (Othman, et al., 2019). It is also seen
that adolescents reveal more information about their pregnancies in order to receive health care
when they are assured the service is confidential. On the other hand, in some cases the minors
are not mature enough to handle a critical situation such as pregnancy and family support is
essential for them (Sychareun, et al., 2018). Ethical principles do not always provide a clear
guidance on handling a specific situation. Confidentiality is one such ethical dilemma which is
faced often by the RNs in healthcare facilities. Sam must address the ethical issue of Jessica’s
confidentiality by using best of her knowledge, relevant laws and ethics, her training and
experience, her moral norms and her consultation from her colleagues or supervisors.
Answer 2
A prominent ethical principle which applies to Jessica’s case is principle of autonomy, which
means her right to choose or determine for herself. This principle would require Sam to support
Jessica. Principle of beneficence also applies as it obligates Sam to do what is good for Jessica.
Principle of nonmaleficence obligates her to not do anything which may harm Jessica. Another
principle is veracity which obligates the healthcare professionals to tell the truth. This principle
would require Jessica to show integrity and truth-telling by revealing accurate information to

Jessica and her family regarding the possible positive and negative health outcomes of her
pregnancy (Aderemi, 2016).
As per the Australian and International legislations, it is recommended that healthcare
professionals must maintain confidentiality of the patients including adolescents unless a consent
is obtained for disclosure or disclosure is required to safeguard their wellbeing, and, in such
cases disclosure is generally discussed with the patient first (WA Child and Adolescent Health
Service, 2017). The law considers human rights of privacy and autonomy for every
individual. Therefore, law recognizes Jessica’s rights to make decisions regarding her health
management and to seek confidential health care services. In 1992 a British principle called the
mature minor principle was recognised in Australia which stated that an adolescent below
18 years has the capability to give informed consent when he or she “attains an adequate
understanding and intelligence to facilitate him or her to understand completely the proposal”
(psychologyboard.gov.au, 2017). Most of the judges conceded that this principle lacked a
certainty of a fixed-age ruling and warned that the capabilities and rate of development of the
individual adolescent must be regarded.
Laws in every State and territory such as “Age of Majority Acts”, or in NSW “Minors (Property
and Contracts) Act” identifies the minor as people under the age of18 years. However, the
impact of mature minor principle raised a doubt regarding the assumption that adolescent minors
were incapabale of decision-making regarding their health management. The confidential health
care delivery to adolescents corresponds with regarding their right to consent to medical
treatment (McNary, 2015).
Answer 3

Sam can address the ethical issue of Jessica’s confidentiality and her safety by
- Holding in confidence private information and using judgement in sharing the
information (ICN, 2012). It means that Sam must keep the information of Jessica’s
possible pregnancy confidential until she has effectively used her judgment regarding
sharing the information. In this option, a judgment is required by Sam which she must
make weighing up the benefits and harms of hiding the information of Jessica’s
pregnancy with her mother. If the harms of not disclosing the information outweighs the
benefits then she must tell the truth to her mother. Sam must consider various aspects to
assess maturity and make sure that confidentiality regarding the health management will
be in Jessica’s best interests. Assessment of maturity should consider characteristics of
Sam, magnitude of the recommended treatment, family aspects, and legal limitations.
Even if not pregnant, Jessica is sexually active and may face potentially life-threatening
risks that would demand breaching Jessica’s confidentiality, and Sam must examine the
more immediate threats, like if Jessica was coerced by her partner.
- Exhibiting professional values such as respectfulness, responsiveness, compassion,
trustworthiness and integrity. In this option Jessica will have to sustain the trust
demonstrated by Jessica in me when she revealed about her suspicion of pregnancy with
her. She must be compassionate towards her apprehensions and emotions. She must
respect her choice of confidentiality of pregnancy. Sam must resolve the issue by finding
a solution which has respect for Jessica’s confidentiality and autonomy and the assistance
and services she required (Chaisson & Shore, 2014). Breaching Jessica’s
confidentiality must be taken very seriously by Sam. The therapeutic relationship with
adolescents is specifically fragile, and the consequent mistrust after breaking the