Informed Consent and Confidentiality: A Nursing Dilemma

Mary Jones, a nurse practitioner, is faced with a dilemma regarding Sandy Wilson's suspected pregnancy at the age of 15 years old. Despite her mother's wishes to keep the pregnancy confidential, Mary must take informed consent from Sandy and involve her mother in decision-making. This is because, as a minor, Sandy does not have the capacity to make decisions about her medical treatment. Mary should proceed with informing Sandy's mother and taking the best course of action for Sandy's protection and well-being, while also considering beneficence and respecting patient autonomy.

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Running head: LEGAL AND PROFESSIONAL ISSUES IN NURSING
Legal and Professional Issues in Nursing
Name of the student
Name of the University
Author note

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Running head: LEGAL AND PROFESSIONAL ISSUES IN NURSING
1.
The problem that exists for Mary is that Sandy, a 15 year old girl coming to her for diet
counseling does not want her mother, Mrs. Wilson to know about her suspected pregnancy. Mrs.
Wilson had come to Mary to know the reasons for Sandy feeling tired lately. However, the issue
for Mary is that she cannot give the detail that Sandy might be pregnant because her patient has
forbidden her to disclose this to her mother. The most basic thing that the nurse must address in
this case is to maintain patient’s right to confidentiality as well as follow her professional
responsibilities in care. The ethical conduct of beneficence is also at stake if Mary does not tell
anything about Sandy’s pregnancy to her mother (Mallari et al., 2016).
2.
In the case scenario of Sandy, the most important ethical and legal factor that Mary needs
to consider is to maintain beneficence of patient, engage in patient-centered care, protect
patient’s right to confidentiality, maintain patient autonomy and do justice to patient. The
principle of beneficence is related to the action of nurse in promoting well being of people and
acting for the best interest of the people (Grace, 2017). Hence, in Sandy’s case, it will be
important for nurse to first enquire how she got pregnant or find out whether Sandy is vulnerable
to child abuse. Knowing about the cause of pregnancy will help Mary to know whether she was
engage in consensual sex or she was molested or raped by someone. If she was engage in
consensual sex, then Mary could proceed with normal nursing care actions needed in this
situation such as performing pregnancy tests to confirm Sandy’s pregnancy, verifying the
possibility of abortion or taking patient’s consent regarding the next course of action. This action
is relevant according to section 6 of the Consent to Medical Treatment and Palliative Care
Act 1995(SA) which states that a young individual of 16 years or above may take his decisions

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Running head: LEGAL AND PROFESSIONAL ISSUES IN NURSING
about the medical treatment that has been proposed by the nurses or the doctors as an adult in
South Australia. The National Framework for Protecting Australia's Children 2009-2020
work on the ultimate objective of providing proper protection and care to young girls in
Australia's to reduce the occurrence of child abuse Costa et al., 2015).
However, if Mary learns about forced sex, then Mary will have to balance the patient’s
right to confidentiality as well as protect her from future harm (Tobiano et al., 2015). The action
to protect patient’s confidentiality is also relevant with Medicare Policy. According to the
Medicare Policy, a young person or a child belonging to any age group who has his or her
Medicare card, the medical information will not be shared to anyone without the consent of the
patient. But if the child belongs to an age of 14 or 15, the medical information will not disclosed
to the parents or guardians of the patient, but it can be shared if the parents request Medicare
Australia to provide the medical information of their children (Harner, 2016). In addition, to
maintain best interest of patient, the nurse should provide proper counseling to Sandy to ensure
that she has not been a victim of child abuse. This is also legally binding for her according to the
Child Care and Protection Act as it mentions controlling a child if he/she is displaying negative
behavior (Day, 2016).
3.
The two courses of action that is available to Mary is maintaining patient’s
confidentiality or maintaining beneficence of Sandy during care. As part of ethical code of
conduct in health care practice, a nurse has the duty to maintain confidentiality of all patients
information and respect patient’s decision regarding care (Anderson et al., 2015). Therefore, the
first course of action for Mary might be to listen to Sandy and not disclose about her pregnancy
to her mother. The other course of action that can occur in this case is that the nurse practitioner

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Running head: LEGAL AND PROFESSIONAL ISSUES IN NURSING
discloses the health condition of Sandy to her mother, since she is young and not matures enough
to take proper decisions about her health. This is relevant to the principle of beneficence, which
emphasizes that a nurse should take best actions to cause no harm to patient and promote
optimum health of patient (Bennett-Woods, 2015). For this, it will be important for nurse to
inform about pregnancy to her mother. This is because without informing her, she cannot take
informed consent, but however taking informed consent is necessary according to medical ethics
and code of conduct (Bowrey & Thompson, 2014). Hence, the second course of action seems
feasible in this case because her mother has a right to be decisive about the medical treatment
proposed by the nurse, for example to undergo abortion, so that she does not experience any
health issues in the future and leads a healthy and a normal life (Stuart,2014).
4.
Based on two options available for Mary, Mary should proceed ahead with the second
option of informing her mother and taking the best course of action for Sandy for her protection
and well being. This course of action has been decided because it is also ethically and legally
good nursing behavior. This is because beneficence of a patient is most critical for health care
professionals (Nelson, 2017). Many a times nurses need to ignore patient’s view about treatment
or negotiate with them to change their decision because patients are not always aware about the
risk associared with making a wrong choice during decision making. Secondly, Sandy is a
teenage and she is not mature enough to take decisions regarding her pregnancy. Hence, for the
protection of Sandy, it will be important for Mary to ignore patient’s autonomy and need to keep
Sandy’s pregnancy confidential. This is because Mary is not mature enough to take decision
regarding next course of treatment and her mother would be the best person to take decisions on

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Running head: LEGAL AND PROFESSIONAL ISSUES IN NURSING
her behalf. This will help Mary to comply with all legal and ethical responsilities in care too
(Michie & Allyse, 2015).
Hence, Mary will have to take major clinical decisions by involving Sandy’s mother in
decision making. According to Australian law, since Sandy is under 18 and of 15 years of age,
Mary Jones needs to discuss the case with the mother of Sandy, Mrs. Wilson about the
treatment that she should undergo. This is because children of a younger age do not have the
ability to decide about the medical treatment and the negative impacts of the health concern they
are suffering from (Cherry & Dillon,2014). It will be important for her to provide appropriate
information to Mrs. Wilson about the side effects, risks involved and the options of treatment
options available for Sandy. It is a legal duty of the nurse practitioner to warn both sandy and her
mother about the risks involved if she decides to go for an abortion. If she does not provide the
details of the treatment proposed, it would be considered as a breach of her duty of providing
proper care to her patient and may result in a legal action of negligence (Herring, 2014). .Mary
Jones should handle the health information by taking consent from Sandy Wilson and does not
disclose her suspected pregnancy to any other healthcare professionals without her consent.
The decision to involve Sandy’s mother is also legally important because parents act as
guardian to their children and they have the right to provide consent to or refuse a medical
treatment proposed by the doctor a medical practitioner. This right is being given in order to
provide guardianship to her child until he or she reaches to 18 years of age. Mrs. Wilson would
want Sandy to focus on her career rather than giving birth to a child at a tender age of 15 years.

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Running head: LEGAL AND PROFESSIONAL ISSUES IN NURSING
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