Ethical Considerations in Nursing Care for Adolescent Patients

This article discusses the ethical considerations in nursing care for adolescent patients, focusing on a case study of a 14-year-old girl seeking contraception. It explores the bioethical principles of autonomy, non-maleficence, beneficence, and justice, as well as the importance of patient confidentiality and autonomy. Recommendations for healthcare professionals are provided, including promoting a healthy lifestyle and educating patients about the risks of unprotected sex and sexually transmitted diseases.

Running head: NURSING ASSIGNMENT
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Name of the Student
Name of the university
Author’s note

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Introduction
The case study is based upon Taylah who had visited the clinic, requesting for
contraception. Taylah is diabetic and his body image clearly depicts her risk taking behavior
related to sexual activity, partying and binge drinking. Although Taylah is only 14 years old, but
she looks older than her age, which probably leads to expectations from others, including the
older boys. Taylah has become sexually active recently and have had sexual intercourse with two
random boys at the parties during binge drinking.
The seriousness of the problem lies in the fact that Taylah is only 14v years old and her
risk taking activities should not only hamper her academic career in the future, but might bring
about several health care complications. Many literary sources have indicated towards the fact
that binge drinking among the adolescent can be related to alcohol related poisoning, black outs
and injury, involvement in the car crashes and the fatalities, alcohol related sexual and physical
assaults and increased risk of sexually transmitted disease or problems at the work or schools.
Furthermore, indiscriminate sexual activity at this age increases the chance of unwanted
pregnancy or the transmission of sexually transmitted disease (Wilkinson et al., 2018). Use of
oral contraceptive at a young age again increases the risk of menstrual cycle irregularities,
weight gain, depression, headache, bloating and mood swings. Some of the research papers has
also claimed that it exposes women to breast cancer (Wilkinson et al., 2018).
Medroxyprogesterone acetate is also associated with a delayed return to fertility and possibly a
reversible osteopenia (Wilkinson et al., 2018). These factors certainly poses health risk for
Taylah. Furthermore, since Taylah is just 14 years old, an ethical issue might arise as whether
Taylah’s parents should be involved in this.

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Body
Bioethical principle
The reports spans round four ethical principles of Beauchamp and Childress (2008),
that includes principles of autonomy, non-maleficence, principles of beneficence and principles
of justice. It is evident from the case study that Taylah had come to the clinic for consulting
about the use of the contraceptives, hence apart from discussing about the method of
contraception, it is also the duty of the nurses to inform the girl about the ill effects of
contraception (Butts & Rich, 2019).
The third ethical principle can be discussed in this context- the principle of non-maleficence,
which means non –harming or inflicting minimal harm to the patient to reach a beneficial
outcome (Winner et al., 2018). Hence, while suggesting the patient about contraception it is also
necessary to take under consideration, the age of the patient.
Beneficence is again an ethical principal that addresses the concept that the action of the
nurses is to do good to promote good to the patient (Almeida, Lins & Rocha, 2015). Act of
beneficence means that even if the nurses discuss the contraception methods with her, focus
should be given that only those medicines should be prescribed will cause less adverse effects.
As an act of beneficence , it also necessary that the nurses inform patient about the adverse effect
of using contraceptive pills and the reckless life that Taylah had been facing with. Being a
responsible nurse, it is necessary to screen the presence of any chronic disease before the
advising the patient with any intervention. There are several things that needs to be checked
before administration of the injection. Taylah should be educated that oral contraceptive pills
might prevent pregnancy to some extent, but it certainly does not save the patient from the

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sexually transmitted disease (Winner et al., 2018). While teaching Taylah about the other
methods of contraception, she should be informed about the disadvantages like high cost
associated with implant or availability of an expert health care professional for the removal of
the implant. In relation to this a paper by Dickerson et al., (2018) have proposed that the medical
intervention in the world of contraception should be on the basis of the concepts equality,
freedom and general welfare of the people. This should entail access to information to education
and service. It can be argued further, that adolescent pregnancy not only harms the teenager but
on the society as a whole (Dickerson et al., 2018). The practicing physicians have often been
caught in the debate between those who argue that favoring the autonomy of the teenager would
decrease mortality and morbidity and those who insist that favoring parental control and
responsibility would protect children from their own irrational deeds. Treatments needs to be
patient specific and entirely based on the needs of the teenagers and not on any preconceived
rules and norms. It is necessary that the clinicians even consider simplest situations as many of
the adolescent would not want to have their parents involved. The nurses who attends the
adolescent patients should be able to address a series of ethical assessments, like her social
maturity, her relationship, whether it is an abusive one or not, the relationship of the teenager
with her parents. It can be said that low self-esteem or presence of moral void might lead to
unprotected sexual activities. Nurses always plays an important role to promote effective
education. This should move beyond the normal biological explanation to the teenagers.
Education is always more than information and since nurses have to work in frontline with the
doctors, they should take on the role of the educators. They also play an important role in their
community to foster effective contraception education. In this case, the nurse should focus

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educating Taylah about the different methods of contraception and specially the future
consequences of life than can, if Taylah continues to live her life in this way.
Patient confidentiality and autonomy
Confidentiality in treating adolescent patients has both instrumental as well as intrinsic
value. The clinicians who are caring for the pediatric and the adolescent patient are quick go
surmise that the duty to respect to autonomy is complicated by the fact that autonomy is a
developmental construct (Lachman, 2012). As an instrumental value the promise of a
confidential care increase the likelihood that the adolescent patients will seek care and will
disclose every health concerns frankly.
Nurses are faced with several ethical and bioethical dilemma, in adolescent health care.
Considering he life style and the health risks of Taylah, the nurses might want to consult with
some guardian or Taylah’s parents for discussing the risk factors. Taylah on the other hand
would never agree to disclose anything to her parents, this conflicts with the health care
professionals might arise. As stated by Almeida, Lins and Rocha, (2015) various conflict
situations might arise where the rules established are not sufficient to clear the ethical questions
that arise in the interrelationship of the young people in this age group with the society.
One of the important pillars of the bioethics is autonomy that gives the power of decision
making in children. In this case, it is the choice of the teenager to lead her life according to her
terms and conditions (Coyne et al., 2017). Suggesting or implementing any interventions that is
contrary to the habits and the life style may give rise to conflicts and thus breaching the right to
autonomy of the patient. Providing autonomy to the patient to decide on the treatment sometimes

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might inflict unwanted harm to the patient, such as in this case, if the nurses only suggest her
about the contraceptives and not the side effects, then that would indirectly harm the patient. It is
up to the physician and the health care professional to protect the patient from harm. When the
risk of the harm is more, protection might lead to paternalistic actions. In many cases the
principle of beneficence has to precede autonomy as per the fundamental codes of medical
ethics, a professional should respect the decision as long the decision is scientifically correct and
is adequate to the case as a health care professional cannot put a patient under risk (Butts & Rich,
2019).Due to the respect for autonomy the doctor often is put in go difficult situations, that needs
discernment to decide on the ethical issues related to health. , self-care and its effect on the
individual who is under the care. Most of the health professionals have claimed that in most of
the cases the adolescent patients are nor been able to take decisions of their own health and
hence pass their decision making the power to their personal representative or to someone whom
the patient considers so. However, it is always not that these tutors always seek the benefit of the
minors (Metzger et al., 2017).
Again with respect for the autonomy, several studies have proved that teenagers often
delay seeking medical help with the fear, that their health care information will be disclosed to
their parents. Hence, in this case raising the topic of parental involvement might scare Taylah to
disclose about her sexual health to her parents. Thus autonomy should be respected. For the
nurses secrecy in such calls are important as the patients knowing that their information would
disclose would not want to report their health problems. In the case study it is mentioned that
Taylah had recently become sexually active with some random boys at the party. Considering
Taylah’s risk taking behavior it is necessary to teach Taylah about the various methods of
contraceptives.

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Some of the health educations that is necessary to be provided to Taylah is the
importance of using male or female condoms over oral contraceptive pills, due to the side effect
caused by the consumption of the pills. Apart from this, the use of contraceptive pills does not
help to prevent sexually transmitted disease. Since Taylah had been having unprotected sex with
two random guys, the chance of contracting STD of course becomes high.
The ethical arguments that are supporting the confidential care for the adolescents are
quite strong and focus on the respect for the emerging autonomy, recognition of evolving the
decision making capability of the patients and also allows the teen to take decisions. It has to be
remembered that adolescent is a time for intense developmental transition. At the time of
adolescence the individuals normally move in to new peer groups, develop emotionally and
intellectually (Coyne et al., 2017). Hence, when the physicians provides them with confidential
care, they are actually allowing the patients how to communicate with the clinicians
Apart from the bioethics there are some laws to uphold the rights of patients. Article 17
of the legislation ensures professional secrecy of patients considering the underage patients who
are capable of taking decisions. The law vetoes the doctors from disclosing the information of
the patient, the confidentiality breach is permitted only in the legal cases, legal duty or any
written authorization from the patient. Violation of the laws might cause penalization. Again, the
HIPAA Health Insurance Portability and Accountability Act (HIPAA) 1996, that provided
protection against the access to protected health information for the adolescents aged more than
18 years. This law is thus applicable to this case scenario, where parental involvement of the
patients might cause ethical dilemma in the patient.

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Conclusion
Adherence to the ethical principles of nursing can become challenging while treating
adolescent patients. In such cases, it is necessary for the health care professional to assess the
importance of the health issue before taking decisions. In many cases the adolescents might
refrain themselves from consulting with the clinician. In order to prevent this the clinicians are
accountable to maintain confidentiality and privacy of the patient information. Furthermore, the
paper has also provided with recommendations like maintaining a healthy life style, preventive
measures against sexually transmitted disease and refraining from unprotected sex. Finally the
paper had provided a strong for the preservation of the patient’s right to autonomy.

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References
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