A Delicate Dilemma: Confidentiality vs. Duty of Care

The assignment discusses the legal issues surrounding a 15-year-old girl, Mary, who has had consensual sexual intercourse with her boyfriend and is now concerned about being pregnant. It highlights two possible courses of action for Mary: disclosing the conversation to Mrs. Wilson, Sandy's mother, which would breach confidentiality; or concealing the information from Mrs. Wilson, which may lead to further questions and ethical dilemmas. The assignment suggests that Mary should discuss with Sandy the consequences of not disclosing the matter to her mother, considering Sandy's age and legal capacity to make informed decisions.

Running head: PROFESSIONAL IDENTITY
Professional Identity
Name of the Student
Name of the University
Author Note

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Table of Contents
Question 1........................................................................................................................................2
Question 2........................................................................................................................................3
Question 3........................................................................................................................................4
Question 4........................................................................................................................................5
Reference List..................................................................................................................................7

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Question 1
In the given scenario, Sandi Wilson, fifteen years old, was sent to Mary Jones a nurse
practitioner for diet counseling as her hemoglobin level was low after she had fractured her legs.
However, when she revealed before Mary that she suspect of being pregnant, Mary came to
know that she did not have any idea what she should do to confirm her suspected pregnancy and
that she had not yet talked about it with her parents.
Here, being a nurse practitioner, she enters a therapeutic relationship with knowledge and
skills that include personal information about the individual in their care and the authority of the
nurse to provide care that the individual requires to be given (Daly, Speedy and Jackson 2017).
The nurses are under ethical obligation to treat the person information provided by the patients as
confidential and private. In the given scenario, after Mary finds out that Sandy suspects to be
pregnant, she must provide accurate and honest information regarding the facts about pregnancy.
When Mrs. Wilson, Sandy’s mother, enters into the room, the ethical issue that arises is whether
to inform sandy’s mother about Sandy’s suspected pregnancy.
There is an assumed confidentiality in the therapeutic relationship, which states that there
is an implied promise existing between the physician and the patient. Moreover, if the physician
discloses confidential information without giving warning to the patient about such disclosure
would amount to an unethical conduct on part of the nurse. Such disclosures made in most
patient-provider relationships, shall amount to betrayal of confidences (Chang and Daly 2015).
Here, Sandy has confided in Mary while she disclosed about her concern relating to suspected
pregnancy and trusted her that she would not disclose the information. Therefore, under the

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given circumstances, Mary is under ethical decision not to disclose the information about
suspected pregnancy to Mrs. Wilson.
Question 2
Nurses are expected to act in the best interests of those in their care and that the nurse
would cater to the needs of the patients. Professional Judgment requires the nurse to recognize
the intricate issues that are associated with the individuals in their care. Similarly, in the given
scenario, Mary shall have to identify all the issues that are associated with sandy and weigh these
in the balance to come to a decision regarding what she needs to do and how she can deal with
things in order to provide appropriate health care assistance to Sandy. There are certain ethical.
Legal and clinical issues associated with the given circumstances, which Mary is required deal
with effectively.
Clinical issues
The clinical issues involved in Sandy’s case relates to the tests that is required to be
conducted for the purpose of confirming whether Sandy is pregnant or her symptoms are likely
due to low-normal range of her hemoglobin level. The clinical issues, which Mary should take
into consideration, are that for performing the pregnancy test, Mrs. Wilson may have questions
regarding the pregnancy tests (Kennedy et al. 2015). Since there is an implied promise of
keeping the information as confidential on part of the nurse Mary, this does not imply that she
can mislead or lie to Sandy’s mother about the tests. She might need to say to her mother that the
tests being done cannot be revealed to her. However, it might give rise to an uncomfortable
situation between the mother and the daughter and under such circumstances, Mary may discuss
with Sandy about the risks of conducting the tests in the presence of her mother.

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Ethical Issue
Confidentiality is one of the fundamental duties of nurses, which can be breached under
circumstances when there is stronger obligation that requires the nurses to disclose the
information. If confidentiality is to be broken, the same must be informed to the patient.
However, such disclosure should be made to those persons with an absolute need to know about
the information (Schadewaldt et al. 2016).
In the given scenario, Mary must discuss with Sandy about the fact that although her
information shall be kept as confidential but she should be aware that there are other ways in
which her parents may have access to the information about her pregnancy tests. If she is
covered by her parent’s insurance, they would receive a bill which if itemized, might mention
about the pregnancy test. Further, if her mother requests a copy of her medical records, she might
come to know about the tests.
Legal issues
As per the Crimes Act (NSW), it deals with the involvement of the 15 years old in sexual
intercourse. After discussing things related to her concern about being pregnant, if Mary finds
out that she had been sexually active with her boyfriend and had a consensual sexual intercourse
with him, then under such circumstances she should make a note of it and provide necessary
therapeutic business. However, if Mary identifies that there has been coerced sexual intercourse,
she is required to notify the welfare authorities under the Children and Young persons (Care
and Protections) Act (NSW).

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Question 3
There are two obvious courses of action, which Mary may undertake in the given
circumstances. Mary owes confidentiality to Sandy and considering the delicacy of the
circumstances, Mary would require a ‘protective space’ for some moment so that she can obtain
necessary help from Mary. Mary may either disclose to Mrs. Wilson about the conversation she
had with Sandy, which would amount to a breach of confidentiality, or she may conceal the fact
from Mrs. Wilson, which may include lying to her, and this concealment would safeguard Sandy.
Although such concealment would protect Sandy protection for the time being but this,
would lead to further questions and eventually bring Maria back to the ethical dilemma that
whether she should disclose the conversation she had with sandy about her suspected pregnancy.
Hence, it is better that Mary discuss with Mary about the consequences of not disclosing the
matter to her mother, that she would come to know about it either through the insurance bills or
if she asks for a copy of her medical tests, which she would, being a mother. Hence, she should
be encouraged to consult with her parents about her circumstances (Johnstone 2015).
Question 4
Under the given circumstances, among the above-mentioned course of actions, Maria
should adopt the option of having a discussion with Sandy about the consequences of not
disclosing the matter to her mother. Maria must have this discussion with Sandy at the very
beginning and make her understand about the limitations and the capacity to the maintain
confidentiality of the conversation.
Maria should explain to Sandy that being a nurse practitioner, she owes confidentiality to
her but she is also entitled to disclose the information if there are stronger obligations that

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requires such disclosure. However, such disclosure shall be made only to persons with the utmost
need to know about the information (Masters 2015). It is the ethical duty of the nurse to inform
Sandy that even if she keeps the conversation confidential for the time being and she is
safeguarded by not conducting the tests in the presence of her mother, but it will only make her
mother ask more questions which might make it difficult for the nurse and sandy to answer.
Moreover, her pregnancy tests may be revealed through the insurance bills or if she asks for a
copy of the medical records, she would eventually come to know about her pregnancy tests.
Hence, Maria should encourage Sandy to consult with her parents about her concern as Sandy
being a competent legal person is permitted to decide whether it would be beneficial to her if the
information is disclosed. Maria, being a nurse practitioner, is under ethical obligation to respect
informed-decision making of Sandy.

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Reference List
Chang, E. and Daly, J., 2015. Transitions in Nursing-E-Book: Preparing for Professional
Practice. Elsevier Health Sciences.
Children and Young persons (Care and Protections) Act (NSW)
Daly, J., Speedy, S. and Jackson, D., 2017. Contexts of nursing: An introduction. Elsevier Health
Sciences.
Johnstone, M.J., 2015. Bioethics: a nursing perspective. Elsevier Health Sciences.
Kangasniemi, M., Pakkanen, P. and Korhonen, A., 2015. Professional ethics in nursing: an
integrative review. Journal of advanced nursing, 71(8), pp.1744-1757.
Kennedy, C., O'reilly, P., Fealy, G., Casey, M., Brady, A.M., McNamara, M., Prizeman, G.,
Rohde, D. and Hegarty, J., 2015. Comparative analysis of nursing and midwifery regulatory and
professional bodies' scope of practice and associated decision‐making frameworks: a discussion
paper. Journal of advanced nursing, 71(8), pp.1797-1811.
Masters, K., 2015. Role development in professional nursing practice. Jones & Bartlett
Publishers.
Schadewaldt, V., McInnes, E., Hiller, J.E. and Gardner, A., 2016. Experiences of nurse
practitioners and medical practitioners working in collaborative practice models in primary
healthcare in Australia–a multiple case study using mixed methods. BMC family practice, 17(1),
p.99.

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