Ethical Dilemmas in Healthcare: A Case Study Analysis

This case study delves into three distinct ethical dilemmas within healthcare settings. The first case examines the conflict between parental rights and compulsory vaccination, focusing on the principles of beneficence and autonomy. The analysis explores the 'No Jab, No Pay' policy, the importance of providing comprehensive information to parents, and the role of nurses in facilitating informed decisions. The second case addresses the ethical considerations surrounding a minor's diagnosis of Chlamydia, balancing the need for confidentiality, autonomy, and non-maleficence. It discusses the application of Gillick competence and relevant Australian legislation, offering recommendations for counseling and family care. The final case presents a scenario involving a child witnessing domestic violence, highlighting the ethical complexities of reporting such incidents, considering the principles of autonomy and non-maleficence. The study explores the implications of the Intervention Orders Act and Family Law Act, and suggests approaches for developing rapport with the child and providing support to the mother, including counseling and guidance on reporting procedures. Each case emphasizes holistic care and the importance of ethical decision-making in healthcare practice.

Running head: ETHICS IN HEALTHCARE
Health across the lifespan
Name of the Student
Name of the University
Author Note

1ETHICS IN HEALTHCARE
Case Study 1: Mia Masterson (No 4 Wellbeing street)
1. In recent times the governments and department of health have formulated and
enforced legislation and policies related to compulsory vaccination, with the sole aim
of decreasing the incidence of contagious diseases (Miller, 2019). In this case, the
parents David and Julian do not approve vaccination of their child Mia, owing to a
previous incidence of autism diagnosis in their relative. Forcefully vaccinating Mia,
against the wishes of the children would result in desecration of their human rights
since the child cannot decide for herself. This might be considered a form of medical
malpractice and might make the parents file a lawsuit (MacDonald et al., 2018).
Nonetheless, unwillingness to vaccinate their child would also lead to defilement of
the No Jab, No Pay policy, thus preventing the child from being admitted to any
preschool or care centre. This case is associated with the ethical issues of beneficence
and autonomy. The nurse has the good intention to vaccinate Mia for preventing the
onset of any illness, thus showing beneficence. However, not considering the wishes
of the parents, and influencing them to decide for mandatory vaccination would cause
breach of autonomy (Hendrix, Sturm, Zimet & Meslin, 2016).
2. The government of Australia had established the National Immunisation Strategy for
Australia 2013-2018, with the aim of providing extensive coverage to all vaccinations
through protected and effectual supply of vaccines (Department of Health, 2016). Not
only do all children require compulsory vaccination, the Immunise Australia Program
has also been initiated for increasing the national rates of immunisation. The
government has also enforced the No Jab, No Pay policy in 2016 that makes it
compulsory for families to get their child immunised, in exchange of welfare
payments such as, the 'Family Allowance' benefit (Trent, Zhang, Chughtai &
MacIntyre, 2019).

2ETHICS IN HEALTHCARE
3. The principle strategy in this case would be to provide complete and exhaustive
information to the parents about the purpose, benefits, and drawbacks (if any) of
vaccination. This will encompass parent educational sessions and can be
accomplished through one-to-one discussions and dissemination of resources.
Adequate evidences will also be shared to help the parents understand that MMR
vaccination does not augment the risks of autism (Chang, 2018). In addition, they will
also be educated that the pharmaceutical companies do not have any monetary
benefits associated with vaccination. In addition, the parents will also be provided a
comprehensive list of immunisation schedule that their child must be subjected to.
4. Holistic care approach in this case study would encompass counselling the parents
and encouraging them to get their daughter vaccinated. It has often been found that
since nurses are the frontline health workers and spend maximum time with patients
and their family members, the latter generally place their trust and conviction on
nurses (Nyssen et al., 2018). Hence, during the counselling sessions, a non-
judgmental approach will be demonstrated, which in turn will allow the parents to
share their concerns, apprehensions, and fear about vaccination (Pérez et al., 2017).
The parents shall also be advised regarding the accessibility of different vaccines.
This can be accomplished if a therapeutic relationship is established with the parents,
and this relationship will be based on trust and reliance.
Case study 2: Taylah Dennison (No 8 Wellbeing Street)
1. Owing to the fact that the Australian government seeks approval from parents of
patients aged not more than 18 years, not informing Taylah’s parents and
commencing her treatment would lead to medical malpractice. Parents are considered
best to judge the treatments and care plans that are in best interest of their ward
(Theologis et al., 2016). Hence, keeping them unaware of the diagnosis of Chlamydia

3ETHICS IN HEALTHCARE
would cause a breach of conduct and might lead to legal action. This case is
associated with the ethical issues of confidentiality, autonomy and non-maleficence.
Though Taylah does not want to inform her parents about her sexual behaviour and
the recently acquire disease, not following her wishes would result in violation of
autonomy and confidentiality. Moreover, taking into consideration the severity and
impact of Chlamydia infection, it is imperative to act in a manner that does no harm to
the patient (non-maleficence) (Sisk, Canavera, Sharma, Baker & Johnson, 2019).
2. Gillick competence is followed in Australia and had been established in Gillick v
West Norfolk and Wisbech Area Health Authority [1986] AC 112. According to this
competence, the right of a parent reduces as their children become progressively
capable (Zimmermann, 2019). The Consent to Medical Treatment and Palliative Care
Act 1995 (SA) it states that all children, aged not more than 16 years have the
authority of providing their consent to clinical treatment, without the need for
informing or obtaining approval from their parents. The government has also enforced
the Minors (Property and Contracts) Act 1970 (NSW) legislation that bestows this
right on children aged 14 years or more, depending on their level of understanding,
responsible behaviour, and maturity level that must not be confused with
chronological age (NSW Government, 2015).
3. Although the Australian legislation allows children to provide their consent to
treatment, it must be taken into consideration that Chlamydia is sexually transmitted
and might even relapse after a certain time (Khosropour et al., 2019). In addition,
owing to the fact that her partners are also at a risk of being affected with this disease,
Taylah will be recommended to inform her parents about her health status and sexual
behaviour. She will be given the advice to arrange for a meeting with her parents in
the healthcare facility, where the latter can be provided guidance.

4ETHICS IN HEALTHCARE
4. The first step of delivering holistic and family care would encompass subjecting both
Taylah and her parents to individual counselling sessions. During the counselling
session, Taylah will be provided a sound understanding of the health risks that are
associated with risky sexual behaviour such as, cancer, infertility and AIDS (Zhu et
al., 2016). She will also be explained that having multiple partners, unprotected sexual
intercourse and alcohol abuse will not only affect her physical health, but will also
make her more prone to recurrent incidence of sexually transmitted infections.
Psychoeducation will also form a core component of this approach (Siahaan, 2017).
Her parents will be recommended to foster amicable relationship with her that will
allow the latter to share her thoughts and perceptions. They will also be advised to
closely monitor her actions and prevent her from indulging in any risky sexual
behaviour that might threaten her health and wellbeing.
Case study 3: Jacob Scanes (No 14 Wellbeing Street)
1. On analysing the case, it can be suggested that Jacob’s flat behaviour and
disengagement in class might be the consequence of being a witness to domestic
violence at home. Domestic violence is a matter of serious concern and the
government has made it mandatory to report such instances of violence, in order to
protect the victim from further threats (Chesney-Lind & Chagnon, 2017). However,
considering the fact that Jacob is too young and might not have attained maturity,
reporting the incident to the officials, without confirmation from his mother might
lead to severe legal consequences such, as arrest of her partner (O’Neal & Spohn,
2017). Moreover, the ethical issues of autonomy and non-maleficence are relevant in
this case. Autonomy provides clients the right to decide what is best for them, without
being under the influence of any care provider. Additionally, considering the fact that
Jacob’s mother might not want to disclose information on this matter, incident

5ETHICS IN HEALTHCARE
reporting would result in breach of autonomy (Walker, 2017). Despite the wish to
provide her assistance and safeguard her from further harm from Dean, incident
reporting might also increase her chances of being attacked by her partner, thus
violating the principle of doing no harm.
2. According to the Intervention Orders (Prevention of Abuse) Act 2009 all people must
be protected from domestic violence and this can be accomplished by imposing
restrictions on the action of the wrongdoer, following which he can be sent for
rehabilitation (Government of South Australia, 2018). The care and maintenance of
children are also administered by the Family Law Act 1975 that governs that place of
residence of a child in case of domestic violence and the people who will be
accountable for health and wellbeing of the child (Abc.net.au, 1975).
3. The major action would include development of a good rapport with Jacob by
providing him a comfortable and secure environment that will allow him to share his
concerns and apprehensions. This will be followed by contacting his mother and
holding a one-to-one discussion with the latter (Arora, Deosthali & Rege, 2019).
Conversation will be initiated with her in order to understand the root causes behind
domestic violence such as, family status and dynamics.
4. Family and holistic approach would encompass conducting counselling sessions for
both Jacob and his mother. This can be accredited to the fact that domestic violence
not only affects the victim physically, but also takes a toll on the mental health of both
victims and witnesses. Jacob’s mother will be educated on her rights and privileges
and shall be recommended to seek help from local agencies and government officials,
if she is again subjected to domestic violence (Roddy, 2016). The counselling sessions
will be delivered over a definite time that will guide her through different education-
style modules, which in turn will be based on psychoeducation and cognitive

6ETHICS IN HEALTHCARE
behavioural therapy. She might also require medical treatment from a primary care
provider or a physician. In addition, she will be made aware of the indications of
potential threat and after obtaining her consent, the incident shall be reported to the
local authorities.

7ETHICS IN HEALTHCARE
References
Abc.net.au. (1975). Family Law Act 1975 Act No. 53 of 1975 as amended. Retrieved from
https://www.abc.net.au/cm/lb/4093556/data/family-law-act-1975-data.pdf
Arora, S., Deosthali, P. B., & Rege, S. (2019). Effectiveness of a counselling intervention
implemented in antenatal setting for pregnant women facing domestic violence: a pre‐
experimental study. BJOG: An International Journal of Obstetrics &
Gynaecology, 126, 50-57. https://doi.org/10.1111/1471-0528.15846
Chang, L. V. (2018). Information, education, and health behaviors: Evidence from the MMR
vaccine autism controversy. Health Economics, 27(7), 1043-1062.
https://doi.org/10.1002/hec.3645
Chesney-Lind, M., & Chagnon, N. (2017). Media representations of domestic violence.
In Oxford Research Encyclopedia of Criminology and Criminal Justice. DOI:
10.1093/acrefore/9780190264079.013.103
Department of Health. (2016). No Jab, No Pay – New Immunisation Requirements for Family
Assistance Payments. Retrieved from
https://www.health.gov.au/sites/default/files/no-jab-no-pay-fsheet.pdf
Government of South Australia. (2018). Intervention Orders (Prevention of Abuse) Act 2009.
Retrieved from https://www.legislation.sa.gov.au/LZ/C/A/INTERVENTION
%20ORDERS%20(PREVENTION%20OF%20ABUSE)%20ACT%202009.aspx
Hendrix, K. S., Sturm, L. A., Zimet, G. D., & Meslin, E. M. (2016). Ethics and childhood
vaccination policy in the United States. American journal of public health, 106(2),
273-278. https://doi.org/10.2105/AJPH.2015.302952

8ETHICS IN HEALTHCARE
Khosropour, C. M., Soge, O. O., Suchland, R., Leipertz, G., Unutzer, A., Pascual, R., ... &
Golden, M. R. (2019). Recurrent/Intermittent Vaginal and Rectal Chlamydial
Infection Following Treatment: A Prospective Cohort Study Among Female Sexually
Transmitted Disease Clinic Patients. The Journal of infectious diseases, 220(3), 476-
483. https://doi.org/10.1093/infdis/jiz113
MacDonald, N. E., Harmon, S., Dube, E., Steenbeek, A., Crowcroft, N., Opel, D. J., ... &
Butler, R. (2018). Mandatory infant & childhood immunization: Rationales, issues
and knowledge gaps. Vaccine, 36(39), 5811-5818.
https://doi.org/10.1016/j.vaccine.2018.08.042
Miller, F. (2019). Children's Competence to Consent to Medical, Surgical and Dental
Treatment: Partner's in Healthcare? (Doctoral dissertation, University of Otago).
Retrieved from
https://ourarchive.otago.ac.nz/bitstream/handle/10523/9416/MillerFiona2019PhD.pdf
?sequence=1&isAllowed=y
NSW Government. (2015). Minors (Property and Contracts) Act 1970 No 60. Retrieved from
https://legislation.nsw.gov.au/#/view/act/1970/60/full
Nyssen, A. S., Gillet, A., Sougné, J., Bidee, J., Gérimont, C., Pepermans, R., & Hansez, I.
(2018). Do management and executive share the same perception on the critical issues
facing the front-line nursing staff?. International Journal of Healthcare
Management, 11(3), 239-242.’ https://doi.org/10.1080/20479700.2017.1353786
O’Neal, E. N., & Spohn, C. (2017). When the perpetrator is a partner: Arrest and charging
decisions in intimate partner sexual assault cases—A focal concerns
analysis. Violence against women, 23(6), 707-729.
https://doi.org/10.1177%2F1077801216650289

9ETHICS IN HEALTHCARE
Pérez, R. P., Martín, D. H., Rodríguez, M. Á. C., de la Parte Cancho, M., Verrier, E. C.,
Arévalo, S. G., & Aguado, I. C. (2017). Vaccination counselling: The meeting point is
possible. Anales de Pediatría (English Edition), 86(6), 314-320.
https://doi.org/10.1016/j.anpede.2016.06.006
Roddy, J. (2016). Counselling and psychotherapy after domestic violence: A client view of
what helps recovery. Springer. Retrieved from https://books.google.co.in/books?
hl=en&lr=&id=K3ikCgAAQBAJ&oi=fnd&pg=PP1&dq=domestic+violence+and+co
unselling&ots=Zo5sU9qvOE&sig=9sHWufAkgnMdRbJC0RzZonbXh_8#v=onepage
&q=domestic%20violence%20and%20counselling&f=false
Siahaan, F. M. M. (2017). Psychoeducation on reproductive health for adolescent with
intellectual disability. In International Psychological Applications Conference and
Trends (InPACT) 2017. Retrieved from
https://scholar.ui.ac.id/en/publications/psychoeducation-on-reproductive-health-for-
adolescent-with-intell
Sisk, B. A., Canavera, K., Sharma, A., Baker, J. N., & Johnson, L. M. (2019). Ethical issues
in the care of adolescent and young adult oncology patients. Pediatric blood &
cancer, 66(5), e27608. https://doi.org/10.1002/pbc.27608
Theologis, A. A., Anaya, A., Sabatini, C., Sucato, D. J., Parent, S., Erickson, M., & Diab, M.
(2016). Surgical consent of children and guardians for the treatment of adolescent
idiopathic scoliosis is incompletely informed. Spine, 41(1), 53-61. doi:
10.1097/BRS.0000000000001162
Trent, M. J., Zhang, E. J., Chughtai, A. A., & MacIntyre, C. R. (2019). Parental opinions
towards the “No Jab, No Pay” policy in Australia. Vaccine, 37(36), 5250-5256.
https://doi.org/10.1016/j.vaccine.2019.07.066

10ETHICS IN HEALTHCARE
Walker, R. M. (2017). Mandatory reporting of intimate partner violence: an ethical dilemma
for forensic nurses. Journal of forensic nursing, 13(3), 143-146. doi:
10.1097/JFN.0000000000000159
Zhu, H., Shen, Z., Luo, H., Zhang, W., & Zhu, X. (2016). Chlamydia trachomatis infection-
associated risk of cervical cancer: a meta-analysis. Medicine, 95(13).
doi: 10.1097/MD.0000000000003077
Zimmermann, N. (2019). Gillick Competence: An Unnecessary Burden. The New
Bioethics, 25(1), 78-93. https://doi.org/10.1080/20502877.2019.1564004