The field of medicine is often faced with several dilemmas as some situations result in conflict between ethics and medical practice. In this paper, we will look at scenario 6 of an old grandmother and her granddaughter. As a group, the decision-making framework we adopted to apply in the use for the assigned case is a Simple Guide to Ethical Deliberation for Professionals, written by Vanya Kovach.
A 65 year old grandmother brings her 14 year old granddaughter to your clinic to request birth control pills for the teenager. The teenager is tearful, keeps saying she is not sexually active and does not want the pill. The grandmother tells you that the girl’s mother is on drugs, is a prostitute some of the time, left this daughter for her to raise, and she is not going to raise another generation of babies. She says, “I cannot watch her all the time, she needs to be on the pill.” What will you do?
A Simple Guide to Ethical Deliberation for Professionals, advises the adoption of the following framework;
The first task entails exploration of the issue at hand and in this case, the fundamental conflict surrounds the ability of a teenage girl to make a medical decision. It is difficult to know whether the child is already sexually active but it is the responsibility of the nurse to make the right decision that would not harm the patient as a result.
2. Professional obligations
The nurse has an obligation to protect the teenage girl from harm in that issuing a medical prescription without proper diagnosis would lead to misdiagnosis. The professional oath requires also that whatever information provided by the girl in the event of an inquiry should not be disclosed to any other person.
3. Boundaries in the situation
The boundaries involve full disclosure of any information not protected by the Fifth Amendment right provided to teenagers under the constitution. Any information that may affect the teenage girl negatively should be made aware to the guardian who is the grandmother.
4. Awareness of self as well as that of others useful in the case
The grandmother should be aware that the teenage girl has rights and cannot be forcefully made to take birth control pills. As a nurse it should be my duty to know if the girl is sexually active or not. The girl should also be aware that teenage pregnancy is a menace in the society and in the event that she wanted to engage in sex, she had the option for birth control.
5. Possible solutions
The solutions available in the table involve guidance and counselling to the teenage girl on the dangers of risky sexual behaviors. Education on disadvantages of unwanted pregnancies and possibility of acquiring sexually transmitted Infections (STI). The other option for a solution is making the grandmother understand that the fact the mother of her granddaughter being an addict and a prostitutes does not guarantee that her daughter will follow suit as she is an individual of her own.
6. Evaluation of solutions
The solutions provided are essential and viable. However, putting the teenage kid under close scrutiny in addition to guidance and counseling services will help in providing a long term solution.
7. Legal rights violated
Forcing a patient to take a particular medicine against her own will violate the basic constitutional rights of the girl. The girl has her rationality intact and is fully capable of making medical decisions on her own.
8. Likely benefits and risks
The risks entail the girl ending up pregnant when not put on the birth control pill as per the demand of her grandmother. The blame will be placed on the nurse. The benefit of not putting the girl on the pill and provision of guidance and counselling will ensure she continues to become a responsible citizen and a well-educated person.
9. Checking and reflecting effect on relationships
The relationship between the girl and the grandmother will be impacted negatively either way whether the girl is on pill or not. The reason being the girl will feel her rights infringed by the grandmother.
Argument to the issue
The issue entails teenage pregnancy. The framework should involve the application of teenage rights and careful monitoring of the activities carried out by the teenage girl. The endangered issue involves the denial of teenage rights with the presumption that an adult should help them in making such decisions (“Our Culture’s Teen Pregnancy Ethical Conflict”, 2017). The case should originate from the fundamental rights of human beings. If the teenage girl consumes birth control pills without engaging in sexual activities, she will be affected in her health in a harmful way. The appropriate approach would entail putting her on counselling services.
Unfortunately none of the group members had such an experience but if we were in the same situation, the feeling would be that of oppression and slavery. Therefore, the teenage girl should not experience the struggle of being discriminated on the basis of her mother’s actions when she herself is different. As the teenage girls, the best friend would be the nurse to confide to and accept medical assistance when needed. The objective of our team entails identifying the real facts behind the grandmother’s desired to put the teenage girl on birth control. The second objective would entail making close monitoring of the teenage girl movements when at home and at school. The motivation behind the case for the team is identifying negative implications of forcing the teenager on birth control (“Contraception and Adolescents”, 2017). It is also an important thing to understand the religious aspect of the 14 year old girl.
The ethical issue surrounding the case entails provision of birth control pills to a teenage based on past records of her mother. The 14 year old granddaughter is presumed to follow the same path as the mother and engaging in drug abuse alongside prostitution. The ethical dilemma arises where the nurse needs to avoid putting the teenage girl on pills while she alleges not to be sexually active. However, if the allegations provided by the grandmother are correct, then when the girls gets pregnant the nurse will be on blame. Also the 14 year old girl has personal rights which protect her. The situation of this case surrounds issues of teenage pregnancy which may lead to the girl dropping out of school at an early age, use of birth control pills among the youth, individual rights and the competence and ability to make personal decisions.
The arguments surrounding ethics that support individual care for teenagers focus on respecting the developing independence. The acknowledgement of changing capacity for decision making, consenting to teens learning accountability in medical care judgment, alongside enlightening access and safety to care aims to promote autonomy of teenagers (“Decision Making/Problem Solving With Teens | Ohioline”, 2017). Adolescence entail a period of strong transition of development.
During teenage years, a person will definitely develop emotionally and intellectually, engage with a peer group, get into workforce or pursue higher education, which may lead to them becoming financially or socially autonomous. When medical doctors deliver personal care for teenagers, they are providing them the chance to study how to engage with them become in charge of their medical care, while supporting and respecting the growth of an evolving self-autonomy.
Studies done previously support this prerogative: when clinicians deliberated on complex subjects with a set of surveyed teenagers, the adolescents in the research stated that the nurses heard their concerns and they felt close to them as they became more and more involved in their health care. No individual would like to stay in the dark ages where the school pregnant children were discriminated and expelled. Teenage pregnancy should be approached with a lot of care as it involves a life crisis.
The ethical reaction to other people’s crisis in life involves kindness, compassion and support. As culture involves a set of accepted norms that govern the society, it becomes a social concern when teenage pregnancies become more frequent and therefore culture has to convey the message of discouraging the act before or after getting pregnant.
Birth control pills
Pediatricians play a significant part in reproductive health care among adolescents. The long-term relations between families and patients permit them to support in promotion of strong decision-making regarding abstinence as well as sexuality to evade the undesirable outcomes related with dangerous sexual actions. As supporters for the well-being and health of teenagers, pediatricians convey their suggestions to teenage patients to practice sexual abstinence since any sexual action where the adolescent is not ready for may result to financial, physical and emotional concerns. Pediatricians have identified that the trends in use of contraception utilized by youths over the last two eras demonstrate a general rise in an increase in use of male condom and oral contraceptive pill (OCP) use (“Birth Control Pill Use – Child Trends”, 2017).
Personal decision making
The skill of decision making is a significant ability to communicate to kids of all ages, since guardians need their offspring to mature as responsible, autonomous, and contented grown-ups. Some study indicate that individuals who have capacity to assess circumstances and make choices are likely to become more prosperous in life. Skills of decision making ought to start quick with providing children with small choices to start choosing their options. Nevertheless, as offspring grow into teenagers the need to develop independence as they grow.
Adolescents need engage in making decisions more often on the choices that affect them. In the process, they get to make mistakes as they learn and grow. However, if parents or guardians like in our case study make the choices for them most of the time then they will be underprepared to take on such task when they grow into adults. Several adolescents possess enough emotional development and cognitive capability to make numerous decisions regarding health care. Investigations done on past research reveal that by age 14 to 15 years, teenagers make decisions based on health-related issues comparable to those made by grown-ups. Due to differences in development between both the affective and cognitive systems, teenagers often have challenges in circumstances with peer distraction or high emotional arousal and might want additional support in decision-making during such situations.
In general, the constitution of a state applies to all individuals regardless of race, age, religion, and color among several other factors. However, children don’t continuously get entitled to full rights of the constitution. Even though teenagers are regarded to possess restricted capacity for decision-making by several policy makers, occasions exist where adolescents provide knowledgeable approval without intervention from parents (“Minor’s Rights Versus Parental Rights: Review of Legal Issues”, 2017). Some of the acts include the emancipated teenager, the matured minor, and lastly an emergency condition. It is significant for all parents to comprehend the Health rights accorded to teens. A key duty during the adolescent years entails striking the equilibrium between parental and autonomy sustenance. Developmentally, adolescents undergo the maturity process: they change from tangible to more intangible rational, they query restrictions, and begin to take accountability for their wellbeing.
C. Ethical Theory
The theory forms an opinion on an individual based on their personality as opposed to an act that may differ from their normal conduct. It considers the motivation, morals and reputation of an individual when evaluating an irregular or unusual behavior deemed as unethical (MacKinnon & Fiala, 2014). The single weakness identified of the particular theory in discussion is that it avoids taking into account the reflection of a change in a person’s moral personality. For instance, a researcher who probably made errors in the previous times may fairly possess similar late night narrative as the researcher in good standing. Both scientists did intentionally plagiarize the work, but the deed was still performed. However, as an alternative a researcher might opt for an unexpected shift from ethical to unethical character that might go overlooked until a substantial volume of indication gathers up contrary to him/her.
Respect for Autonomy
The code asserts that the process of making decisions should concentrate on letting individuals to be independent so as have capacity to make choices that directly affect their existence (“Are Students (and Minors) Protected by the Constitution?”, 2017). Consequently, the general public should be in control of their lives since they entail the only persons who totally comprehend their kind of lifestyle choices. Every individual deserves respect because he/she is the only person who has had the exact life experiences and can comprehend his motivations, emotions and his physical capabilities in such an intimate way fully. This ethical approval and principle of respect for autonomy is a branch of the beneficence principle which is a moral order that regards every individual as independent beings who have control and authority over their life experiences and can get the kind of lifestyle they want.
Personal freedom and beliefs are the fundamentals upon which the modern bioethics law and concept is based (Savulescu & Schuklenk, 2016). Liberty or autonomy of an individual allows each person regardless of their background or societal status the right to make their decisions. Personal freedom is directly opposite to the medical profession paternalism or parentalism which allowed the doctor to make critical decisions on behalf of the patient as long as the decision was thought as good for the person sick. The doctors made the decision for the patient whether or not the patient agreed under the assumption that they did not understand much concerning their conditions.
Interpersonal relationships form the basis upon which respect for an individual as a person is derived (Yolanda, 2017). Only five medical practitioners have accepted the decent idea in their practice over the years. The Doctors low turn out to the idea is understandable as taking the patient autonomy ethical principle would ultimately change the physician’s role in many ways. Accepting the idea would also mean that the doctor’s become partners rather than absolute arbiters during patient care and treatment. Secondly, it would also mean that the medical practitioners become educators in enlightening their patients well concerning their medical conditions so that they can make appropriate decisions. Lastly, accepting patient autonomy would make some clinicians make foolish decisions a situation which may be very distressing to the clinicians. For most physicians dedicated to maintaining and preserving the patient wellbeing, having to allow the patients select for themselves ineffective regimens or terrible treatment methods can be both disheartening and frustrating. Allowing decisions made by the patients is part of accepting the patient autonomy principle hence there is a need to understand it by both the physician and the patients fully.
Decision-making capacity and consent
Patients under medical treatment can only exercise their autonomy if they have an apparent mental capacity to be able to do so. Every human being that has attained the adult age and is of sound mind has the right to determine what shall be done to his or her body. The principle of patient autonomy can only be used well in the clinical practice if both the physicians and the patients comprehend decision-making capacity process. Decision-making capacity is the patient’s ability to make crucial decisions concerning his or treatment care as directed by the clinician. The patient’s level of knowledge concerning specific decisions is related to the seriousness of the treatment outcome and the nature of the information presented to the patient. Unless the patient lacks sound mind or is unconscious, he or she can participate in the decision-making process. Patients must be able to understand all the options available so as to have the adequate decision-making capacity. They must also know the consequences, costs, and benefits of choosing to act on such options. Patient’s disagreement with the physician directives, however, cannot be used as grounds for determining whether the patient is incapable of making good decisions.
Patients can sometimes refuse even lifesaving healthcare programs, decisions which may lead to catastrophic consequences including loss of life. Most patients refuse extensive medical care due to religious beliefs and traditional customs as seen with the majority of Jehovah’s Witness faithful’s. In most cases, surrogate decision makers are involved in the patient’s decision-making process if the patients are unable to make crucial decisions regarding their healthcare. Surrogate decision makers can be spouses, parents of adults, older children and others including the attending clinicians.
Under some circumstances, the hospital bioethics committee or the law court can be forced to intervene and determine the appropriate decision maker for the patient (Imber, 2017). Unique situations represent those that involve children as they have not attained the age of majority which is required in making the right thing. In most cases, however, children are treated with the same rules that apply to the adults and are allowed to make their decisions regarding their health (“Minor’s Rights Versus Parental Rights: Review of Legal Issues”, 2017). The more severe the outcomes and consequences, the more capacity, consultation and understanding of the options, consequences, and values involved are required of them to make a decision.
The problem identified above can only be solved through provision of proper guidelines that protect teenagers from forceful treatment with regard with medical issues. The ethical concern of permitting teenage pregnancy or putting teenagers on birth control pills is vital as it entails definition of fundamental rights.
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