The popularity of contraception has risen a lot in recent decades all over the globe. Despite this, there still are different ethical concerns for adolescents regarding the use of contraception (Ott, 2014). Birth rates have been reported to be dropping for younger women because of the decision of marrying late. However, the rates of sexual relations in adolescents have been found to be increasing. In regards to this, it has been seen that the pregnancy rates for teenagers showed a decline as a result of administration of contraception. The fertility rate among teenagers has shown a decline from 17.5 births per 1000 girls (2005) to 11.4 births per 1000 girls in 2015 (AIHW, 2018).
Although a significant decrease is seen for teenage pregnancy rates, it is still an issue that requires attention. In addition, the risks of sexually transmitted infections or unintentional pregnancies are increased as a result of sexual engagement in teens. Furthermore, there are different ethical and legal dilemmas pertaining to contraception use that must be addressed (Brierley & Larcher, 2014).
To be able to address all the identified concerns, this essay would identify different ethical and legal dilemmas regarding the application of contraception among teenagers. In addition, this study would also provide appropriate solutions for the identified dilemmas which would be supported through appropriate evidence.
One of the ethical issues identified through the case study is regarding the ‘autonomy' of the patient. ‘Autonomy' is defined by the ability of the patient to make decisions with respect to their self-care and health (Butts & Rich, 2019). Another identified ethical issue is about the confidentiality of client's information. The third ethical issue which holds significance is regarding the informed consent, and whether it can be availed from a young woman. The fourth and final identified issue concerns with facilitating awareness about the policies of local child protection.
In the presented case study, the patient is a 14 years old minor, Taylah, who has appeared in the health clinic without her parents. She was seen to be hesitating in discussing her issues to the nurse which was present at the clinic. In addition, her other concern is that she does not want her parents to know about this case. One of the main important concerns regarding ethics in healthcare is maintaining the autonomy of the patient. It is crucial that healthcare professionals work towards protecting the clients form any kind of psychological or physical harm (Bourgeois, DesRoches & Bell, 2018). However, in situations which involve risk to patient's safety, involving the parents may also be required. In addition to autonomy, there is the concept of ‘beneficence' which concerns with healthcare professionals to work with the focus of providing care under the best interest of the patient. The professionals are required to make such decisions which favour the welfare of the patient. For this case study, the patient seems to be able to understand the issues in avoiding the use of contraception. This is helpful in ensuring that she follows the safety measures while engaging in sexual relationships (Botkin et al., 2015).
Regarding the ability of the adolescents in taking and managing decisions regarding their health, studies show that they are not that inefficient in these situations. For this, such cases require to be passed to legal representatives. Another scene which is generally seen in regard to the autonomy of the patient is that the teenagers lack engagement and might restrict themselves into sharing correct information with the professionals. This affects the delivery of healthcare to the patient as the professionals are not able to provide them with appropriate advice because of lack of information. It is thus important that confidentiality and loyalty are well maintained to build a strong relationship between the nurse and the patient (Chadwick & Gallagher, 2016).
For healthcare professionals, maintaining the confidentiality and privacy of their patient is highly important. In this case study, it was seen that the patient was concerned regarding the sharing the information presented by her to anyone, to which the nurse assured her that all the information would be kept confidential while maintaining her privacy. The responsibility of protecting the patient's confidentiality lies on the professionals. In addition, the law also works to protect the client's confidentiality (Anthony & Stablein, 2016). In addition, it is also the responsibility of the nurse professionals that the practices performed by them are done with complete honesty, courtesy and respectfully. Thus, supporting the patient and encouraging them for their health outcomes would positively impact them and improve their engagement in the process (Chadwick & Gallagher, 2016). Developing effective communication is one of the most important strategies to receive appropriate information from the client. It involves the use of techniques of active listening and improving the patient's education regarding the different available solutions. It also involves informing them about the appropriate clinical care and discussing the different options of healthcare for the situation of the patient (Larcher & Brierley, 2016). As for this case, it was seen that the nurse able to elicit adequate information from the client, after this she can make suggestions to the patient for the available contraception techniques and inform her about how they work along with any possible side effects.
It is the responsibility of the healthcare professionals that the patient is given complete information regarding the treatment process and any questions which might need to be asked from the clients. It involves providing detailed information regarding the planning of procedure, any involved risks in the process, and getting the consent from the patient. The nurse in this case, while communicating with patient Taylah, provided her with the requirement of personal information and details so that she could give her the best advice possible. As per the 3.5, Code of Conduct which concerns with confidentiality and privacy of the clients, it is important that the professionals received informed concern from the patients and provide them complete and accurate information about the care (Pharmacy Board of Australia, n.d.). Furthermore, healthcare professionals are required to document the consent given by the patients. For this case study, since the patient is a minor, it becomes important that the information shared is comprehensible for her better understanding.
It is the duty of the professionals to take decisions which favour the care of the patient. To be able to ensure this, it is required by the professionals to take timely measures and appropriate decisions as this would help in causing the least harm to the patient. In addition, it is of high importance that there is a healthy relationship for the nurse and patient because this would facilitate the best sharing and use of information for patient care. This would help the nurse in ensuring that child protection policies are maintained. As per the Code of Conduct 11.2 for the registered nursing practitioners in Australia, the professionals must work to ensure appropriate service and protection to the client (Pharmacy Board of Australia, n.d.).
Legal issues pertaining to the use of contraception in teenagers
The National Codes of Conduct are based on different local as well as international Codes of Conduct which are applicable to the sector of healthcare. The standards for practising nursing are set by these codes. In addition, there are laws which regulate the National Codes of Conduct and help to enforce and protect them (AHMAC, 2014). The identified legal issues in the case study are associated to the autonomy of the patient, competency of the healthcare professional, informed consent, privacy and confidentiality, along with the provision of appropriate services of healthcare.
While considering the ethical issues for the client, the best solution would be that the enquiry of the teenage patient is passed to the legal representative. Studies have shown that sometimes even the healthcare professionals do not have the complete confidence that the minor's benefits are being looked after by the tutors. Due to such reasons, the proposition of these healthcare professionals is questioned.
As per clause 3 of the NSW code, it is the core responsibility of the healthcare professionals that the client encounters no harm. AHMAC (2014) mentions that subclauses 2(a) and 2(b) represent that adequate care is provided to the patient seeking for professional help and advice. Therefore, it becomes a legal responsibility for the professionals that they maintain proper competence for their practice. Furthermore, the subclause of 2(d) expresses that the patient expects to be provided with appropriate suggestions from the healthcare professionals (AHMAC, 2014). In addition, even if the professional is selecting options for the care of the patient, it is important that the patient's best interest is the focus.
The discussion regarding the issues of patient's consent in the care is regulated by common law. It is the duty of involved healthcare professional to provide appropriate care to the patient (Pharmacy Board of Australia, n.d.). Without receiving consent from the concerned patient, the professional can be held liable for any negative outcomes for the patient. However, the law has expressed that there can be some cases where it is not suitable to wait for the patient to give consent to the professional like in cases where the patient does not have the adequate cognitive functioning capabilities (Bourgeois, DesRoches & Bell, 2018). In this scenario, the patient is a minor which raises the doubt of the validity of consent from her. Any legislature has not defined a specific age for receiving informed consent. However, the healthcare professionals are finding the patient to be incompetent for giving the consent, the help and advice of the colleagues may be sought in such scenarios (Larcher & Brierley, 2016). As per the third Code of Conduct, it is of utmost importance that the advice provided by the healthcare professionals is relevant for the patient, respectively (Pharmacy Board of Australia, n.d.). Furthermore, it is the responsibility of the professional to respect patient's decisions for the selection of the appropriate option of treatment.
The concerns of child protection are regulated by Australia's public law. Under this, the professionals are to provide appropriate healthcare service to the teenage patient according to their condition. In addition, the policies for child protection supports the Plan International Australia concerned with protecting boys, girls, young men and women from any harm (AIFS, 2018). Application of such legal aspects would help to provide appropriate measures for the provision of ethical and legal rights of the patient.
Different conflicts can be related to the identified ethical and legal issues for the healthcare of the teenage patient. In addition, there exists a dilemma for the provision of the best care of individual teenagers. The laws and different codes of conduct cannot always be sufficient for addressing these issues. This suggests the requirement of the healthcare professional's ability to think critically and make best decisions after analysing the condition of the patient. Furthermore, to address such issues, it is required that the professionals consider the patient's autonomy, the benefit of the patient and positive outcome of health for them. In addition, it is important that the ethical and legal issues considered through empathy and compassion for the patient while developing an appropriate relationship between the nurse and patient.
This study helped in highlighting different issues pertaining to ethics in the given case study. In addition, these ethical issues had a relation to the legal aspects of the study. This study additionally supported different issues concerned with ethics and legality through appropriate literature. Furthermore, a clear overview of how such cases are required to be addressed was obtained through studying the issues related to autonomy, confidentiality along with privacy and competence while also including the informed consent and care of the teenage patient. It was identified that considerations made for the ethical as well as legal codes along with the ability of the professional to make a decision and think critically, help to facilitate proper care to the patient.
Regarding the identified ethical and legal issues, the solutions and literature given are appropriate according to the case study. The solutions favoured the patient care in every aspect. Furthermore, the nurse in the case study applied appropriate strategies when communicating with the client. It was observed that although there is a prevalence of ethical dilemmas in the care of teenage health, it is important that the decisions relate to the patient's best interest. It involves increasing awareness and encouraging the minor to use contraception to have better health outcomes.
AIFS. (2018). Australian child protection legislation. Retrieved from https://aifs.gov.au/cfca/publications/australian-child-protection-legislation
AIHW. (2018). Teenage mothers in Australia 2015. Retrieved from https://www.aihw.gov.au/reports/mothers-babies/teenage-mothers-in-australia-2015/contents/table-of-contents
AHMAC. (2014). A national code of conduct for health care workers. Retrieved from https://www.health.qld.gov.au/system-governance/policies-standards/national-code-of-conduct
Anthony, D. L., & Stablein, T. (2016). Privacy in practice: professional discourse about information control in health care. Journal of Health Organization and Management, 30(2), 207-226. https://doi.org/10.1108/JHOM-12-2014-0220
Botkin, J. R., Belmont, J. W., Berg, J. S., Berkman, B. E., Bombard, Y., Holm, I. A., ... & Wilfond, B. S. (2015). Points to consider: ethical, legal, and psychosocial implications of genetic testing in children and adolescents. American Journal of Human Genetics, 97(1), 6-21. https://doi.org/10.1016/j.ajhg.2015.05.022
Bourgeois, F. C., DesRoches, C. M., & Bell, S. K. (2018). Ethical challenges raised by opennotes for pediatric and adolescent patients. Pediatrics, 141(6), e20172745. doi:10.1542/peds.2017-2745
Brierley, J., & Larcher, V. (2014). Clinical trials of contraceptive agents in those under 16 years of age: Are they necessary, ethical or legal? Archives of Disease in Childhood, 99(12), 1070–1073. doi:10.1136/archdischild-2014-306854
Butts, J. B., & Rich, K. L. (2019). Nursing ethics. Burlington, Massachusetts: Jones & Bartlett Learning.
Chadwick, R., & Gallagher, A. (2016). Ethics and nursing practice. London: Macmillan International Higher Education.
Katz, A. L., Webb, S. A., & Committee on Bioethics. (2016). Informed consent in decision-making in pediatric practice. Pediatrics, 138(2), e20161485. https://pediatrics.aappublications.org/content/138/2/e20161485.abstract
Larcher, V., & Brierley, J. (2016). Developing guidance for pregnancy testing of adolescents participating in research: ethical, legal and practical considerations. Archives of Disease in Childhood, 101(10), 980-983. doi: 10.1136/archdischild-2016-310725
Ott, M. A. (2014). Contraception for adolescents. Pediatrics, 134(4). Retrieved from https://pediatrics.aappublications.org/content/134/4/e1257
Pharmacy Board of Australia. (n.d.). Code of conduct for registered health practitioners. Retrieved from http://apps.who.int/medicinedocs/documents/s17804en/s17804en.pdf
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