Ethical Dilemma: Reporting Child Abuse For Stella

Whether to report the case of child abuse by Stella’s Aunt’s boyfriend to the authorities.

Should Victoria maintain confidentiality in a case of child abuse?

What should Victoria do in this case of child abuse where Stella maintains that the information should not be disclosed to anyone?

Should Victoria act to the interest of Stella even when there is clear evidence that she has been abused?

Should Stella’s aunt know about the sexual relationship between Stella and her boyfriend being the primary carer for her?

Is it morally right for Stella to be in a sexual relationship at 16?

The people involved in the scenario are Stella Nguyae, her boyfriend, her aunt, her aunt’s boyfriend, Victoria (nurses), and Doctor Howe.

The first duty of a nurse is to act in the interest of people who need nursing care. For this particular scenario, Stella is the primary responsibility for Victoria. She deserve the best nursing care.

The second responsibility for a nurse is providing care by promoting an environment where human rights, customs, beliefs and values of the patient, family and community are respected. In some instances somebody closely related to a patient is regarded as a patient to and that goes to mean the parent or guardian to a child patient like Stella’s Aunt (NMBA, 2018). Stella’s values, human rights and personal beliefs. These include her value for privacy. Stella’s has rights against abuse of any kind.

The nurse has a duty of holding in confidence, personal information and using judgment in sharing the information provided. This specifically address her duty to maintain confidentiality of all information shared by Stella. With Stella being not close to her aunt, she deserve that her sexual relationship be kept private. Disclosing the information would have adverse effects on Stella like being thrown out of the house. The nurse should apply a solid judgment and assessment on the appropriateness of sharing the information as well as the repercussion for doing that.

It is the nurse’s role to ensure that equity and social justice prevail in the access to healthcare, distribution of resources, and other communal and economic services. In this matter, it is clear that Stella has been a victim of child abuse and she deserve justice. She also deserves contraceptive treatment despite still being a child.

Professional values of respectfulness, responsiveness, concern, dependability and truthfulness are to be demonstrated by all nurses in practice. This therefore means that since Stella trusts Victoria to the extent of sharing her confidential information with her, Victoria should maintain the integrity. She is also supposed to remain concerned about Stella’s health by providing the best contraceptive medication advice and care to prevent early pregnancy.

Nurses and Practice

Nursing practice as per the ICN standards requires that Responsibility, accountability, maintaining standards of personal health, using judgment when delegating responsibility, maintain standards of personal conduct, using the advancement in technology and advances in science in ensuring dignity and rights of people, and promoting ethical behavior. These ethical aspects are very important considerations in Stella’s concern s they directly link with her current state. She deserve the best nursing care that uphold her interests to confidentiality (on pregnancy and abuse) and preventing early pregnancy.

Stella’s personal choice of privacy and confidentiality is must be respected. Her best interests and beliefs of her relationship being private and keeping the abuse undisclosed apply specifically in regards to this principle. Autonomy involves respecting the individual’s right to decision making even when the nurse is of a contrary opinion.

This is basically the duty to benefit others. It is Victoria’s role to provide contraceptive care that will prevent Stella from becoming pregnant. The nurse in this case should develop her knowledge on contraceptives and ensure that the care prescribed will benefit the patient wholly.

Non-maleficence

This is the obligation to doing nor harm and preserving the state of safety. It ranges from a duty to provide care of the best quality like for this case care providing the best contraceptive pills and even treating the bruised from the abuse by her aunt’s boyfriend. It requires that Victoria acts in compliance with nursing Code of Conduct and even reporting the incidence of abuse to the necessary authority when there is a possibility that the harm will reoccur.

The kind of justice that can apply in Stella’s case is rights-based- one of respecting her rights. It also comprises of respect for morally acceptable laws and accountability of one’s action or in action and for this case, the violent “uncle” facing legal justice.

The Family Law Act, s 4 definition of abuse that is relevant to this case scenario is the case of causing a child to suffer psychologically and including without limitation, being subject to exposed family violence. In the case of M v M tested the above definition on the effect of granting custody to exposing a child to an unacceptable risk and concluded that the decision to be made must consider the best interests of the child. The civil standard of the balance of probabilities is applied once there is a positive finding. However, the higher end of the civil standard is to be in agreement with the decision in the case of Briginshaw v Briginshaw. This applies in Stella’s case whereby, if the report of abuse gets to the authorities, she might be homeless or will have problems living with her aunt anymore, yet she cannot relocate to live with her cousin until after a year.

The Australian parliaments have enacted mandatory laws to report incidences of child abuse and neglect. The reporters are supposed to report known or suspected cases of abuse relating to children (AGDS, 2018). This puts Victoria under a command to report the case of child abuse which Stella is unwilling to disclose.

The law provides for workers preserving and protecting the confidentiality of their consumers. The Commonwealth Privacy Act 1988 and the Privacy and Personal Information Act, 1998 (NSW) all provides for confidentiality in work relations. However, the law in healthcare and confidentiality requires that a case of foreseeable harm be reported (AGDH, 2018). Victoria is therefore under an obligation to report the case of abuse before the situation is too bad. Stella is at risk of becoming seriously injured if she continue living with her “uncle” who she described as very temperamental.

Legal Compliance

Nurses ought to practice reporting obligations under the National Law and other relevant legislation. Victoria is to be guided by sections 129 120, 131 and 141 of the National Law to report the issue of abuse because it is under guidelines for mandatory notifications ("View - Queensland Legislation - Queensland Government", 2018).

Lawful Behavior and Mandatory Reporting

Nurses are supposed to practice ethically and with honesty. Victoria failure to report a case of mandatory notification would be unlawful and would lead to serious consequences. She is supposed to comply with the set legal policies and legislation. Stella is a vulnerable to harm. The Code of Mandatory Reporting provides for the reporting obligations about child abuse.

Informed Consent and Decision Making

Deciding on health matter is not the duty of the health facilitator alone. It is a duty of both parties and including family when it is a case involving a child. The nurse should give care to Stella in a person-centered approach whereby she provide the best contraceptive treatment. Victoria is also supposed to act as the advocate of Stella on matter relating to the abuse she has gone through under her aunt’s boyfriend. Informed consent involves supporting provision of more information especially on the abuse and the sexual relationship involving Stella.

The immediate step for action that should be prescribed for Stella are;

• Taking the best contraceptive medicine before 72 hours.
• Agreeing to her request of privacy and confidentiality.
• Advising Stella on the risks and adverse effects of engaging in a sexual relationship while still young with or without protection because it is ethically immoral
• Treating the bruises from injury caused by abuse from the “uncle”
• Mental support because of the emotional and psychological challenges she has gone through following her mother’s death, not knowing her father and the poor relationship between her and the aunt.

The final steps that can be implemented include a close follow up and education to ensure that the contraceptive medicine is being taken the right way to ensure that Stella does not become pregnant unprepared. A professional counsellor may be chosen to help her recover from her emotional stress. The management may also choose a competent lawyer to advice on how to go about the issue of abuse. The treating team report may decide to report the matter of abuse to the police without involving or disclosing any appointment between Stella, Victoria and Doctor Howe, or follow up Stella to ensure that she is stays free from abuse.

Evaluation involves looking back at the decision making process, undertaking training where necessary on matters relating to advocacy for children and use of contraceptives. Because of the ethical dilemma, the medical team may choose to seek support from people specialized in the specific matters like advocacy and child abuse.

AGDH. (2018). Australian Government Department of Health | 6.3 Confidentiality and the law. Retrieved 29 Aug. 2018 from https://www.health.gov.au/internet/publications/publishing.nsf/Content/drugtreat-pubs-front11-fa-toc~drugtreat-pubs-front11-fa-secb~drugtreat-pubs-front11-fa-secb-6~drugtreat-pubs-front11-fa-secb-6-3

AGDS. (2018). Child Abuse and Neglect: A Socio-legal Study of Mandatory Reporting in Australia | Department of Social Services, Australian Government. Retrieved 29 Aug. 2018 from https://www.dss.gov.au/families-and-children/publications-articles/child-abuse-and-neglect-a-socio-legal-study-of-mandatory-reporting-in-australia

Briginshaw v Briginshaw 1938 60 CLR 336 (Austl.).

Family Law Act 1975 (Cth) No.53 (Austl.)

M v M 1988 166 CLR 69 (Austl.).

NMBA. (2018). Nursing and Midwifery Board of Australia - Guidelines for mandatory notifications. Retrieved 29 Aug. 2018 from https://www.nursingmidwiferyboard.gov.au/codes-guidelines-statements/codes-guidelines/guidelines-for-mandatory-notifications.aspx

Privacy and Personal Information Act 1998 (NSW) No.133 (Austl.).

The Commonwealth Privacy Act 1988 (Cth) No.119 (Austl.).

View - Queensland Legislation - Queensland Government. (2018). Retrieved 29 Aug. 2018 from https://www.legislation.qld.gov.au/view/html/inforce/current/act-1977-047