Ethical Case Analysis #3: To Tell or Not to Tell a Teen.

Lisa, a fifteen-year-old who recently moved from Montana, is being seen today for the first time for a well-child examination by a Kennedy, a new advanced registered nurse practitioner (ARNP). Kennedy has not yet received her medical records from Lisa’s former pediatrician’s office.

In the exam room, Lisa tells Kennedy that she is healthy and takes no medications, only vitamins. She says she is an honors student, on the school softball team, and plays the violin. When the ARNP asks whether she is sexually active, she says no, but admits that she is thinking about it because she is in love with a boy from her old school. The two have been dating for a year and have recently started talking about having sex. Kennedy asks if they have talked about birth control, too. Lisa says they have and informs Kennedy that she started taking birth control pills a few months ago. The nurse practitioner mentions the necessity of using a condom as well to guard against sexually transmitted diseases. Lisa replied “but we are both virgins, so neither one of us has to worry about that”.

Kennedy briefly leaves the room to let Lisa get undressed for the exam. In the hallway, Kennedy sees Lisa’s parents, who have accompanied her to the clinic.  They say they must speak to her immediately and in confidence.  Kennedy is surprised, but shows them to her office. There, they inform her that Lisa has congenital HIV and that she is taking HIV medications that were prescribed by her former infectious disease pediatrician. They also tell her that Lisa does not know she has HIV – they have told her the medications are vitamins.

Without mentioning anything that Lisa told her in confidence, Kennedy tells her parents that she thinks it’s time they told her she is HIV positive. Her parents get very angry. They insist that Lisa is still a child, and there is no reason to tell her yet. Kennedy reluctantly mentions Lisa’s boyfriend and the length of their relationship. She reminds them that Lisa’s boyfriend will be at risk if he and Lisa being having sexual contact.

Lisa’s parents say they know all about her boyfriend, but they insist the relationship is not mature enough for them to be thinking about sex – “all they do is play video games together”. Her parents adamantly disagree with the nurse practitioner’s view that Lisa is old enough to know her HIV status and say they will sue if she tells Lisa without their permission.

Write a paper to address the following:

• Summarize the case
• Discuss the ethical dilemma(s) and pose the dilemma as one ethical question.
• Identify ALL the pertinent ethical principles related to this case and provide rationale as to why they are involved in the ethical dilemma.
• What the nurse(s) should have done differently (if anything) and why.
• 5 page maximum – not including the title or reference pages
• Utilize at least (2) scholarly references appropriate to topic in addition to your Guido text for a total of 3 scholarly references.
• Be sure to also review the assignment rubric!

 

Based on a case from the Hastings Center Report: http://www.thehastingscenter.org/Publications/HCR/