Fetal Alcohol Syndrome ethical/moral question

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Specializes in ICU.

I am a CNA working in CBRFs and group homes. In this particular home we have an adult female with FAS. She was adopted at a young age and just in the last year has had limited, supervised contact with her birth mom/family. She also has a boyfriend. Her boyfriend has recently been talking to her about drinking and partying. The group home staff is concerned about this behavior as she seeks approval from males.

I went into work today and read the notes from the last staff meeting (I'm a float and don't get to all staff meetings as I work at 8 different homes). The home manager stated that if she brings up drinking we should remind her that she is disabled because her mom drank while she was pregnant with her.

I feel extremely uncomfortable saying this to her, so is one of the regular staff at that house. Should I bring this up to a supervisor? Is this a legitimate concern? I think it's incredibly insensitive and don't think she would even understand if we did say this to her. Help! I need advice.

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I believe that your home manager is wrong and beyond insensitive. This woman should not be treated as handicapped but as an individual who should be supported in living her life as fully and independently as she is able. Drinking is legal, partying, boyfriends, etc is all part of life. I am not sure of her age, you say adult female, but it seems as if the partying and boyfriend are all new things for her. Just as I would for my own maturing children, or just as I would have prefered for myself when I was younger and experiancing these types of things, she should be educated as much as possible and then allowed to make her own decisions. You should never point out her handicap in such a way, that would be horrible and will not give her the information she needs to protect herself, such as to use protection so that she does not become pregnant, do not drink if she thinks she could be pregnant, does she understand how a woman can become pregnant, how many drinks is too many and other things she needs to know to protect herself.

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Specializes in Public Health, DEI.

It would be totally inappropriate and disrespectful to say that to her. Depending on the degree of her cognitive impairment, it may be appropriate to talk to her about the effects of overconsumption in general, but what your NM is asking you to do goes far beyond that. Your patient has the right to make her own decisions, as we all do. Your boss should be ashamed of herself. In group homes even more than in many other areas of nursing, patients need us to act as advocates, not to strip them of their right to make independent decisions.

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I think the Manager, who might or might not be a nurse, Mercyteapot, is wrong.

I'm not at all certain that the young woman would understand all that was said to her, although I think she likely knows that she is somehow different. And I think she would understand a carefully, thoughtfully composed talk about drinking, sexually responsible behavior, and the like. Will she remember it in the heat of passion? Don't know. Should she have a chaperone? Probably.

I really have to question the "right" to make independent decisions on such weighty matters - is it a right for the mentally handicapped? And she is handicapped, no matter what the current linguistic trend is today in referring to the mentally slow or retarded or developmentally disabled. Without wishing to hurt or offend anyone,

the fact does remain that those who are less than average in their mental processes need some degree of care, supervision, and protection.

I think it's really outrageous - and wrong - to believe that this group of people deserves all the rights but they are not held responsible to the full degree that the average individual is with regard to responsibly caring for their offspring or in facing the consequences of lawbreaking, for example.

This particular person - she apparently can't fully care for herself. How in the world would she care for a baby, should she become pregnant? Does anyone see a problem here? Does anyone have an answer short of abortion? Does anyone think honestly that she has a RIGHT to all the activities granted a fully competent adult?

PetsToPeople, if she needs to be supported, it's because she has some handicap.

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Specializes in Public Health, DEI.

To address one of your points, I specifically referenced tailoring what is said to her based on her ability to her ability to understand. The OP doesn't clarify the degree of disability here, but she clearly is capable of some independence given the concerns about negative decisions she may make.

Moving on, she "deserves" the right to respect, the way we all do. Telling her that she's "the way she is" because her mother drank during pregnancy would be just plain old mean. There are much better ways to

address the consequences of excessive drinking. Think about it- the way you're comfortable with is basically saying to her "you wouldn't want a baby messed up like you, would you?"

As for her rights as a person who needs some assistance in her life, those would be protected constitutionally and through a slew of civil rights legislation. I'm perfectly ok with the answer that I don't make the laws and I'm relieved you don't, either. This post isn't about the wisdom of alcohol and unprotected sex. It is about providing guidance on those topics without being dictorial or cruel.

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Specializes in ICU.

This would be a completely inappropriate way to try to guide this woman to making responsible decisions. It is hurtful and probably wouldn't even be effective! The thought of someone saying that to someone else just makes me sick.

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Specializes in ICU.

Thank you for your responses! She is 25 with the mental capacity of a 16-18 year old. she is in the community working different jobs on a daily basis but cannot ride the city bus by herself. She does not need assistance with personal cares and can make simple meals by herself. Safety is our #1 priority with her. In the past she has given her phone number to strange men and also sent inappropriate pictures. She is not allowed her own cell phone or Internet access. All visits with her boyfriend and birth family are supervised. There is a history of physical/sexual abuse by the birth family.

We encourage her to be as independent as possible. I just don't know how to handle the situation with the house manager. She's not an RN. I'll be calling a supervisor Monday morning to see what he thinks.

Clearly, telling the consumer why she is disabled is the wrong way to discourage her drinking. She hasn't yet, but the boyfriend has talked about it. During visits we redirect the conversation if drinking or drugs come up.

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Specializes in Public Health, DEI.
To address one of your points, I specifically referenced tailoring what is said to her based on her ability to her ability to understand. The OP doesn't clarify the degree of disability here, but she clearly is capable of some independence given the concerns about negative decisions she may make.

Moving on, she "deserves" the right to respect, the way we all do. Telling her that she's "the way she is" because her mother drank during pregnancy would be just plain old mean. There are much better ways to

address the consequences of excessive drinking. Think about it- the way you're comfortable with is basically saying to her "you wouldn't want a baby messed up like you, would you?"

As for her rights as a person who needs some assistance in her life, those would be protected constitutionally and through a slew of civil rights legislation. I'm perfectly ok with the answer that I don't make the laws and I'm relieved you don't, either. This post isn't about the wisdom of alcohol and unprotected sex. It is about providing guidance on those topics without being dictorial or cruel.

In re-reading your post, I think I understand you to be disagreeing with the response the manager is suggesting. While I still strongly disagree with your feelings about how many rights this young woman may have, I apologize for my second paragraph, which I based on my own misreading of your post.

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Specializes in Public Health, DEI.
Thank you for your responses! She is 25 with the mental capacity of a 16-18 year old. she is in the community working different jobs on a daily basis but cannot ride the city bus by herself. She does not need assistance with personal cares and can make simple meals by herself. Safety is our #1 priority with her. In the past she has given her phone number to strange men and also sent inappropriate pictures. She is not allowed her own cell phone or Internet access. All visits with her boyfriend and birth family are supervised. There is a history of physical/sexual abuse by the birth family.

We encourage her to be as independent as possible. I just don't know how to handle the situation with the house manager. She's not an RN. I'll be calling a supervisor Monday morning to see what he thinks.

Clearly, telling the consumer why she is disabled is the wrong way to discourage her drinking. She hasn't yet, but the boyfriend has talked about it. During visits we redirect the conversation if drinking or drugs come up.

I'm relieved to read that the house manager isn't the NM, as I had assumed. I'd hate to think of a healthcare professional that has chosen to work in this field suggesting such insensitive language. I know it happens all the time, but I'm glad that isn't what's going on here.

You say the visits with the boyfriend are always supervised. Are there plans for them to be alone at some point? Are these visits always in the home, or does she go with the boyfriend for more traditional dates out in the community? (Well, to the extent that dates with a chaperone when one is 25 years old could be considered traditional, anyway...) None of this information would actually change my feelings about your original question, I'm just nosy, lol!

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Specializes in ICU.

If he visits the house they have to stay in the common areas. This is common practice on all the homes I work in when the consumers have a boyfriend/girlfriend. They play football together for Special Olympics, see each other at work, went swimming by his house this summer. As of now there are no plans for them to be alone with the opportunity for physical relations.

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Does anyone see a problem here? Does anyone have an answer short of abortion? Does anyone think honestly that she has a RIGHT to all the activities granted a fully competent adult?

You must be kidding, or completely off your rocker, to even put this opinion in words. There are many answers besides abortion, such as, I don't know, let's say pregnancy prevention or adoption. Just because she has FAS does not mean she will pass on handicaps to her child. And yes, she absolutely HAS THE RIGHT to do all the activities that she can perform without being a risk to herself or someone else. How dare you...oh, that made me so angry I wanted to spit.

PetsToPeople, if she needs to be supported, it's because she has some handicap.

Well, no way, I wasn't picking up on that (I hope my sarcasm is obvious)! Obviously she has a handicap, she has FAS, but that does not mean she can not be educated to the extent of her congnitive ability.

I she accompanied by someone at all times when she is away from the facility? If not, then I was a teenager once, and I can see plenty of times when she and her boyfriend could become intimate.

And she may be 25 with the cognitive ability of an 18yr old, and from what you describe she is acting much like an 18 yr old , and just like a teenager, she can get herself into some serious trouble if she doesn't have a strong guiding hand to help her when the not so smart decisions seem like the best ones based on what your hormonal body is telling you.

A handicapped individual is a human just as any of us are, and as a human we are sexual beings, whether we are handicapped, elderly, a teenager, etc we will have sexual needs throughout our lives and it is TOTALLY normal and acceptable and should not be discouraged but we should be fully educated on the risks, both physical and emotional, so that we can be empowered to make the best decisions for ourselves.

It sounds like this person does not have very good family support. This would be a perfect time for you to become an advocate for this patient of yours and help to guide them the best way you can. You work with the people of this home so you should have some idea on how best she may learn or understand.

Everyday we are presented with hundreds of opportunites to make a difference, so many of us are so caught up in ourselves that we never see them. You've recognized an opportunity, now make your decision, will you do what you can to help this girl? If you cannot, then just stay out of it and atleast not add to the negativity that this girl must face on a regular basis.

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Does anyone think honestly that she has a RIGHT to all the activities granted a fully competent adult?

On a slightly lighter note, I see people walking around Walmart all the time that I personally believe shouldn't be allowed the rights of "fully competant adults", but yet there they are, lol!:yelclap:

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