Help! Ethical Dilemma

[paulianne]

with regards to ethical dilemmas i am in a little dilemma what to do in my situation:

maria, a fifteen year old girl, is visiting a health clinic accompanied by

her mother. they are initially seen to by doris a nurse. her mother diane

is very upset and anxious since her daughter is looking and feeling very

week. she has not been eating appropriately and has vomited several times in

the past week.

as soon as diane leaves the room to answer an urgent call, maria discloses

that she is afraid that she might be pregnant and does not want her mother

to find out since she would be very cross and probably against the suspected

pregnancy. diane enters the room and asks doris for her professional help.

what in your opinion should be the correct course of action that doris

should be taking?

how should come to a conclusion please?

regards

paulianne

[decembergrad2011, BSN, RN]

It's going to depend on your state re: legal.

I would consider the pros and cons of disclosure vs. not. Then I would consider the fact that being scared of possibly being pregnant does not mean someone is pregnant...and that a urine sample can test for many things all at once

[SheldonCooperPHD]

Unfortunately I believe the statute is that if a child over 12 years of age discloses and requests confidentiality, it must be honored per HIPAA laws. That said, as a professional your power comes in coaching the child to value the mothers support. Remind her she cannot deal with this problem alone, nor should she. Both she and the potential baby are at risk to do so. Also remind her that since she came in with mom, under moms insurance, that the statement could give her secret away.

[nurseprnRN, BSN, RN]

@sheldoncooperphd: citation, please. i can find no such reference in the ocr hipaa statute. i don't believe this is true.

if there is a citation that says it is, i stand corrected, but i we see "hipaa says so" or "hipaa says no" all too often.

[KelRN215, BSN, RN]

Unfortunately I believe the statute is that if a child over 12 years of age discloses and requests confidentiality, it must be honored per HIPAA laws. That said, as a professional your power comes in coaching the child to value the mothers support. Remind her she cannot deal with this problem alone, nor should she. Both she and the potential baby are at risk to do so. Also remind her that since she came in with mom, under moms insurance, that the statement could give her secret away.

I don't think this is an across the board rule. A 13 year old could request confidentiality for any number of reasons, many of which health care professionals shouldn't and CAN'T honor. If this 13 year old in the OP says to the nurse, "I think I'm pregnant and I don't want my mom to know", the providers can likely give her a pregnancy test without mom's knowledge. If she says "I don't want my mom to know because the baby's father is my 25 year old teacher" we're talking statutory rape and not only can the nurse not keep this confidential, but she MUST report it (at least in my state).

If a 14 year old gets into a car accident because he/she was skipping school and is brought into an ER and needs to be admitted, they may say "Don't call my mom because I don't want her to know I'm skipping school." No dice, the hospital is going to call the parents/legal guardian because they cannot treat the child without the parents' consent, other than emergently.

In my state, matters relating to sexual health of teenagers are, for the most part, confidential. When I worked in the hospital, we occasionally had teenagers who we treated for STDs without the parents' knowledge. Interestingly, though, teenagers do need their parents' consent for an abortion in this state.