Should Sharna Report The Suspected Child Abuse And Neglect?
Ethical and Legal Decision-Making Framework
1. Identify issues and collect information
1.1 Identify the problem
• Issue 1: Should Sharna respect Ginty’s right to refuse further treatment.
• Issue 2: Should Sharna report the suspected child abuse and neglect?
1.2 Identify who is involved
• Ginty, Ginty’s two children, Sharna, Garry and Child Safety Service.
2. Evaluate
2.1 Ethical Principles
• Autonomy – Competent adults with capacity have the right to refuse treatment. Respecting Ginty’s rights and values.
• Beneficence – Medically, it may be in Ginty’s best interest to continue her treatment as she is a young woman and the treatment could potentially prolong her life and allow Ginty to watch her children grow and have more time together. …show more content…
However, this needs to be balanced against the impact of continuing the treatment would have on Ginty, including her psychosocial well-being. It was also in the children’s best interest to report the suspected abuse and neglect.
• Non-maleficence – Consider Ginty’s rights and values and if treatment is appropriate.
Medically, it may be in Ginty’s best interest to continue treatment. However, continuing the treatment may cause greater harm to Ginty’s psychosocial well-being and dignity. Sharna has a duty to protect the children from harm, thus, it is mandatory for Sharna to report the suspected child abuse and neglect.
• Justice –
Rights-based justice – Respect Ginty’s right to refuse treatment.
Legal justice – Sharna is obliged to report the suspected child abuse and neglect and is responsible for her actions/inactions. Additionally, Sharna is accountable for her actions on Ginty’s refusal of treatment.
2.2 Code of Ethics
The following elements from Code of Ethics for Nurses (ICN Code of Ethics for Nurses, 2012) can be applied to this …show more content…
case;
• Element 1:
Element 1.2 highlights that nurses are required to respect patients’ rights, values, customs and spiritual beliefs (ICN Code of Ethics for Nurses, 2012, p.2). Thus, Sharna must respect Ginty’s rights and values of refusing treatment.
Element 1.5 notes that nurses have a responsibility to initiate and support actions to meet the health and social needs of the public, particularly those in vulnerable populations (ICN Code of Ethics for Nurses, 2012, p.2). Children are a vulnerable population because their autonomy is limited. Therefore, Sharna has the responsibility to initiate actions by reporting the suspected child abuse and neglect in order to meet the health and social needs of the children as the children themselves are unable to advocate for themselves.
Element 1.6 states that nurses demonstrate professional values including respectfulness and compassion (ICN code of Ethics for Nurses, 2012, p.2).
Sharna needs to demonstrate professional values of respectfulness by respecting Ginty’s decision to refuse treatment and demonstrate compassion to Ginty by supporting her decision and providing care that enhances her quality of life.
• Element 2:
Element 2.1 clarifies that nurses carry responsibility and accountability for nursing practice (ICN code of Ethics for Nurses, 2012, p.3). Hence, Sharna is responsible and accountable for her actions/ inactions to report the child abuse and neglect.
2.3 Legal Issues
The first legal issue to discuss is Ginty’s refusal of treatment. Two sources can be applied to this case: Statute Law (Guardianship and Administration Act, Sch 4) and Common Law (Re B (adult: refusal of medical treatment). The (Guardianship and Administration Act, Sch 4) states that an individual is considered to have capacity if they are capable of understanding the nature and impact of their decision and communicated the decision in some way (Guardianship and Administration Act, Sch 4). The Common Law (Re B (adult: refusal of medical treatment) states that unless the illness has significantly affected the patient’s capacity, a seriously disabled patient still has the same rights as a healthy person and their personal autonomy needs to be respected. McDonald and Then (2014, p.84) explained that competent adults have
the right to refuse treatment even if this may result in serious harm or death due to lack of treatment.
Sharna needs to understand that Ginty refused her treatment three months ago while she still had capacity and not during her current situation where her capacity may have been impacted due to her deterioration. Additionally, Ginty has communicated her decision for refusal of treatment by expressing that it made her feel worse and wished to spend the remainder of her time with her children instead. Therefore, Sharna should respect Ginty’s autonomy and support these decisions. If Sharna fails to respect Ginty’s decisions, civil actions may occur due to not following a competent adult’s decision as the law clarifies that respect to competent adult’s decision is first and foremost (McDonald & Then, 2014, p.84).
The second legal issue is suspected child abuse and neglect. Two Statute Laws apply to this case: (Child Protection Act) and (Public Health Act). The (Child Protection Act, s 13E) states that a relevant person including registered nurses who have a reportable suspicion about a child must make a mandatory report. Reportable suspicion is defined as a reasonable suspicion that the child has suffered, is suffering, significant harm caused by physical or sexual abuse and may not have a parent that is able to protect the child from the harm (Child Protection Act, S 13E). Harm to a child is defined as any detrimental impact on the child’s physical, psychological or emotional wellbeing (Child Protection Act, s 9).
Under the (Child Protection Act, s 13E & S 9), Sharna is obliged to make a mandatory report on her suspicion of child abuse and neglect. It is evident that Ginty’s children are suffering from physical harm and possibly psychological harm. Additionally, Ginty is unable to protect her children or care for them adequately due to her deterioration and illness. Therefore, Sharna needs to advocate for the children and make a mandatory report to the Child Safety Services.
Sharna would be protected from legal liability and disciplinary action for her report as she is making the report in good faith (Public Health Act s 197). Sharna also has the right to disclose confidential information if concerns about reporting need to be discussed with other nurses or employer (Child Protection Act, s 13H). If Sharna fails to make a report on her suspicion of child abuse and neglect, this results in an offence being committed as this is a breach in professional code of ethics, thus, Sharna may be held liable civilly and criminally and may undergo an administrative process (Public Health Act, s 193).
2.4 Conclusions
The law has clearly identified that Sharna needs to respect Ginty’s autonomy of refusing treatment and is obliged to make a mandatory report of the suspected child abuse and neglect.
3. Action
3.1 Nursing Code of Professional Conduct Principles
• Principle 1
Principle 1.1 (a) says that nurses need to be aware of their responsibility to abide by any reporting obligations (Code of Conduct for Nurses, 2017, p.6). Sharna is responsible for and obliged to report the suspected child abuse and neglect.
Principle 1.3 (a) states that nurses need to abide by relevant mandatory reporting requirement for vulnerable populations including child abuse and neglect (Code of Conduct for Nurses, 2017, p.7). Therefore, Sharna should make a mandatory report on her suspicion of child abuse and neglect as the children are a vulnerable population.
• Principle 3
Principle 3.6 (b) says that nurses must accept a patient’s right to refuse treatment and need to ensure that the patient receives relief from any distress (Code of Conduct for Nurses, 2017, p.11). Sharna needs to respect Ginty’s rights to refuse treatment and provide Ginty with the support she requires and to alleviate any distress or pain Ginty may be experiencing.
Principle 3.6 (e) elaborates that nurses are required to take reasonable steps to make sure support is given to patient and their families (Code of Conduct for Nurses, 2017, p.11). Sharna needs to provide the support Ginty and her family requires. Including, making a mandatory report of the child abuse and neglect and advocating for the children. Sharna also needs to ensure that Ginty is receiving support for her decision and is provided with sufficient pain relief and care that she requires.
3.2 Options for Action
• Report the suspected child abuse and neglect to the Child Safety Services and engage in a conversation with Ginty asking if she is aware of her children’ situation.
• Discuss suspected child abuse and neglect with other nurses or higher nursing staff if support is required from them or unsure about what actions to take.
• Respect Ginty’s decision to refuse treatment and understand that if Ginty’s wishes and rights are not respected, disciplinary actions can occur.
• Provide Ginty appropriate care and needs that she requires.
• Review decision-making and reflect if things would be done differently and how it can be improved.
4. Implementation
• Act on decision and manage the foreseeable consequences. If Sharna chooses not to report the child abuse and neglect, she will be held liable civilly and criminally and may undergo administrative process.
• Document key information, including Ginty’s refusal of treatment and that she has expressed this by stating that the treatment resulted in her feeling worse and she would value spending time with her children with the time she has left.
• Consider Ginty’s future care. Due to Ginty’s fast deterioration, having a conversation with Ginty about options for her future care plans for when she gets sicker and is unable to make her own decisions may be required. This includes talking about Advance Health Directive or appointing a power of attorney.
• Document suspicion of child abuse and neglect and what actions were taken.
5. Reflection
Shana should evaluate and reflect on her decisions and seek support if required.
1. Identify issues and collect information
1.1 Identify the problem
• Issue 1: Should Sharna respect Ginty’s right to refuse further treatment.
• Issue 2: Should Sharna report the suspected child abuse and neglect?
1.2 Identify who is involved
• Ginty, Ginty’s two children, Sharna, Garry and Child Safety Service.
2. Evaluate
2.1 Ethical Principles
• Autonomy – Competent adults with capacity have the right to refuse treatment. Respecting Ginty’s rights and values.
• Beneficence – Medically, it may be in Ginty’s best interest to continue her treatment as she is a young woman and the treatment could potentially prolong her life and allow Ginty to watch her children grow and have more time together. …show more content…
However, this needs to be balanced against the impact of continuing the treatment would have on Ginty, including her psychosocial well-being. It was also in the children’s best interest to report the suspected abuse and neglect.
• Non-maleficence – Consider Ginty’s rights and values and if treatment is appropriate.
Medically, it may be in Ginty’s best interest to continue treatment. However, continuing the treatment may cause greater harm to Ginty’s psychosocial well-being and dignity. Sharna has a duty to protect the children from harm, thus, it is mandatory for Sharna to report the suspected child abuse and neglect.
• Justice –
Rights-based justice – Respect Ginty’s right to refuse treatment.
Legal justice – Sharna is obliged to report the suspected child abuse and neglect and is responsible for her actions/inactions. Additionally, Sharna is accountable for her actions on Ginty’s refusal of treatment.
2.2 Code of Ethics
The following elements from Code of Ethics for Nurses (ICN Code of Ethics for Nurses, 2012) can be applied to this …show more content…
case;
• Element 1:
Element 1.2 highlights that nurses are required to respect patients’ rights, values, customs and spiritual beliefs (ICN Code of Ethics for Nurses, 2012, p.2). Thus, Sharna must respect Ginty’s rights and values of refusing treatment.
Element 1.5 notes that nurses have a responsibility to initiate and support actions to meet the health and social needs of the public, particularly those in vulnerable populations (ICN Code of Ethics for Nurses, 2012, p.2). Children are a vulnerable population because their autonomy is limited. Therefore, Sharna has the responsibility to initiate actions by reporting the suspected child abuse and neglect in order to meet the health and social needs of the children as the children themselves are unable to advocate for themselves.
Element 1.6 states that nurses demonstrate professional values including respectfulness and compassion (ICN code of Ethics for Nurses, 2012, p.2).
Sharna needs to demonstrate professional values of respectfulness by respecting Ginty’s decision to refuse treatment and demonstrate compassion to Ginty by supporting her decision and providing care that enhances her quality of life.
• Element 2:
Element 2.1 clarifies that nurses carry responsibility and accountability for nursing practice (ICN code of Ethics for Nurses, 2012, p.3). Hence, Sharna is responsible and accountable for her actions/ inactions to report the child abuse and neglect.
2.3 Legal Issues
The first legal issue to discuss is Ginty’s refusal of treatment. Two sources can be applied to this case: Statute Law (Guardianship and Administration Act, Sch 4) and Common Law (Re B (adult: refusal of medical treatment). The (Guardianship and Administration Act, Sch 4) states that an individual is considered to have capacity if they are capable of understanding the nature and impact of their decision and communicated the decision in some way (Guardianship and Administration Act, Sch 4). The Common Law (Re B (adult: refusal of medical treatment) states that unless the illness has significantly affected the patient’s capacity, a seriously disabled patient still has the same rights as a healthy person and their personal autonomy needs to be respected. McDonald and Then (2014, p.84) explained that competent adults have
the right to refuse treatment even if this may result in serious harm or death due to lack of treatment.
Sharna needs to understand that Ginty refused her treatment three months ago while she still had capacity and not during her current situation where her capacity may have been impacted due to her deterioration. Additionally, Ginty has communicated her decision for refusal of treatment by expressing that it made her feel worse and wished to spend the remainder of her time with her children instead. Therefore, Sharna should respect Ginty’s autonomy and support these decisions. If Sharna fails to respect Ginty’s decisions, civil actions may occur due to not following a competent adult’s decision as the law clarifies that respect to competent adult’s decision is first and foremost (McDonald & Then, 2014, p.84).
The second legal issue is suspected child abuse and neglect. Two Statute Laws apply to this case: (Child Protection Act) and (Public Health Act). The (Child Protection Act, s 13E) states that a relevant person including registered nurses who have a reportable suspicion about a child must make a mandatory report. Reportable suspicion is defined as a reasonable suspicion that the child has suffered, is suffering, significant harm caused by physical or sexual abuse and may not have a parent that is able to protect the child from the harm (Child Protection Act, S 13E). Harm to a child is defined as any detrimental impact on the child’s physical, psychological or emotional wellbeing (Child Protection Act, s 9).
Under the (Child Protection Act, s 13E & S 9), Sharna is obliged to make a mandatory report on her suspicion of child abuse and neglect. It is evident that Ginty’s children are suffering from physical harm and possibly psychological harm. Additionally, Ginty is unable to protect her children or care for them adequately due to her deterioration and illness. Therefore, Sharna needs to advocate for the children and make a mandatory report to the Child Safety Services.
Sharna would be protected from legal liability and disciplinary action for her report as she is making the report in good faith (Public Health Act s 197). Sharna also has the right to disclose confidential information if concerns about reporting need to be discussed with other nurses or employer (Child Protection Act, s 13H). If Sharna fails to make a report on her suspicion of child abuse and neglect, this results in an offence being committed as this is a breach in professional code of ethics, thus, Sharna may be held liable civilly and criminally and may undergo an administrative process (Public Health Act, s 193).
2.4 Conclusions
The law has clearly identified that Sharna needs to respect Ginty’s autonomy of refusing treatment and is obliged to make a mandatory report of the suspected child abuse and neglect.
3. Action
3.1 Nursing Code of Professional Conduct Principles
• Principle 1
Principle 1.1 (a) says that nurses need to be aware of their responsibility to abide by any reporting obligations (Code of Conduct for Nurses, 2017, p.6). Sharna is responsible for and obliged to report the suspected child abuse and neglect.
Principle 1.3 (a) states that nurses need to abide by relevant mandatory reporting requirement for vulnerable populations including child abuse and neglect (Code of Conduct for Nurses, 2017, p.7). Therefore, Sharna should make a mandatory report on her suspicion of child abuse and neglect as the children are a vulnerable population.
• Principle 3
Principle 3.6 (b) says that nurses must accept a patient’s right to refuse treatment and need to ensure that the patient receives relief from any distress (Code of Conduct for Nurses, 2017, p.11). Sharna needs to respect Ginty’s rights to refuse treatment and provide Ginty with the support she requires and to alleviate any distress or pain Ginty may be experiencing.
Principle 3.6 (e) elaborates that nurses are required to take reasonable steps to make sure support is given to patient and their families (Code of Conduct for Nurses, 2017, p.11). Sharna needs to provide the support Ginty and her family requires. Including, making a mandatory report of the child abuse and neglect and advocating for the children. Sharna also needs to ensure that Ginty is receiving support for her decision and is provided with sufficient pain relief and care that she requires.
3.2 Options for Action
• Report the suspected child abuse and neglect to the Child Safety Services and engage in a conversation with Ginty asking if she is aware of her children’ situation.
• Discuss suspected child abuse and neglect with other nurses or higher nursing staff if support is required from them or unsure about what actions to take.
• Respect Ginty’s decision to refuse treatment and understand that if Ginty’s wishes and rights are not respected, disciplinary actions can occur.
• Provide Ginty appropriate care and needs that she requires.
• Review decision-making and reflect if things would be done differently and how it can be improved.
4. Implementation
• Act on decision and manage the foreseeable consequences. If Sharna chooses not to report the child abuse and neglect, she will be held liable civilly and criminally and may undergo administrative process.
• Document key information, including Ginty’s refusal of treatment and that she has expressed this by stating that the treatment resulted in her feeling worse and she would value spending time with her children with the time she has left.
• Consider Ginty’s future care. Due to Ginty’s fast deterioration, having a conversation with Ginty about options for her future care plans for when she gets sicker and is unable to make her own decisions may be required. This includes talking about Advance Health Directive or appointing a power of attorney.
• Document suspicion of child abuse and neglect and what actions were taken.
5. Reflection
Shana should evaluate and reflect on her decisions and seek support if required.