Nursing Ethics: Jocelyn Case Study
Case Study 6:
Jocelyn is a 36-year-old female with Angelman’s Syndrome – she has severe developmental delay, psychiatric disturbance, impaired gait and mobility, epilepsy, poor fine motor skills and requires 24-hour care. She currently lives in a group home which is fully funded with 24/7 nursing care. She has 3 other housemates Theresa, Ben and Adam all of whom have developmental delay and disabilities like Jocelyn. Jocelyn gets along well with her house mates most of the time. Occasionally she has conflict with Theresa, who bites herself and blames Jocelyn. Sometimes Adam teases Jocelyn and Jocelyn gets annoyed at him and, as she cannot verbalise her annoyance, she occasionally hits Adam. Apart from these minor conflicts, the housemates live together well.
Of the housemates, Jocelyn and Adam are the closest friends. Jocelyn and Adam went to the same ‘special school’ when they were children and have known each other almost all their lives. They have always gotten along well and the decision was made to include them together in their group home as they offer each other a lot of emotional and psychological support.
Both Adam and Jocelyn have their parents appointed as legal guardians under the Guardianship Act.
Despite her disability Jocelyn is outgoing, makes friends easily, finds great enjoyment in life and laughs a lot. One day, you are the nurse on duty and are in the nursing office. You hear Jocelyn and Adam in the lounge room and go out to see them. You find Jocelyn and Adam are on the couch together undressing each other and engaging in intimate behaviour with each other.
You immediately separate them, redresses them and complete an incident report. This requires both families to be informed of the incident.
Jocelyn’s parents are of the belief that if both Jocelyn and Adam are happy with their behaviour and not distressed by each other then there is an implied consent. It may be assumed that they both wish to be sexual and they should be allowed to do so. They are both adults and, despite developmental delay, would have intimacy desires like other adults and should not be obstructed from doing so. Jocelyn’s parents request that Jocelyn be commenced on an oral contraceptive pill to prevent her getting pregnant. They state that while they feel Jocelyn may be able to consent to having sex she will not physically or emotionally handle having a baby and would be unable to care for a child. Additionally, there is an almost certain probability that the child would also have Angelman’s Syndrome. As such, they do not want Jocelyn to have a child.
Adam’s parents have a different perspective. They are incredibly angry about Jocelyn and Adam engaging in sexual behaviour and feel that they should not be permitted to have this opportunity. Adam’s parents believe that neither Jocelyn or Adam have the developmental maturity to understand what sex is, the intimacy involved in sex, the consequences of sex and therefore should not be permitted any intimate type of relationship. They state that they would like Adam and Jocelyn to be separated and to never be left alone together. They would like a video camera installed in Adam and Jocelyn’s room to ensure they are not going to each other’s room night. They do not feel that it is appropriate for Adam and Jocelyn to remain friends. They have also requested that medication be trialled for Adam which will make him impotent and if this is ineffective they would like to have Adam castrated so that he is unable to have sexual intercourse throughout his life. They have based this decision on a belief that Adam does not have capacity to understand the seriousness of sex, and does not have the capacity to deal with the outcomes of sex (sexually transmitted diseases or pregnancy of the partner).
Q1: Which ethical principles are challenged in this case study, and how?
The ethical principles that are challenged in the case study are autonomy, beneficence, non-maleficence and justice. The principle of autonomy provides for the individual’s right to determine what happens to his or her body. In the case study, Adam’s parents hold that Both Adam and Jocelyn do not have the mental capacity to make decisions about their sexuality. The parents from both sides also propose various solutions to the incident without seeking the consent of Adam and Jocelyn. The principles of beneficence and non-maleficence assert that people should always seek to do good and no harm in all situations, respectively. Some of the proposed solutions in the case study go against the two principles. Adam’s parents want both Adam and Jocelyn separated. The separation might have major negative implications on the two since they have grown together. The parents of Adam also want him to be made impotent through medication or be castrated if the option of medication is not viable. These processes may be harmful to Adam. The principle of justice affirms that people should always act fairly for a fair outcome. Fairness in the case study relates to how the involved parties want the case of Adam and Jocelyn handled. Everyone gives sentiments which portray the two as unequals which promotes inequality.
Q2: Identify the legal issues raised.
The major legal issues that arise from the case study are consent and justice. Nurses should always obtain the consent of those under their care. Patients should consent or imply consent to nursing plans regardless of their mental status. The proposed solutions in the case study ought not to be implemented without adequate consultation with Jocelyn and Adam. All people have a right to fair treatment at all circumstances. All peoples in Australia hold equal rights and should be treated fairly. Both Adam and Jocelyn have a right to their sexuality.
Q3: Discuss the relevance of Guardianship to this case study.
Guardianship in the case study should be used to facilitate the independence of the mentally disabled persons instead of causing restrictions. A guardian should only be allowed to decide on behalf of a mentally disabled person in situations whereby the people are unable to make decisions for themselves. Both Adams and Jocelyn hold consent on their sexuality. The consent of the guardians should only be applied in situations such as ward treatment. The guardians should, therefore, empower Jocelyn and Adam to make decisions.
Q4: Considering at least 2 different ethical theories, outline some possible actions the nurse may take in responding to this situation.
In response to the situation, the nurse may opt to separate Jocelyn and Adams completely, allow them to continue interacting but restrain their levels of interaction or allow them to maintain their intimate relationship. The three actions can be analysed using rights and utilitarian ethics. The rights ethics emphasises on strict adherence to individual rights and equality, whereas utilitarian ethics is concerned with the benefits of the action. Separating the two would be wrong according to the rights ethics as it will deprive them both their sexuality rights and the right to association. This move would, however, be acceptable under utilitarian ethics. It would help in ensuring that Jocelyn and Adams do not have to suffer the consequences of sexual involvement. Controlled interaction would be unacceptable under rights ethics but rightful under utilitarian ethics. While the action would deprive the two of the full right to association, it would enable them to maintain some level of interaction without necessarily engaging in sexual behaviour which is deemed unlikeable in their situation. Allowing continued intimacy would be ethical in rights ethics but unacceptable in utilitarian ethics. It would allow the two to enjoy their sexuality rights fully. However, the action could not be beneficial to them as well as to their guardians, especially if consequences such as pregnancy and STI’s arise.
Q5: What should be done?
The best action to take in the case study is to educate both Jocelyn and Adam on their sexuality. Having more knowledge of their sexuality would enable them to gain more understanding of the consequences of intimacy as well as how they can be mitigated. Jocelyn and Adams have a right to their sexuality. It would, therefore, be unfair and unethical to restrain them from making decisions about their sexuality since they are not extremely incapacitated.