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Hello Professor and Classmates,

Issue: A mother who is HIV positive has passed the virus to her adolescent child. The mother is refusing to disclose the virus to her adolescent daughter out of fear of ruining the child’s chance at a normal childhood.

Discussion: While the mother has every right to protect her daughter, this is a situation where the daughter is at an age where she should know the truth about her health. This is not an easy situation to deal with by any means and the way this situation is handled will determine the impact that it has on the child’s mental health condition. Although the daughter is not at an age where she can handle her own medical treatment, I believe she has the right to know about her condition. In some cases a minor can consent to treatment but this is often regulated by state and HIPAA defaults to whatever guidelines that are outlined by the state regarding adolescent consent. In the aforementioned situation the child has no clue that they are HIV positive. Most people would conclude that the mother should tell the child because it will help the child cope with being HIV positive early on rather than find out about it later on in life where it will have a greater impact on the child’s mental health. In some cases the doctors may be worried as well about the mother’s reaction if they tell the child that she has HIV. Physician assurances of confidentiality may increase an adolescents’ willingness to disclose information but this may not work out in favor of the physician if they disclose to the child that she is HIV positive (Berlan E. D., Bravender T., 2009).

This scenario is a doubled edge sword because the child has the right to know about her condition and the mother has a right to privacy. The mother is right in her regard to be worried because there is a chance that people will judge her because of her daughter’s condition. Protecting a person’s dignity has been a part of medical practice since the early 1900’s (Elsayyad, A., 1960). I believe the staff could do a better job of explaining the condition to the child so that the mother does not have to but it is the mother’s decision at this time to disclose the information to the child. The mother decisions will have both negative and positive results regardless of her decision to withhold the condition from the child. Making an ethically sound decision in this case is difficult because it is not a decision that can be made on the spot, there are second and third order effects that will take place and they must be accounted for before a decision is made.

Plan of Action: For now, the staff should abide by the mothers wishes and treat the daughter as they have been, but they should come up with a plan of action with a counselor, psychologist or psychiatrist to sit with the mother and weigh the pros and cons of withholding the condition from the child. I would recommend and / or take the following actions to assist the family in aforementioned situation.

Develop a plan of action with a counselor, psychologist or psychiatrist:

1. Plan of Action: I would speak with a counselor to determine the best approach to use to convince the mother that explaining the condition to the child is in the child’s best interest. When a child understands the seriousness of their health condition they are more apt to abide by the rules outlined by the doctor. The daughter in this scenario may began to understand that it is imperative she takes her medicine. There are a few benefits that the mother can obtain from this as well because she has been living with the condition and is able to manage it as an adult. A counselor will be able to help the family understand that there are other families living with the condition and are able to live a normal life. The may be able to place them in contact with focus groups as well to help gain support as well. I believe that the aforementioned plan of action is a solid enough approach for the staff to take, at the least it will be a start in what I believe is the right direction.

2. Counseling: The mother and daughter will both need to undergo counseling. Initially the family may attend counseling together but each party will eventually need to undergo one-on-one counseling with a licensed practitioner in order to address their individual struggles with living HIV positive.

3. Recommend Focus Groups: I would research and find focus groups so that the family can have support. It is important to interact with individuals who understand delicate conditions enough to not judge individuals for their conditions. These focus groups may include activities like sporting events and other social events with other people or families who are HIV positive. This is likely very important for finding dates as well.

4. AIDS: The last and likely the most important aspect of this treatment is to let the child know that it is not her fault that she has this condition (Mabuka J., Nduati R., Odem-Davis K., Peterson D., Overbaugh J., 2012). The mother will need to have this addressed as well because she may continually blame herself for the child’s condition when at the end of the day it is a condition that a lot of people suffer from regardless of how it was contracted. Making the best of a bad situation is the most important aspect that the family should take from this plan of action (just not in those words).

I do not believe that I need more information that what was provided. I believe that the mothers concerns are normal. I believe that her reasoning for with-holding information form the child is logical to a point, but is not in the best interest of the child. I believe that the plan of action is ethical and that no further information is needed.

V/R

Carl D. Nelson Jr.

Berlan E. D., Bravender T. (2009). Confidentiality, consent, and caring for the adolescent patient. Curr Opin Pediatr. (Links to an external site.)Links to an external site. 450-6. doi: 10.1097/MOP.0b013e32832ce009.

Elsayyad, A. (1960). "Informed Consent for Comparative Effectiveness Trials" (Links to an external site.)Links to an external site.. New England Journal of Medicine. 370: 1958–1960. doi (Links to an external site.)Links to an external site.:10.1056/NEJMc1403310 (Links to an external site.)Links to an external site..

Mabuka J, Nduati R, Odem-Davis K, Peterson D, Overbaugh J (2012). Desrosiers RC, ed. "HIV-Specific Antibodies Capable of ADCC Are Common in Breastmilk and Are Associated with Reduced Risk of Transmission in Women with High Viral Loads" (Links to an external site.)Links to an external site.. doi (Links to an external site.)Links to an external site.:10.1371/journal.ppat.1002739 (Links to an external site.)Links to an external site.. PMC (Links to an external site.)Links to an external site. 3375288 (Links to an external site.)Links to an external site.. PMID (Links to an external site.)Links to an external site. 22719248 (Links to an external site.)Links to an external site..

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