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Jane, a 21-year-old unmarried high school dropout who is currently employed as a waitress at a local restaurant, visits the free family planning clinic in her community. She has used the free clinic for her gynecological care and often for her general health problems. Morgan, one of the RNs who help staff the clinic, has been Jane's primary contact at the clinic for health care. The physician who staffs the clinic also performs abortions on clients who insist on the procedure although she has personal and moral issues about it. Morgan is fearful that Jane is at the clinic for another abortion - which she seems to use as a form of birth control. Jane had one when she was a Junior in high school at age 17, the year she dropped out and was not on any form of birth control. Jane was given oral birth control pills after the first abortion, but admits that she is forgetful. She has been treated several times at the clinic for sexually transmitted infections and admits that she is highly sexually active. After escorting Jane into an exam room, Morgan asks why Jane is at the clinic today, Jane states that she is pregnant again and needs an abortion because she cannot support a baby on her income. Morgan performs a complete physical on Jane and finds her to be in excellent health except for some lung congestion probably related to her smoking. An ultrasound shows that she is about eight weeks pregnant with a healthy fetus. Jane denies the use of any street drugs or prescription medications.
Morgan, in the discussion with Jane about why she became pregnant again, suggests a longer-acting form of birth control, such as Depo-Provera (by injection) or an intrauterine device. Jane cringes at the thought of shots, even as infrequently as four times a year, and says she knows women who have had bad cramping and even infections from IUDs. She wants to stay on the pill. Morgan also introduces the idea of adoption for the baby, but Jane states she Catalano Page 2 of 2 Nursing Now 8e Ch07 Case Study doesn't want a child looking her up in fifteen or twenty years to see who her "real" mother is. Morgan tells Jane that it is very difficult to find a parent after a sealed adoption, but Morgan insists that she has seen enough shows on cable television to know that it isn't all that difficult. Morgan gets the physician and brings her into Jane's room. From the beginning of the visits to the clinic, the physician is frustrated with the interactions with Jane. Jane does not seem to see the seriousness of the situation which makes the visits uncomfortable for the physician. The physician intensely dislikes performing abortions but will do one when she thinks
it is best for her patient, as with Jane's first one. The physician also brings up the topic of alternative birth control methods or adoption, but Jane will have nothing to do with them. After considering all the elements of the case, the physician decides to not perform an abortion on Jane. Questions . What is paternalism? Is the physician practicing unjustified paternalism? How and why? What are the key elements of the ethical dilemma? How can the RN affect the outcome of the dilemma?
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