Every young person is different and the circumstances which bring young people to you will vary from case to case. You must always decide whether to disclose information about a young person or whether to maintain the young person’s confidentiality in relation to each separate case. A “batch” approach which requires disclosure simply because someone is under a particular age and/or involved in a particular activity is not appropriate and may expose young people to further risk.

Ethical principles lie at the heart of decisions of this sort.

The Principles underpinning the Ethical Framework are:

• Proportionality and Probability of risk
  This principle centres on the balance between child welfare on the one hand and child protection on the other. It recognises that there is a subjective nature to “probability”. Therefore the next principle to be applied is:
• Professional Etiquette
  In discussions like this all participants engage in the highest standards of professional responsibility and knowledge. This is where their experience and learning has led them to: to apply their professionalism to analyse and understand the particular problem and put forward an appropriate solution.
• Autonomy (Equity)
  The principle of autonomy encapsulates respect for the individual at the heart of the discussion. This Principle is counter-balanced by the next one:
• Justice
  This principle centres on the respect and awareness of the needs of the community.

Applying the Principles to the Framework.

The ethical decision making framework has three stages to it.

Stage 1. Clarity
Be clear about what decision you making. Define the problem and its causes and be as clear as possible about what it is that you are seeking to decide on.

Stage 2. Analysis
Apply an ethical analysis to the problem through the ethical principles:

• To determine the proportionality/probability of risk in this decision:
  • What is the level of the young person’s understanding of consent?
  • What is the focus of your organisation here? What will the focus of other organisations be?
  • Would disclosure result in more harm or more benefit to
    • the young person?
    • the community?
• To assert the influence of Professional Etiquette to this case:
  • What does your (or other) codes of conduct and professional guidelines say about cases like this? GMC, NMC (standards of conduct, performance and ethics), GTC, SSSC
  • What is your risk analysis and professional intuition of this situation?
  • Are you deciding on the basis of this specific case?
• To analyse the ethical principle of autonomy and equity (respect for the individual) in this case:
  • Is the young person truly an empowered partner in this decision?
  • Can the young person’s input be complemented by other relevant data?
  • How does this meet the young person’s needs as outlined in The Five Key Questions
• To analyse the ethical principle of Justice (respect for the community) in this case:
  • Who else is involved in this case who might be impacted upon by its outcome (i.e. by the decision reached)?
  • What is the responsibility of
    • the community to this young person?
    • this young person to the community?

Stage 3. Recording

Write up your ethical commentary to the case.

Typically you will find that the ethical principles will compete and that they may even clash with one another. There is no hierarchy of importance of these ethical principles. What they will describe to you is the ethical backdrop of the decision that you have to make. You may find in one case that professional etiquette so strongly determines your discussion that autonomy in that case is less relevant ethically than justice. You may in another case experience the principle of proportionality so strongly that autonomy for this individual is dominant.

A recording pro-forma is available should you wish to use it. You may wish to write a commentary or simply tick boxes to satisfy yourself that you have considered all relevant aspects of the ethical framework surrounding this case. It is acknowledged that not all professionals will wish to use the pro-forma.

You now have a robust and reliable ethical base for your decision, providing a distinctive ethical perspective. It is only one of many relevant perspectives – although a highly significant one to take into account.

Ethical Framework – recording pro-forma
You do not have to complete this pro-forma – it is provided as an aide memoir only. If you wish to use it you can write a commentary or simply tick boxes to satisfy yourself you have considered all strands of the ethical framework.
Clarity: What decision is being made?
Analysis of risk: What is the level of the young person’s understanding of consent?
What is the focus of your organisation here?
What will the focus of other organisations be?
Would disclosure result in more harm or more benefit Potential harm to the young person Potential benefit to the young person
Potential harm to the community Potential benefit to the Community
Professional etiquette: What do your codes of conduct and professional guidelines say about cases like this?
What is your risk analysis and professional intuition of this situation?
Are you deciding on the basis of this specific case? Yes/No: Remember – decisions should only ever be taken on the basis of the specific case
Autonomy and equity (respect for the individual): Is the young person truly an empowered partner in this decision?
Can the young person’s input be complemented by other relevant data?
How does this meet the young person’s needs as set out in The Five Key Questions?
Justice: Who else is involved in this case who might be impacted upon by its outcome (i.e. by the decision reached)?
What is the responsibility of: the community to this young person? this young person to the community?