Pediatric Ethics Paper 1

Running head: PEDIATRIC ETHICS POSITION PAPER

Pediatric Ethics Position Paper

Allison Layton

Sonoma State University

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Currently in the United States, it is general practice for abstinence-only sex education to

be taught in schools. For multiple reasons, including the concrete fact that there is no safer way

to be protected for sexually transmitted infections and pregnancy, abstinence is a good sexual

health practice to be advocated to youth. However, to expect adolescents to refrain from

participating in sexual activities because they have been taught the benefits of abstinence is

unrealistic. One of the key principles and ethics in nursing is the promotion of autonomy, both in

their practice and in their patients. Nurses are encouraged and expected to facilitate autonomy in

their patients by providing those patients with as much information and education as possible in

whatever topic in which they are lacking knowledge. Patients need to have access to benefits,

risks, and alternative options when implementing any health care practice in their lives in order

to make an informed decision, yet abstinence only sex education programs are based on

providing either no or very little information regarding sexual health options.

Since 1996, well over one billion dollars has been directed toward abstinence-only sex

education in America (Sonfield, 2009). In order for schools or sex education programs to

receive any of this funding, Sonfield (2009) states that the programs “must exclude any positive
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discussion of contraception or safer-sex practices and must teach questionable ‘facts’ including

that nonmarital sex is likely to have harmful psychological and physical effects” (p. 70). This is

a blatant assault against the principle of autonomy. The federal funding restrictions could not

make it any clearer that information is being withheld from adolescents being educated about

sexual health by these funded programs. Education about any topic related to health should

include all the options available related to that certain area of health. Most people would agree

that when educating a patient who had cancer, telling that patient that chemotherapy was his or

her only option when surgery or radiation therapy was also available, is immoral. But it seems

that when it comes to educating children about sex, another health issue, it is ethically acceptable

to withhold information regarding their options.

Aside from not providing adolescents with the whole picture of safer sex practices and

options, the efficacy of abstinence-only programs needs to be evaluated. An article from

Contraceptive Technology Update discusses the success of abstinence-only programs that strictly

teach abstinence and comprehensive sex education programs that encourage abstinence, but also

provide information on contraceptives. The article states:

A current assessment of 56 such programs indicates that most abstinence only programs

did not delay initiation of sex. However, most comprehensive programs, which

emphasize abstinence and the use of protection for those who do have sex, showed strong

evidence of positive influence of teens’ sexual behavior, including delaying initiation of

sex and increasing condom and contraceptive use. (“Condoms”, 2009, p. 134)
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A study conducted by Thomas in 2009 yielded similar results. The study involved teens who

pledged to remain abstinent until marriage, reflecting the current teaching of abstinence-only

programs, and teens who did not pledge to be abstinent. It was found that “youth who took a

virginity pledge reported a similar level of sexual intercourse to that of closely matched

nonpledging youth in a longitudinal study that assessed outcomes five years after pledging”

(p. 63). Not only did those youth who planned on following the abstinence-only guidelines

participate in sexual activity just as much as other youth, when they did participate in sexual

activity, they did so without protection more often than the youth who did not pledge to follow

the abstinence-only guidelines. “A higher proportion of pledgers than nonpledgers had never

used a condom over this time period. Pledgers were also less likely to have used any birth

control method in the last year” (p. 63). This study indicates that students who follow the

abstinence-only guidelines still participate in sexual activity, but they do so unsafely because

they were never educated about STI prevention or birth control methods. Another study

regarding the effectiveness of abstinence-only programs conducted by Ott and Pfeiffer found that

“abstinence only education programs show no effects on adolescent sexual behavior” (2009, p.

576).

The overwhelming evidence that abstinence-only sex education does not actually prevent

children from partaking in sexual activity and it simply prevents them from receiving adequate

information about alternative safer-sex practices, is definitely a call for action. Due to

abstinence-only programs which have yet to show any real results on delaying teen sexual

activity, adolescents are being denied health information, and as a result, they are participating in

high risk sexual behavior because they are uneducated about using contraceptives to prevent

STIs and pregnancy. Without proper education about the risks and benefits of all contraceptive
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choices and safer-sex options, teens can not make informed decisions, which is extremely vital

when dealing with a sensitive health issue like sex. Sexual health is perhaps one of the most

important areas for autonomy to be emphasized and facilitated. Lack of autonomy in sexual

health decisions related to a lack of information about safer-sex practices can lead to outcomes in

adolescents’ lives that have a long term impact such as contracting an STI or conceiving a child.

Autonomy, being independent and in control of one’s own decisions and judgments, is

an especially important trait for nurses to instill in their adolescent patients. The preteen and

teenage years are a time in a child’s life when peer pressure and persuasion can be the most

influential factors of his or her decision making. A 2008 study by Morrison-Beedy, Carey, Cote-

Arsenault, Seibold-Simpson, and Robinson addresses peer pressure and girls’ choices to remain

abstinent or how they deal with sex once involved in sexual activity. When discussing the girls

in their sample, the researchers found “it was noteworthy that girls did not mention fathers, or

other adults, regarding their decision to remain abstinent” (Morrison-Beedy et al., 2008, p. 190).

Neither parents nor other adults directly influence adolescents’ decisions to either have or abstain

from sexual activity. That decision is most impacted by the adolescent and his or her peer

groups. Since adults telling youth to remain abstinent while ignoring the need to educate those

youth about safer-sex practices to utilize when they do become sexually active does not seem to

affect adolescent sexual activity, it is unethical to continue to withhold valuable medical

information. In fact, it has been shown that teens educated in safer-sex practices “were more

likely to have had more frequent communication with sex partners and parents, perceived fewer

barriers to using condoms, and were less fearful of negotiating condom use” (Morrison-Beedy et

al., 2008, p.191). It makes sense that if adolescents are aware of safer-sex practices, including
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various contraceptive choices, they will be more likely to employ that knowledge when choosing

to participate in sexual activity or to remain abstinent.

With knowledge about STIs and pregnancy, as well as the measures necessary to prevent

both, adolescents may decide that abstinence is the best option for them. Others may choose to

engage in sexual activity, but they will have information and intelligence about safer-sex

practices on their side to help them reduce risky sexual behavior and make healthy choices.

Whichever decision an adolescent makes regarding sex, they need to have all the information

made available to them about their options in order for that decision to be an informed one that

they can feel confident with. Having all options explained to them and using that knowledge to

make the best choice concerning sexual activity facilitates autonomy in adolescents and allows

them to make a decision about a very personal and sensitive part of their life experience be one

that they feel proud of and secure with, and that is an outcome that all nurses and other adults can

agree with.
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References
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Contraceptive Technology Update. (2008). Condoms: fears of partner disapproval, less pleasure

linked to teens' nonuse: give teens accurate information regarding use of condoms.

Contraceptive Technology Update, 29(12), 133-136. Retrieved from

http://search.ebscohost.com

Morrison-Beedy, D., Carey, M., Côté-Arsenault, D., Seibold-Simpson, S., & Robinson, K.

(2008). Understanding sexual abstinence in urban adolescent girls. JOGNN: Journal of

Obstetric, Gynecologic & Neonatal Nursing, 37(2), 185-195. Retrieved from CINAHL

Plus with Full Text database.

Ott, M., Pfeiffer, E. (2009). “That’s nasty” to curiosity: early adolescent cognitions about sexual

abstinence. Journal of Adolescent Health, 44(6), 575-581. Retrieved from

http://www.sciencedirect.com.iii.sonoma.edu/science?_ob=ArticleURL

Sonfield, A. (2009). Advocates seek support for 'real' sex education. Contraceptive

Technology Update, 30(6), 69-70. Retrieved from http://search.ebscohost.com

Thomas, J. (2009). Virginity pledgers are just as likely as matched nonpledgers to report

premarital intercourse. Perspectives on Sexual & Reproductive Health, 41(1), 63.

Retrieved from http://search.ebscohost.com