Confidentiality and privacy are two of the fundamental rights of every individual. Protecting these rights with respect to every patient’s personal information is not just ethical but a legal obligation as well. One of the key components of patient and nurse relationship is the assurance that each healthcare workers hold to respect, and that is to value and safeguard every patient’s information and their privacy. But when does the breach of confidentially happen? When is the nurse required to draw the line? An example of these applies on infectious diseases and cases of abuse, where challenges occur that compels the nurse to report the incident because the patient and public’s safety outweighs individual privacy. In the article discussed on bioethics on NBC’s ER episode, nurse Carol Hathaway was trapped on an ethical dilemma, whether to respect her patient’s confidentiality by committing to what she promised and not disclosing her patient’s personal information but risking her patient’s safety or breaking it to guarantee that her patient receives the right care and treatment (Nathanson, 2000).
Ethical dilemmas are perplexing and definitely not easy for everyone involved. As nurses we have the responsibility to advocate for patients, together with the commitment to practice with beneficence, which is to take positive actions to help others. In the scenario, nurse Carol has both intentions why she felt the need to breach her patient’s confidentiality but that did not come without its consequences. Following the theoretical framework for deontology, where actions are judge whether it was right or wrong based on the morality of the action itself. Deontology supports an act if it was deemed to be truthful, fair and according to the rule, such as fidelity in keeping one’s promises and respecting the patient’s autonomy of allowing her to make her own decision, following this theory, nurse Carol’s actions will be consider wrong for breaching the patient’s confidentiality despite her good intentions behind it. But on the other hand, the theory on utilitarianism, states that the value of something is determined by its usefulness.
This principle judges an action with its main emphasis placed on the outcome and the consequences of that specified act, which in this situation, nurse Carol informed Andrea’s parents to assure that she gets appropriate treatment for cervical cancer. Considering what the nurse did, her actions are supported by her intent to promote safety for her patient and others as well as to prevent harm. Another theoretical framework that can be look at is the virtue ethics, which analyzes an issue according to the individual’s trait. This views nurse Carol acting as a virtuous person; which focuses on her character and not on the duty itself (Purtilo & Doherty, 2011). Looking at the situation and its different angles, the first step is to recognize an ethical dilemma and the people that are involved. As well as to establish possible alternatives to the situation, which could be that the nurse can request the involvement of the ethics committee. By having a multidisciplinary outlook on the case, the situation can be seen in different perspectives, in order to formulate a better course of action. Education plays another important role in our duties as nurses.
If the two young patients involved on the article, are taught on the importance and severity of the situation, may be they will understand the consequences of their action and will take responsibility for it, by taking the initiative to inform their parents and to follow up with necessary treatment. Nurse Hathaway could also prevent Andrea from attempting suicide if instead of informing the school about what she did, the nurse just took the opportunity to talk to the principal about initiating a campaign to increase public awareness, by educating the students regarding HPV, its link to cervical cancer, and the importance of prevention, early disease recognition and treatment. The social worker together with the nurse can facilitate different interventions to guarantee that Andrea will have proper treatment and the support she needs.
By choosing the best possible course of action, we can therefore implement it and evaluate towards the end, whether it produced a beneficial outcome for the patient. An ethics committee is composed of members from multiple healthcare disciplines. Their purpose is to help address the conflict or uncertainties within an ethical dilemma and to implement interventions to achieve a resolution that is based on patient rights. Primarily to establish a shared decision between the patients, their families together with their clinicians to design a reasonable policy to achieve a patient centered outcome (Pearlman, 2010).
In this particular issue, nurse Carol can consult the ethics committee in order to help her come up with a plan that will be safest for the patient and beneficial for everyone involved. Discussion and resolution of ethical issues requires critical thinking skills. But unlike clinical problems, these resolutions involve the negotiation of closely held personal values and philosophies not facts nor measurable clinical data. This involves a process when they take on a new possibility as they are put to rational and respectful consideration.
Nathanson, P. (2000). Betraying Trust or Providing Good Care? When is it okay to break confidentiality?. Retrieved December 14, 2012, from http://web.archive.org/web/20110706061843/http://www.bioethics.net/articles.php?viewCat=7&articleId=133 Pearlman, R. (2010). Ethics Committee and Ethics Consultation. Ethics in Medicine. Retrieved from http://depts.washington.edu/bioethx/topics/ethics.html Purtilo, R., & Doherty, R. (2011). Ethical Dimensions (5th ed.). St. Louis, MO: Elsevier Saunders.
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