Patient confidentiality has become an integral aspect of healthcare ethical standards since the HIPPA law came into being. (Erikson 2005). According to the American Nurses Association (ANA) code of ethics “the nurse has a duty to maintain confidentiality of all patient information” (Nursingworld, 2005). When a patient’s confidentiality is violated, his/ her wellbeing is negatively impacted. Patient confidentiality encompasses protecting any information the patient reveals to medical staff, and not divulging or sharing it to others. If trust is betrayed, the patient would be uncomfortable and reluctant to share their private and personal information. The nursing profession is built on trust and providing good care, and there are limited reasons to breach a patient’s trust. A breach of confidentiality means disclosing a patient’s information to a third party without the patient’s consent or an order from court and this may be done by phone, verbally or electronically. If this type of disclosure of the patient’s information is shared to unauthorized persons, a breach of confidentiality results and this has ethical and legal implications.
The law protects patient’s right to confidentiality and nurses have a moral duty to do the right thing for the patient. Understanding the ethical principles is very important because it provides the basis for nursing practice. According to the American Nurses Association, the ethical principles that underlie confidentiality are autonomy ( agreement to respect another’s right to self-determine a course of action; support of independent decision making), beneficence ( compassion; taking positive action to help others; desire to do good; core principle of our patient advocacy) and nonmaleficence (avoidance of harm or hurt ).These principles ensure that nurses act in a way that benefits the patient, causing no harm, respecting the patient’s personal information and promoting patient’s right to self-governing. It must however be noted that there are many situations that can arise in which patient confidentiality becomes a dilemma for nurses. Dilemmas around confidentiality arise when the principle of confidentiality is in possible conflict with other ethical principles such as avoiding harm to the patient or others.
The scenario below underscores this point: A day after he was admitted to the hospital, Fiifi was informed that he is HIV positive. The medical team advised him to contact his sexual partner and inform her of his status. For the past 15 months, Fiifi has been in a relationship with Derby and they are expecting a baby in 6 weeks’ time. Before this relationship Fiifi admits having a series of sexual partners. 5 days later, it became clear that he has not told Derby of his HIV status. Being aware of the baby, soon to be born, the medical team tells Fiifi that steps should be taken to assess whether Derby is HIV positive and whether the baby is at risk or not so that necessary treatment could be initiated. At this point, Fiifi was reluctant to tell Derby and even threatens to sue the hospital if she is told without his consent. What should the team do? This is a typical case of ethical dilemma; should the team inform Derby or what? A critical analysis reveals that the principle of autonomy requires that personal information should not be disclosed without consent.
However, in some cases the autonomy of another person may also be at play as it is in this case Derby, the previous sexual partners and the baby when born. Not disclosing information may limit their ability to make decisions regarding treatment and lifestyle and thereby violating the principle of non maleficence. Even though maintaining confidentiality is crucial, the consequences of disclosing or not disclosing are also important considerations. In this scenario for example, the consequences of non-disclosure can be identified as, the risk that Derby may be HIV positive and the effect of not providing information to enable her to be tested is that she is harmed by not knowing her HIV status and not receiving a course of treatment. If Derby is HIV positive and is not aware of the risk, the consequences are that she will not take steps to minimize the risk of infection to the baby; For example, obtaining treatment during pregnancy or prophylactic treatment and knowing not to breastfeed.
If Derby finds out later that there was a risk to her and that she was not informed, she may lose trust in the healthcare system. The scenario here presents a conflict in which the nurse is torn between an obligation to the patient and an obligation to the others (Derby, the baby to be born and the other sexual partners). Using the ANA code of ethics as a frame of reference, The Code of Ethics for Nurses with Interpretive Statements (ANA, 2001), emphasizes the responsibility of the nurse to promote the welfare, health and safety of the public.
Further, the code states that the primary commitment of the nurse is to the patient. This is like a double-edged sword. It must however be noted that there is an exception to the principle of confidentiality, which justified on the basis that a breach of confidentiality would help prevent harm to an identifiable person, and this is buttressed by the ANA’s provision that there are some exceptions to this duty such as a greater need to protect the patient and other parties (Nursingworld, 2012).
American Nurses Association. (2005). Code of ethics for nurses with interpretive statements. Retrieved fromhttp://nursingworld.org/ MainMenuCategories / EthicsStandards/ CodeofEthicsforNurses.asp American Nurses Association. (2012). Code of ethics for nurses with interpretive statements. Retrieved from http://nursingworld.org/ MainMenuCategories/ EthicsStandards/ CodeofEthicsforNurses.asp Erickson, J., Millar, S. ( 2005). “Caring for Patients While Respecting Their Privacy: Renewing Our Commitment”. OJIN: The Online Journal of Issues in Nursing. Vol. 10 No. 2, Manuscript.