Patient confidentiality is a fundamental practice in healthcare and it is integral part of healthcare ethical standards (Purtilo & Dougherty, 2010). According to the American Nurses Association (ANA) code of ethics “the nurse has a duty to maintain confidentiality of all patient information” (Nursing world, p.6). Also, when a patient confidentiality is violated the nurse may risk their safety and welfare. There are a few exceptions to this obligation such as: an increase need to protect the patient and other parties or mandatory laws that protect public health (Nursing world, 2012). The dilemma disclosed in the article Betraying Trust or Providing Good Care? When is it okay to break confidentiality? Constitutes an ethical dilemma for the nurse caring for a teenage patient diagnosed with a sexually transmitted disease as well as related cervical cancer. The nurse sooner or later has to notify the patient parents due to further treatment is needed and parental consent is required. The nurse also has to notify the patient’s school since it raises concern for public health issues.
There are many compelling concerns presented in this article. First of all, if a patient’s confidentiality is betrayed the patient may not want to cooperate in the future with the healthcare team. The patient may decide he/she doesn’t want medical care period, so this could risk the treatment of the patient. Secondly, the nurses must show respect and dignity for the patient by honoring the patient’s privacy. Lastly, the sanctity of the nurse-patient relationship mandates maintaining confidentiality. The patient entrusts the medical professional with private and confidential information. The medical professional must be absolutely certain of the risks versus benefits when deciding to breach confidentiality (Nathanson, 2000).
The decision to break confidentiality should only be made using a systematic approach that follows an ethical decision making model. The first step in this process is gathering all relevant information. Once the healthcare provider is certain that all pertinent information is evaluated they can determine the type of ethical dilemma. In this case the ethical dilemma was the choice to maintain or breach patient confidentiality. After determining the nature of the dilemma it is important to use a theoretical framework to analyze the issue. The nurse using a utilitarianistic theory would look at all consequences of breaking confidentiality versus maintaining confidentiality. If the nurse utilizes a deontological approach the decision is made based on the nurse’s duty and responsibility to uphold patient confidentiality. The nurse would then determine what to do in the situation by looking at all the alternatives. After determining a course of action the nurse must proceed with the action that is thought to be best. In the end the nurse should evaluate the outcomes of the decision for future professional development (Purtilo & Dougherty, 2010).
A nurse faced with this type of situation may seek advice from the institution’s ethics committee in order to determine the appropriate course of action. An ethics committee may be composed of clinical personnel as well as non-clinical personnel. The committee most likely has and ethical consultant available as well to guide the decision making process. The role of an ethics committee in the clinical setting is to provide support and guidance to caregivers when they are faced with an ethical problem. The committee helps to “reduce moral distress and maintain ethical practice” (Lachman, 2010, p. 1). In the previously mentioned case involving the teenage patient’s right to confidentiality the ethics committee may have taken the following approach. First the committee would determine the patient’s ability to make decisions.
They would then review all clinical information and facts related to the case. All of the alternatives would be examined and then valued according to the risks and benefits for the patient. Facility policies related to patient confidentiality as well as legal implications would be referenced. In this case the committee would investigate the potential for community harm related to the situation. After determining an ethical plan of action, recommendations would be made to the physician and nurse in this case (Lachman, 2010). In the end the decision would be a collaborative effort between the nurse and physician based on the recommendations. Protecting a patient’s private health information is an ethical practice that helps to maintain the trusting relationship between patient and nurse.
The professional nurse is obligated to do so not only by the professional code of ethics but also by government mandates related to Health Insurance Portability and Accountability Act (HIPAA). There are instances when the best interests of the patient or community safety provide good cause for breaking patient confidentiality. It is important for the nurse to use an ethical decision making process either alone or in collaboration with the healthcare team to determine the appropriate course of action (Purtilo & Dougherty, 2010).
American Nurses Association Code of Ethics retrieved from Nursingworld (ANA website) available at http://www.nursingworld.org/MainMenuCategories/EthicsStandards/CodeofEthicsforNurses/Code-of-Ethics.pdf
Lachman, V. (2010). Ethics, law, and policy. Clinical ethics committees: organizational support for ethical practice. MEDSURG Nursing, 19(6), 351-353.
Nathanson, Pamela G., “Bioethics on NBC’s ER: Betraying Trust or Providing Good Care? When Is It Ok to Break Confidentiality?” (February 24, 2000) located at http://www.bioethics.net/articles.php?viewCat=7&articleId=133
Purtilo, Ruth M. & Doherty, Regina (2010). Ethical Dimensions in the Health Professions  (Vital Source Bookshelf). Retrieved from http://pageburstls.elsevier.com/books/978-1-4377-0896-7/id/B9781437708967000126_f5010
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