As healthcare professionals, we must know that if confidentiality is breached, patients may be reluctant to disclose full information to any healthcare professional or even avoid seeking care. (Nathanson, 2000) “The deontological theory states that people should adhere to their obligations and duties when analyzing an ethical dilemma. (Rainbow, 2002) Therefore, a person who follows the deontology theory will produce very consistent decisions since they will be based on their set duties. Following the deontology theory, as healthcare providers, it is our obligation and duty to respect our patients enough to respect their right to confidentiality.
Breaches of confidentiality breaks that level of trust and respect that healthcare professionals work so hard to gain, that after that is broken, and it’s extremely difficulty to rebuild that trust and respect. It is true that there are times as healthcare professionals that we are obligated by law to break confidentiality.
In the story of the ER episode, Carol Hathaway has an obligation to notify the public health department of this situation, this is to protect the health of the community.
(Nathanson, 2000) There are several consequences in the activities that these teen girls are participating in. If they continue to participate in these “sex parties” they put everyone involved at risk for HVP, cancer, and ultimately death if left untreated. If it is made aware to the school that these “sex parties” are happening, schools, healthcare professionals, and parents can get involved with educating these teens about these consequences.
As stated in the article written by Nathanson, it does not have to be told where this information came from, and Carol could have been calling as a concerned citizen and doesn’t have to divulge her information as a health care provider.
This is a great example of using the six step Uustal model. When applying this model in this situation, start with step 1: Identify the problem and gather all relevant information. In this ER episode two 14 year old girls are present, but they reveal to Carol about “sex parties” with multiple partners, which could involve several teenagers. Step 2: identify the type of ethical problems.
As stated in step one it is extremely concerning to Carol that there are multiple partners and Carol has an emotional dilemma that there may be many other teens affected by some sort of sexually transmitted disease, whether it be the human papillomavirus or something else, all of the teens involved should be tested and treated. Step 3: use ethics theories or approaches to analyze the problem. As stated above, Carol may be guided by the deontology theory which states that people (such as nurses) should adhere to their obligations and duties when analyzing an ethical dilemma. Rainbow, 2002) Not only is it her duty to treat Andrea, but it is also her duty to ensure safety to the other teens that are possibly involved. Step 4 states explore the practical alternatives. Carol has made the decision on what she believes is the best thing to do for the group of teens. Carol must do this wisely though as to not break her confidentiality agreement to her patient. As stated above, when Carol decides to call the school, she should not reveal her identity or where she got the information from.
She should call as a concerned citizen that has obtained this information and stated that maybe some education to these teens is necessary. Step 5 is to complete the action. Carol knows what she believes is right, now she must follow through and make the phone call. If Carol fails to act, these “sex parties” could continue to happen and there could be more and more serious cases of STD’s come into the ER, or worse, a teenager could never get checked until they have full-blown cancer and it could be too late to save them. Step 6 is to evaluate the process and outcome.
Carol must now evaluate the situation and her actions and how they may directly affect her patient, Andrea. This is important in the way that she could negatively affect the nurse-patient relationship, depending on what decision she makes and how it is approached. (Purtilo, 2011) Carol could have presented the situation to the ethics committee. The ethics committee could have given insight to what the best thing to do in this situation was and what the best outcome would be. The ethics committee could have informed her that notifying the school would be breaking the patients’ rights, because they are not required to know.
They could help Carol with understanding what would be the best way to approach the situation and how they could help Andrea be the one to tell her parents and go from there. This is a very difficult situation for a nurse to be in. She has many responsibilities and obligations and finding the right way to deal with the situation may be a challenge, but as a nurse she knows that she has to do what is best for everyone involved. Sometimes getting through to the patient is extremely difficult, but knowing the right