Patients should feel at ease when giving personal information to their physician or nurse (Burkle & Cascino, 2011). Patients may resist offering pertinent information if they feel their confidence may be betrayed. Confidentiality can only be broken when it involves a gunshot wound, injuries resulting from child abuse or an infectious disease, which would put the community at risk. Such is the case presented in Nathanson’s article titled: “Betraying trust or providing good care? When is it okay to break confidentiality?” (2000). The article addresses an ethical dilemma presented in an episode of NBC’s ER. Nurse Carol Hathaway promises two reluctant teenage patients who are seeking care, that anything they tell her will remain confidential, even from their parents and anyone else. Agreeable to this, the girls divulge they have been sexually active with multiple partners and suspect they have been exposed to a sexually transmitted disease (STD). Tests were performed on the teenager for STD’s and receive Pap tests to detect any cervical abnormalities. The test results confirm, Andrea, is positive for the human papillomavirus (HPV) and cervical cancer.
Promising Andrea confidentiality, Nurse Hathaway knows she must break the promise or potentially endanger herself and the community. Nurse Hathaway is faced with ethical consequences if she breaks confidentiality with her patient. Of these consequences are reluctance to disclose pertinent information, feelings of betrayal, enraged parents, disrespect of staff members, job termination, demeaned hospital reputation, poor school reputation, and a non supportive bureaucratic and legal system (Burkhardt & Nathaniel, 2008). Nurses are fearful of these ethical implications, which keep them from disclosing important information, which can have disastrous results (Griffith, 2008). Deontology best describes Nurse Hathaway’s ethical framework when she finds it necessary to break Andrea’s confidentiality. The deontology theory is based on the concept that a person adheres to what is right and wrong in their actions and thoughts rather than the consequences (Purtilo & Doherty, 2011). Since this has become a public issue she is compelled to fulfill her duty by courageously choosing to bring the situation out in the open.
Her reasoning for informing Andrea’s parents and school would ensure the appropriate course of treatment and avoiding further injury for the teen and society. Even though Nathanson says there is no advantage in notifying the school of Andrea’s sexual involvement with multiple partners, Nurse Hathaway chose to do so. By doing this, Andrea attempts to take her life when she finds out the school is aware of her situation. There are several ethical decision-making models to choose from but the best would be Uustal’s model to handle this particular situation. Uustal proposes a nine-step method to direct one toward making an ethical decision. This model follows the nursing process and also includes and explanation of values when using and ethical decision-making model. Step 1) those implicated in the dilemma are the teenage girls, their parents, the students at the school and Nurse Hathaway. Whether or not to inform the school of the sexual behavior of the girls and of Andrea’s diagnosis is the ethical dilemma at hand. Step 2) without giving specific information about the girls, the school needs to be aware of the student’s sexual conduct with multiple partners.
Step 3) the spread of HPV and the concern for the protection of the community from STD’s related to promiscuous sex are the issues related to the situation. A resolution to the dilemma would to inform the school of the concern for the sexual behavior of the students. Step 5) with good intentions, Nurse Hathaway notifies the school of the girl’s activities but should not kept their identities anonymous and only discussed her concern for the students in general about their participation in multiple sex partners. Step 5) implementing education in the school regarding the risks, treatments and prevention of STD’s would follow. Step 6) the main priority should have been informing the school of the promiscuity among the students rather than of the two teens in question and Andrea’s new found diagnosis. Step 7) Nurse Hathaway should have only discussed her concern for sex with multiple partners between the students. Step 8 and 9) if Nurse Hathaway had followed this model, education could have occurred, the school would have been protected and Andrea’s privacy would have been respected.
This particular model allows for the analysis of various options to sensitive, ethical dilemmas. An ethics committee consists of of representatives from different fields in and outside of health care as well as professionals, lawyer, clergyman, etc., from the community. With different perspectives, experiences, and educational backgrounds the committee can have a well-rounded discussion and provide suggestions proposed to advocate for the rights of patients and foster mutual decision making in the event of an ethical dilemma. When conflicting moral claims are presented, the ethics committee can suggest an unbiased approach to solving the ethical dilemma (Burkhardt & Nathaniel, 2008). Consulting with an ethics committee would have been in Nurse Hathaway’s best interest before deciding to break confidentiality. Had she not divulged pertinent information about Andrea to her school, Andrea most likely would not have attempted suicide.
In conclusion, as nurses we are confronted with ethical dilemmas pertaining to upholding confidentiality in our day-to-day practice. Ethical decisions should not be taken lightly and treated exclusively with sensitivity for our patients and the public. Making the wrong decision could cost us the trust we build with out patients and community and our job.
Burkhardt, M. A., & Nathaniel, A. K. (2008). Ethics & issues in contemporary nursing (3rd ed.). Clifton Park, NY: Delmar Cengage Learning. Burkle, C. M., & Cascino, G. D. (2011, December). Medicine and the media: Balancing the public’s right to know with the privacy of the patient. Mayo Clinic Proceedings, 86(12), 1192-1196. Ethical decision-making lecture [Module 3 lecture]. Retrieved from Grand Canyon University: http://my.gcu.edu. Griffith, R. (2008). Patient confidentiality: rights and duties of nurse prescribers. Nurse Prescribing, 6(2), 116-120. Purtilo, R. B., & Doherty, R. B. (2011). Ethical dimensions in the health professions (5th ed.). St. Louis, MO: Elsevier.