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Navigating Ethics of Patient Confidentiality
Ethical implications of a breach of confidentiality
There are some responsibilities and ethical considerations that nurses are required to observe at any given time. One such consideration is maintaining the privacy and confidentiality of the medical information gathered from patients (Erickson & Millar, 2005).
If the information is to be released to a third party, the implied or expressed consent of that patient should be acquired. Charges against the breach of confidentiality should be subjected to nurses or other healthcare practitioners who release the information without the patients consent. Breach of confidentiality is contestable in a court of law is subject to huge fines. Sometimes, nurses may be compelled to disclose this information to a third party without the outright consent of the patient. It could be due to a government direction or for the benefit of the patient.
From the case study, the nurse known as Carol Hathaway must disclose information to Andreas parents (Nathanson, 2000). The boundaries of her confidentiality ended with the fact minors consent is not lawfully acknowledged. Although some states allow minors consent especially for sex checkups, the same is not allowed for the treatment of cervical cancer treatment. The responsibility for the minors consent to cancer treatment lies with the parents.
However, in case the cancer is sexually transmitted, the parents do not have to offer consent for the treatment. At least 95% of cases of cervical cancer are transmitted sexually. In such a scenario, the nurse is not required to seek the consent of the minor. From a legal perspective, the consent of the minor has ceased to exist. Nonetheless, it will be important to use a collaborative approach to inform the parents. At this point, the breach of confidentiality is ethical and poses no threat to either the patient or the nurse.
On the other hand, if Hathaway informs the school of Andreas medical information, she will have violated her responsibility to confidentiality and privacy (Nathanson, 200). Firstly, sex is a matter of choice and not every student engages in a group of unprotected sex. Therefore, there is no need of disclosing information for something that does not affect the community. Therefore, it is unethical to disclose the information in such a context. Disclosing the information will lead to a violation of trust and Andrea might even commit suicide. Nevertheless, Hathaway should inform the school that students are engaging in group sex and the probable consequences of such behavior.
Ethical theories and principles
Two important ethical theories are evident in this case, utilitarian and deontological theories. Utilitarian theory is concerned with distinguishing evil from good based on actions. According to Lea, Williams & Patricia (2005), a good act produces great happiness to a majority of the people. However, the utilitarian theory argues that some good has to be sacrificed for greater achievement. In this case, Hathaway should make Andrea happy by keeping the promise of not disclosing her ordeal. However, disclosing Andreas condition to her parent can also lead to good deeds.
On the other hand, the deontological theory determines the right action based on the intention, and not the outcome. In this case, the intention of disclosing Andreas information will be to enable the treatment of cervical cancer. In this context, Hathaway should disclose the information to fellow medical practitioners and parents.
Disclosure of information without a patients consent is a violation of the principle of autonomy (Ministry of Ethics, 2010). However, non-disclosure can cause harm to Andreas parents. In this case, the act of non-disclosure violates the principle of non-maleficence (American Nurses Association, 2012).
A reasonable alternative using a decision-making framework
The decision-making framework provides enables a nurse to gather relevant information. The decision-making framework enables the nurses to identify the ethical problem. Using the framework, a nurse can invoke ethical theories, explore practical alternatives, undertake the action, and evaluate the action outcome.
The nurse should inform the patient about the dangers of cervical cancer. Aware of the consequences of the disease, the patient is likely to offer consent for disclosure of health information. The nurse has to inform the minor that the disease is treatable if detected and treated earlier. Perhaps, this will make the patient trust the nurse with the health information as a means of expediting the treatment process. In addition, by invoking the provisions of utilitarian and deontological theories, the nurse has a reason to disclose the information to Andreas parents (Lea, Williams, and Patricia, 2005).
Ethical committees approach to the dilemma
The ethical committee will look at the rightfulness or intention of the disclosure to determine whether Hathaway acted ethically. Since Hathaways intention was to the betterment of Andreas life, then the approach was ethical. In any case, the committee should vindicate the nurse of any malicious motive. Although Hathaways action amounts to a breach of confidentiality, the committee can determine the case using the principles of non-maleficence and beneficence.
If the principle of autonomy is not breached, it will not harm the parents and hence Hathaway should be exonerated. The committee may determine whether any form of collaboration was used and the subsequent outcome. In this case, the collaborative approach includes following the guidelines of the hospital, seeking a second opinion, and asking for consent from the patient (Bosek, 2009). However, Hathaways intention to disclose a patients information to the school is unethical and amounts to a breach of confidentiality.
References
American Nurses Association. (2012). Short Definitions of Ethical Principles and Theories Familiar words, what do they mean? Web.
Bosek, M.S. (2009). Identifying Ethical Issues From the Perspective of the Registered Nurse. JONAs Healthcare Law, Ethics, and Regulation, 11(3), 91-99.
Erickson, J.I & Millar S. (2005). Caring for Patients While Respecting Their Privacy: Renewing Our Commitment. Online Journal of Issues in Nursing, 10 (2), 23-34.
Lea, D. H., Williams, J & Patricia, D. (2005). Ethical Issues in Genetic Testing. J Midwifery Womens Health, 50(3), 234-240.
Ministry of Ethics. (2010). Consequences of breaching confidentiality. Web.
Nathanson, G. P. (2000). Bioethics on NBCs ER. Betraying trust or providing good care? When is it okay to break confidentiality? Web.
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