Applying Ethical Frameworks in Practice - Part 2
Can you keep a secret? - Applying Ethical Frameworks in Practice introduction?? That question could quite possibly contain the most intriguing words uttered between two people! When spoken, they ignite a flame of curiosity within the hearer that will not be extinguished until the sacred secret is whispered. An explicit trust is expected with such a disclosure; a trust that, when broken, can destroy a relationship. When that “secret,” or confidence, is exchanged between a patient and healthcare provider, however, a whole new level of discretion is required.
This paper will explore the meaning of confidentiality in the healthcare setting, define the meaning of a breach of that confidentiality, and determine when it is ethical for a healthcare provider to break a patient’s confidence. Simply put, “confidentiality is the practice of keeping harmful, shameful, or embarrassing patient information within proper bounds” (Purtilo & Doherty, 2011, p. 206). When a patient discloses personal information, he or she seldom feels compelled to remind the healthcare provider of the confidentiality of the issue.
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There is typically an innate sense of trust that is understood by the patient. The Health Insurance Portability and Accountability Act (HIPAA), implemented in 1996, provides protection for patients regarding their private health information. This rule also makes provisions for disclosure among healthcare providers, allowing that information to be shared among these entities for the purpose of providing patient care and other such vital purposes (HHS, n. d. ).
What happens, though, when the confidential information a patient shares cannot ethically remain confidential? An ethical dilemma is born. The term ethical dilemma refers to a situation in which there are two morally correct paths to take, but to follow one means the other cannot be followed. The choice is often between two equally undesirable options. There is no absolute right or wrong answer, but the choice that is made is, essentially, the lesser of two evils (Purtilo & Doherty, 2011).
Ethical dilemmas have no real solution, but rather a resolution (GCU NRS-437V Lecture 3, 2011). The article, Bioethics on NBC’s ER, examines an episode of the television series, ER, in which a nurse is faced with the ethical dilemma of whether to breach the confidentiality of a 14-year-old patient who is diagnosed with cervical cancer. The dilemma is created when the nurse promises the patient that she will not inform her parents of the results of STD testing, which ultimately leads to the cancer diagnosis (Nathanson, 2000).
While this nurse was attempting to gain the girl’s trust in an effort to convince her to receive treatment, she essentially created the dilemma by making a promise of which she had no way of knowing whether she could honor. The first ethical principle that must be considered is that of fidelity, or being faithful to the commitments one has made (Purtilo & Doherty, 2011). In this case that commitment is the promise to withhold test results from the patient’s parents.
To notify the patient’s parents would be a violation of the fidelity principle on the nurse’s part, and could potentially create trust issues for the patient regarding healthcare providers in the future. On the other hand, to abstain from disclosure of that information could possibly be fatal for the patient if she did not receive treatment for her cancer. The principle of veracity essentially binds one to the truth (Perlite & Doherty, 2011).
It is the nurse’s duty to disclose the truth about the diagnosis to the patient and, in doing so, she might be able to make the girl understand the severity of the diagnosis and the urgency of treatment. Though the nurse would be breaching the confidentiality with her young patient by revealing the test results to her parents, perhaps she could convince the patient to tell her parents herself. If successful, this could strengthen the patient’s confidence in her healthcare providers, along with creating a sense of autonomy.
The principle of autonomy, which allows a patient to self-determine their treatment, is, in this instance, conflicting with the principle of paternalism. Paternalism comes into play when the patient’s preferences clash with professional’s judgment regarding what is best for the patient (Purtilo & Doherty, 2011). Because of the patient’s young age and the fact that she is a minor, paternalism is a fitting principle on which to lean in this situation. Utilizing this rinciple allows the nurse to act upon her judgment of what is in the young patient’s best interest, which in this case could save the patient’s life. The utilitarian theory of ethics is appropriate in this situation. This theory states that the best approach to a dilemma is the one that brings about the best overall consequences (Purtilo & Doherty, 2011). In the example of this young girl, the best overall consequence would be for her to receive treatment for her cancer, even at the risk of betraying her trust. Therefore, notifying her parents would be the soundest approach.
The Ideal Observer Theory is implemented into the situation by utilization of an ethics committee. Such a committee is a mandated entity in acute care settings as established by President George Bush in 2002. This committee, consisting of members from varying disciplines, acts as the ideal observer, or unbiased party, in resolving dilemmas such as this one. Because of the diversity of the group members’ experiences and education, the committee is better equipped to develop a well-balanced alternative (GCU NRS-437V Lecture 3, 2011).
In conclusion, a nurse’s responsibility is, first and foremost, to the patient. The American Nurses Association outlines, in its Code of Ethics, nurses’ duties regarding confidentiality. The Code states that a patient’s well-being, rights, and safety are the primary concerns in determining the need to disclose confidential information (American Nurses Association, 2001). If breaching confidentiality, such as the one illustrated in the television show, results in the very best patient outcome, then it is not only warranted, but also wanted.
American Nurses Association (2001). Code of ethics for nurses: Provision 3.2. Retrieved from: http://www.nursingworld.org/MainMenuCategories/EthicsStandards/Codeof EthicsforNurses/Code-of-Ethics.pdf. GCU NRS-437V Lecture 3 (2011). Ethical decision making. Retrieved from: https://lc-ugrad1.gcu.edu/learningPlatform/user/users.html?operation=loggedIn – /learningPlatform/loudBooks/loudbooks.html?viewPage=current&operation=innerPage¤tTopicname=Ethical Decision Making&topicMaterialId=875a116e-998a-48aa-8d33-31ca3336f88c. Purtilo,