Patient confidentiality is of paramount importance to both the physician and the patient. Full and frank disclosure of information by a patient is vital in arriving at a correct diagnosis. Privileged information includes the patient’s medical history, diagnosis, and lifestyle. In this case, the medical team, a nurse, has a legal and ethical obligation to keep this information utterly privileged unless compelled to by law. Any disclosure of this information to a third party without the patient’s consent is deemed a breach of confidentiality (America Medical Association n.d).
Patient confidentiality is not a new concept in the medical field: it goes way back to the Hippocrates oath. However, the idea of patient confidentiality has evolved. To seal possible loopholes brought about by modern changes such as technology and social changes, specific rules and exceptions have been laid down to ensure patient confidentiality is still taking center stage. The exceptions to patient confidentiality are child abuse, injury resulting from violence, and reportable infectious and sexually transmitted diseases stated by HIPAA. These exceptions are due to social considerations and are ethically and legally justified (Confidentiality and HIPAA n.d)
Provision four of the ANA codes of ethics states that nurses should be held accountable and responsible for their actions. A patient’s rights include rights to privacy and confidentiality (American Nurses Association n.d). Therefore, a breach of the patient’s rights is unethical, and the nurses must be held accountable for their actions. A clinician-patient relationship is also assumed to be an implied contract. Therefore, a breach of confidentiality is deemed to be breaking the implied promise, which gives rise to mistrust.
In ideal situations, these rules would apply perfectly, but it is crucial to consider the factors that may prompt the nurse to breach confidentiality. Ethics is mainly doing the moral thing regardless of laws and pre-existing assumptions. If upholding the rules is at the cost of a greater good, then the law-abiding decision may not be ethically correct. One of the nurse’s duties as per ANA is the reestablishment of welfare in the care of persons, families, and the public.
Ethical theories and principles
Ethical theories help solve ethical dilemmas. One of the ethical theories is the Utilitarianism theory. According to this theory, the ethically correct decision is the one that yields the most significant benefits. This theory provides rational and logical grounds to base a decision on (UK clinical ethics network n.d). The ethical principle of beneficence reinforces this theory because it also advocates doing good when faced with a moral dilemma. In line with this theory, the nurse should disclose the patient information. It’s a win-win situation for everyone; the patient gets the medical attention she needs, and the nurse helps avert a dangerous crisis in the school. I am inclined to state that this is a sure way to solve this ethical dilemma because it is morally responsible even though it has little regard for the law.
Deontology theory is an ethical theory whose basis for decision-making is complete adherence to duties and obligations. The theory assumes upholding rules and responsibilities is ethically correct. This criterion may be used to make consistent decisions. It, however, does not lend logic to its conclusions (UKClinical ethics network). In this scenario, the doctor must uphold patient confidentiality, but this would be detrimental to the patient’s health. She fails to get the medical attention and care she needs and that of the other students as they would run the risk of contracting the virus. This decision would also be against the principles of no maleficence and beneficence.
Virtue ethics is an ethical theory whose determining factor is one’s moral character. It pays little attention to the person’s actions which may either be true or contrary to his character. In this instance, the patient’s moral behavior is, to some extent, questionable. This is, however, not sufficient grounds to base a decision. One would have to introduce the rights ethical theory (UK clinical ethics network). This theory upholds an individual’s rights and the rights of the larger population. The doctor would then be compelled to enforce the privacy and confidentiality of her patient. The principle of respect for patient autonomy is upheld, but this also tramples on beneficence and no maleficence. However, this decision is not prudent because it would have dire consequences on both the patient and students.
A framework for ethical decision making
A relevant and suitable framework for ethical decision-making is the four-quadrant approach. It involves answering four significant questions; Indications of medical intervention, Preferences of a patient, quality of life, and contextual features (UK clinical ethics network). The patient has been diagnosed with cervical cancer, which could be fatal if she does not receive the proper medical attention. The patient prefers to keep her condition from her parents and her schoolmates. Despite the need to protect her right to autonomy, she is a minor, and therefore the decisions rest on her parents’ shoulders.
Consequently, it is in her best interest that the nurse discloses this information. In doing so, the patient’s quality of life will improve. This answers the third question. The contextual features, in this case, are that the nurse’s ultimate decision impacts the other students as well.
The decision based on this approach is to disregard patient confidentiality and disclose the patient. This is morally responsible because the nurse, too, has a more significant ethical obligation to the students. Technically the patient is a minor, and issues of her health are her parent’s responsibility; therefore, disclosing that information is, in a real sense, no breach of confidentiality but more of an obligation. However, this approach fails to consider the patient’s views.
An alternative to this dilemma would also be using the four principles of biomedical ethics, which are respect for autonomy, beneficence, non-maleficence, and justice. There would, however, be a conflict between the principles of patient autonomy and beneficence. An autonomous decision is an informed decision regardless of the patient’s view. In this case, the most informed decision would be to disclose the patient’s information.
The benefits that accrue to the patient far outweigh the need to respect the patient’s wishes, and this decision would have the least harm to the patient. This reflects the principles of beneficence and no maleficence. The major challenge is deciding whether the nurse has justifiable grounds for disclosing this information to the school. The patient may be viewed as contemptuous, but
the nurse’s actions are justified because her fellow students’ health is at a dangerous risk. The nurse can still alert the school’s principal and still manage to keep her patient’s identity concealed
This ethical decision-making approach is significant because it allows the nurse to reach a reasonable and rational decision when ethical boundaries are not drawn.
An ethical committee’s approach
An ethical committee’s primary purpose is to protect the patient’s interest, address the moral issues and still strike a healthy balance in circumstances where there is no clear distinction between ethical boundaries. The committee must consider legal factors and ethical issues. Therefore, it is faced with the unique challenge of harmonizing the two aspects and reaching a decision that serves all stakeholders. The committee represents rich and experienced views, given the broad spectrum of people in it. In this case, a collaborative approach is sought to reach a consensus and provide the best solution given the patient’s perspective.
An ethical committee’s approach
The ethical theories and principles provide a suitable approach to arriving at an amicable and reasonable decision. The different views offer different perspectives, which offer a wide range of alternatives. The ethics committee must take a patient-focused approach to conclude. Members should base their choice on the theory that seeks to protect the patient’s interests and, at the same time, be of very little harm to the patient. In this case, the patient is a minor, and upholding her demands has excellent repercussions on her.
A collaborative approach takes into account the legalities and ethical issues. The law does not require the nurse to disclose the patient’s information since cervical cancer is not in the category of reportable sexually transmitted diseases. However, the moral thing to do is alert the principal about the student’s careless sexual behavior and the inherent risk. Serving the patient’s interests puts her and fellow students’ health at stake. Therefore, the ethics committee is faced with the challenge of reconciling all these factors and reaching a prudent decision.
References
American Medical Association. Patient confidentiality. Accessed on 19 March 2013.Available on </http:www.ama.assn.org/>
American Nurses Association. Code of ethics for nurses on with interpretive statements. Accessed on 19 March 2013. Available on <http://www.med.upenn.edu/bioc>
Confidentiality and HIPAA. Accessed on 19 March 2013. Available on <http://www.texashte.com/documents/curriculum/health-sciences/hipaa pdf/>
UK Clinical Ethics Network. Ethical issues. Accessed on 19 March 2013.Available on <http://www.UKCEN.net/index.php/ethical issues/confidential/ethical considerations>
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