In medical practice, confidentiality is an important item in the code of conduct. Confidentiality ensures that the information that medical practitioners obtain from patients in the course of receiving medical care is not disclosed to a third party without the consent of the patient. An ethical dilemma occurs when there is a conflict of a code of conduct with moral issues. A case in point was observed in the ophthalmology clinic where a patient with visual impairment did not wish to give up driving. The ethical dilemma in this case was between the need to protect the patient’s confidentiality at the expense of other road users, and the moral obligation to report the patient to appropriate authorities thereby protecting other road users from accident that might be caused by this patient.
- Identify the problem: Protecting patient’s confidentiality at the detriment of the safety of other road users.
- Take into consideration factors that relate to the situation and generate alternatives for resolving the dilemma: One alternative considered was to persuade the patient to go and report himself to the appropriate authorities for his driver’s licence to be withdrawn. This step was clearly not agreed to by the patient. Another was to report directly to the authorities.
- Examine and categorize the alternatives, identifying those that are consistent and inconsistent with your personal values: Since the patient was not ready to report himself to the authorities, reporting the patient thereby saving other people from the risk of accident was the alternative consistent with my values.
- Predict all possible outcomes for those acceptable alternatives: A possible outcome of this alternative is the patient’s loss of confidence in the healthcare system and worst, a lawsuit for breach of confidentiality.
- Prioritize acceptable alternatives: Reporting the unrepentant patient remained the only good option in the situation.
- Develop a plan of action: A plan of action was to report the case to my superior who in turn will be expected to channel it to the appropriate quarters for action. I will follow it up to make sure the appropriate action is taken to prevent the risk to other road users. In the event that the issue is not forwarded to the right channel, I will do it myself.
- What possible issues can arise from this plan of action: There might be a refusal of action from the superior, favouring the confidentiality of patients over the moral duty of protecting the lives of other innocent people. This will most likely result in reluctance in action by the superior.
- Evaluate the action taken: In the light of the prevailing circumstances, the moral obligation to protect the lives of other innocent people I think supersedes the confidentiality of the medical information of a single patient. In the face of non-cooperation of the patient, the report of the patient’s visual impairment to the appropriate authorities in order to prevent the patient being a liability to other road users is a step in the right direction to fulfilling this obligation.
REFERENCES
Royal College of Nursing (2003). Confidentiality. RCN Guidance for Occupational Health Nurses. RCN, London.
