Nurses must uphold patient confidentiality at all times except in cases when withholding protected information would result in the patient’s death or cause severe harm to other people. The patient’s welfare is the priority of health care providers. Nurses are mandated by their Professional Code of Ethics to provide the highest standards of health care service. Their work entails immediate and direct contact with patients and they are expected to protect patients’ rights. Since their job entails access to and collection of sensitive personal information, a nurse “holds in confidence personal information and uses judgment in sharing this information” (ICN, 2012, p.2).
There are instances in every nurse’s professional career when he/she nurse is faced with an ethical dilemma. She/he has to make a decision between two competing values. Such a situation is illustrated in an episode in NBC’s ER (2000), where a nurse had to break her promise of confidentiality to Andrea, a teenage patient diagnosed with cervical cancer. The two competing values were upholding patient confidentiality versus access to cancer treatment. The breach of confidentiality results in loss of patient trust but such action can gain access to cancer treatment leading to a prolonged life.
Ethical implications of breach of confidentiality
When the nurse in the ER episode opted to divulge the health information of Andrea, she broke her promise to the patient and this is a clear example of a breach of confidentiality. With this act, the patient would feel the nurse had betrayed her trust. Since patient’s privacy is protected by law, the nurse faces several ethical and even legal consequences. Three potential effects of her action are filing of civil suits against her and her employer, disciplinary action by the State Board of Nursing, and even job loss (Killion & Dempski, 2006). For the first likely scenario, the nurse can be held liable for releasing unauthorized information with a case on breach of confidentiality. Since the information disclosed is sensitive, she can be sued for invasion of privacy and has to pay damages when proven guilty. The second scenario is the disciplinary action from the Board which may result in the cancellation of her license. For the third scenario, the nurse can be terminated for violation of hospital policies and existing laws on confidentiality.
On the part of the patient, the breach of confidentiality results in the patient’s loss of trust not only on the specific personnel but also on the hospital itself. She may not anymore seek treatment because of shame. The ER episode showed Andrea attempting to commit suicide and this is a clear illustration of the effects of the breach of confidentiality. When nurses fail to value the trust of patients, the quality of life of patient may be diminished because she can go into depression.
However, the breach of confidentiality can result in a better life for the patient when treatment is provided. In the case of Andrea, she cannot seek treatment on her own because minors cannot get treatment for cancer without parent’s knowledge (Nathanson, 2000). The breach of confidentiality can also have a positive effect for other potential victims because interventions can be made. In the case of cervical cancer, curtailing further spread of HPV virus among teenagers can result in the prevention of cancer. This would then result in a better quality of life for those who have been infected since they can seek treatment for themselves.
Ethical principles
The principles of privacy, quality of life, care, competence, and beneficence are applicable in the above-mentioned case. Patients are assured by law and by code of ethics of health professionals that their rights will be respected and their privacy protected. The information patients give to the healthcare personnel are to remain confidential. Patients specify to whom such data can be shared and this is upheld by health personnel especially the nurses. When patients feel their privacy is respected, they begin to trust the nurses and caregivers. Thus, a relationship of trust would ensue between nurse and patient. In the case of Andrea, the nurse gained the trust of Andrea because she assured her that all information the patient shared as well as the test results would remain confidential. The principle of quality of life here refers to Andrea and to other teenagers who may also have been infected. Competence is related to Andrea’s capacity to seek treatment. She could not do it on her own, thus she need the support of her parents. The ethical principle of beneficence supports the action of the nurse in the ER episode. Beneficence is the “concept of doing good for another” ( Hoeman, 2008, p.33) and when the nurse opted to divulge information, this was the principle that supports that action. Despite being aware that such action can negatively impact her job status, she did it because informing the parents would benefit the patient in the sense of being able to access health treatment.
Decision-making framework
A decision-making framework developed by the Hastings Center on Bioethics can be applied to this dilemma. This is a six-step process that begins with formulating the ethical question and ending with the action and evaluation. The ethical question is “should patient confidentiality be breached so that a minor can access cancer treatment.” The next steps are listing the facts, enumerating stakeholders and their values, generating options, and justifying decisions. As the facts have been discussed in the previous paragraph, this section will discuss other steps. The stakeholders are the nurse, patient, parents, other sexually-active teenagers, hospital administration, and ethics committee. The options in this dilemma are (a) telling Andrea’s parents so that she gets cancer treatment; (b) reporting to the school about Andrea’s case so that other teenagers and their families be alerted to the potential infection and so that these kid get treated and further spread is prevented; (c) convincing Andrea to tell her parents; and (d) reporting the case of suspected sexual activities of minors to the social services. An alternative decision from that presented in ER is the nurse convincing Andrea to tell her parents about the results so that there is no breach of confidentiality. Instead of informing the school about Andrea’s case, she can alert social services so that they investigate sexual activities of minors which can negatively impact public health.
Ethics committee response
The ethics committee could look at the dilemma as an issue on public health. Sharing the information about one patient violates privacy however such act can prevent a potential epidemic of cervical cancers among minors. The committee can also look at the breach of confidentiality as a necessary action for the nurse to facilitate the patient’s access to the necessary treatment which could not be otherwise acquired. Thus, using the principles of privacy, care, quality of life, beneficence and public health, the Ethics Committee can rule in favor of the nurse on the grounds that the breach of confidentiality was a necessary action so that the patient and other infected individuals would have access to the needed health care.
References
Hoeman, S. P. (2008). Rehabilitation Nursing: Prevention, Intervention, and Outcomes. St. Louis, MO: Elsevier Health Science
International Council of Nurses (ICN) (2012).The ICN Code of Ethics for Nurses. Retrieved from http://www.icn.ch/images/stories/documents/about/icncode_english.pdf.
Killion, S.W. & Dempski, K.M. (2006). Quick Look Nursing: Legal and Ethical Issues. Sadbury, MA: Jones and Bartlett Publishers, Inc.
Nathanson, P. (2000). “Betraying Trust or Providing Good Care? When is it okay to break confidentiality?” Retrieved from http://web.archive.org/web/20110706061843/http://www.bioethics.net/articles.php?viewCat=7&articleId=133
