The primary effect of a breach in confidentiality in the healthcare field is a loss of trust in the patient-caregiver relationship (Erickson and Millar, 2005). Because trust between the patient and all medical caregivers including nurses is something that the medical profession wants to foster, there is an ethical duty for the caregiver to keep patient information confidential. In particular, there are several aspects of the patient-care giver relationship that are supported by the ethical duty to keep patient’s information confidential. First, the duty is upheld to allow patients to fully disclose information to medical personnel (Nathanson, 2000). With all the information available, it greatly increases the chance that effective medicine can be practiced and the patient’s therapy will be successful. Second, the medical professions recognize the right of the patient of respect, the right to individual privacy, and the right to autonomy separate from any medical relationship they may have with the patient (Nathanson, 2000). These considerations all culminate in a relationship between the patient and the medical caregiver of living up to the patient’s expectations of privacy and earning the patient’s trust (Nathanson, 2000).
Overall, ethical theories and principles are based on basics rights that humans should provide to each other in their interactions. One source of these ideas is professional ethical codes that are drafted and maintained by related organizations. For example, the American Nurses Association (ANA) maintains a code of ethics (2001). One of the provisions of this code is that “nurse promotes, advocates for and strives to protect the health, safety, and rights of the patient” (ANA, 2001). This provision has been interpreted to mandate a nurse’s duty to maintain patient confidentiality. The interpretive statements for this section discuss the fact that this duty is associated to the right to privacy but also notes that it can be modified in order to “protect the patient, innocent parties and in the circumstances of mandatory reporting for public health reasons” (ANA, 2001). These ideas form the basis for the right of confidentiality that is in conflict in the factual scenario from the ER television show discussed by Nathanson (2000).
Although the duty to confidentiality clearly supports ethical concerns related to the rights to privacy and supports relationship goals between the patient and caregiver, dilemmas like those described by Nathanson also need to be addressed within the ethical analysis. As noted by the article and in the AMA provision exception, a nurse also has the duty to protect the health and safety of the patient and have the patient suffer no further harm (Nathanson, 2001). It is the conflict between maintaining the patient’s right to confidentiality about her actions in taking part in the sex partiers and her cancer diagnosis and the aim to have her obtain the best medical care and support to address the disease that forms the dilemma. One resolution to this dilemma is to determine this falls within the “protect the patient” exception to the code. In doing so, the nurse selects the duty to protect the patient over her right to privacy and tells her parents about the situation in order to prevent further harm to the patient. It is noteworthy that this situation is also impacted by the patient’s minor status. This situation argues for involving the parents in the situation through disclosure. In sum, this alternative framework and resulting disclosure to the patent’s parents is well supported given the factual situation presented within the television show.
There is also the related issue of disclosing to an authority, such as the patient’s school, of the occurrence of the sex parties, as there is a possibility of innocent students becoming involved and being exposed to HPV as a result of the school not addressing this behavior because of lack of knowledge. In this case “innocent” is used in the sense of not knowing about the possibility of HPV exposure and the possible resulting cancer. Again, there is a dilemma pitting the patient’s right to confidentiality against the nurse’s general duty to protect innocent parties from health-related threats. However, as mentioned by Nathanson, unlike the more easy traceability and mandatory reporting involved with sexually transmitted diseases such as syphilis, gonorrhea or chlamydia, HPV is less visible and the end result of cancer is much less certain (2001). This aspect of the disease can make the decision to disclose the situation to the school much less clear than otherwise and also raise the question as to whether it falls within an exception within the code. Within the fictional world, having the patient attempt suicide after disclosure to the school by the nurse is reflective of this alternative ethical framework being less applicable in that case (Nathanson, 2001).
Finally, if an ethical committee addressed this situation there would be the added responsibility of a careful consideration of the policy position of the hospital as a factor (American Medical Association, 1994). But even with this consideration, the committee’s recommendation would be provided in the educational and advisory purpose as suggested for such committees. In this particular situation, most committees could provide many additional years of experience and alternative viewpoints to the analysis that one individual alone does not have (American Medical Association, 1994). This could have been very helpful to nurse faced with this situation. Having a committee decision behind a caregiver’s actions can help resolve the issue in a clearer fashion than may be possible only through an individual’s problem-solving. For example, as suggested by Nathanson (2001), if the ER nurse had consulted a committee before informing the school, it is possible that the idea of an anonymous disclosure about the sex parties could have been suggested and followed, thus avoiding the attempted suicide. Thus, the fictional situation within the article provides clear conflicts between the various ethical obligations of a nurse, but focusing on the various rights that need protection and perhaps bringing in the help of a committee, the best ethical approach can be determined and followed.
References
American Medical Association (1994). Ethics Committees in Health Care Institutions. Opinion 9.11. AMA Code of Medical Ethics. Retrieved from
http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/opinion911.page
American Nursing Association (2001). Code of ethics for nurses with interpretive statements. Nursing World. Retrieved from
http://nursingworld.org/MainMenuCategories/EthicsStandards/CodeofEthicsforNurses/Code-of-Ethics.pdf
Erickson, J. and Millar, S. (2005 May 31). Caring for patients while respecting their privacy: renewing our commitment. OJIN: The Online Journal of Issues in Nursing. 10, 2, Manuscript 1. Retrieved from
http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume102005/No2May05/tpc27_116017.html
Nathanson, P. (2000 February 24). Bioethics on NBC’s ER: Betraying trust or providing good care? When is it okay to break confidentiality? Bioethics.net. Retrieved from
http://web.archive.org/web/20110706061843/http://www.bioethics.net/articles.php?viewCat=7&articleId=133
