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“Bioethics on NBC’s ER” by Pamela Nathanson


The nursing practice operates within eight ethical elements. One of the most important ethical elements is confidentiality. However, confidentiality complicates ethical principles when nurses face the dilemma of disclosure to improve the quality of services and protect communities against imminent harm. According to Beech (2007), confidentiality plays an important role in improving the nurse-patient relationship. It builds trust between patients and nurses and increases confidence among patients to provide confidential and sensitive information. However, nurses may disclose patients’ tests and diagnosis reports to protect communities and patients’ interests. The paper evaluates the dilemma presented by Pamela Nathanson in BIOETHICS ON NBC’S ER, on confidentiality and disclosing patients’ information with the aims of providing better care.

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Ethical Implications of Confidentiality Breach

Confidentiality refers to patients’ right to privacy. Additionally, it extends to the agreements made between patients and nurses regarding non-disclosure of patients’ information to parties outside the healthcare profession. According to Griffith (2008), disclosure of patients’ information to other parties disregards patients’ autonomy. Every patient is entitled to privacy and freedom of choice. Similarly, disclosure affects patients’ confidence in nursing care. The sharing of patients’ information is a form of betrayal and mistrust. The process interferes with patients’ trust in confidential care and discourages patients from seeking medical help in fear of exposing their weaknesses, illnesses, and infections. Sharing patients’ information undermines patients’ rights to privacy and control over their personal matters (Beech, 2007). It creates mistrust that can force patients to give false information, desist from important tests, and adopt non-conventional means to tackle their illnesses. Patients have a right to seek legal actions if there is proof or strong suspicion of the disclosure.

Ethical Theories and Principles

Ethical theories in nursing practice follow moral justifications, duties and obligations of practitioners, as well as justice entitled to patients. The common ethical theories in nursing care are virtue ethics, consequentialism, principlism, and deontology. Virtual ethics focuses on the moral character of nurses. According to White, Gena and Baumle (2010), virtual ethics represents the valuable character traits compelling practitioners to engage in trustworthiness, honesty, and justice. Nurses should follow practical wisdom when dealing with patients. In case a nurse promises confidentiality, the decision of non-disclosure should be motivated by the socially valuable traits of honesty and trustworthiness. Deontology focuses on rules and regulations governing any practice.

On the issue of confidentiality, deontology supports any action taken within professional or state laws and statutes. Consequentialism focuses on decisions’ outcomes. Nurses actions are justifiable under consequentialist ethics theory if thay believe that disclosure is bound to improve patients’ condition, or general public health. The theory focuses on the greatest good achievable for the largest group possible. Despite the theory’s acceptability in many healthcare settings, it may affect individual rights and autonomy. Principlism combines virtual ethics with the most acceptable social, religious and individual beliefs. It focuses on practical wisdom and greatest good to increase the value and justifications for decision-making. It emphasizes on autonomy and beneficence. Additionally, it concentrates on protecting lives through justice and truth.

Alternative to the Ethical Dilemma

According to Nathanson’s (2000) case study, Hathaway is not bound by state rules to disclose Andrea’s results. Similarly, it is obvious that Andrea is conversant with STDs, hence the request of confidentiality. Although Hathaway believes that it is important to inform Andrea’s parents, the decision should be the last alternative in case Andrea resists treatment. Hathaway should uphold her virtues and explain the implications of the findings to Andrea. The nurse should allow Andrea to take charge of her situation in order to build trust and confidence. However, disclosure of information to Andrea’s parents may affect her response to medication and trust in healthcare services.

It may compel Andrea to reject medication in protest against Hathaway’s decision. Similarly, it may complicate family relationships in case Andrea’s parents decide to question Andrea’s morality. Additionally, Hathaway should not inform the school since it would disregard her autonomy and expose her to possible peer attacks and psychological traumas. Hathaway should organize guidance and counseling sessions to prepare Andrea for cancer treatment, while encouraging her to communicate with parents for emotional, financial and psychological support. If Andrea agrees to tell her parents, she will build trust in Hathaway, as well gain confidence to share personal and confidential information in case any problem arises. The framework is inspired by the need to promote good and lasting relationships between patients and nurses.

Approach by Ethical Committees

Deontologists would encourage Hathaway to follow the nursing codes of ethics. The law does not allow Hathaway to disclose patients’ information. Although the sex parties are illegal, HPV does not require public disclosure. The team would argue against any form of disclosure. Consequentialists would support disclosure to the school and parents. Disclosure to the school would help in terminating all sex parties. Similarly, disclosure to parents would facilitate collaborative treatment and home-care. The theorists would be inspired by the greatest good for the majority in the society. Virtual ethics theorists would be against any form of disclosure since it would require Hathaway to apply the most appropriate practical wisdom, while maintaining valuable character traits of trustworthiness and honesty. Principlists would advocate for partial disclosure. The theorists would consider the patients’ interests and professional mandates. They would advocate for disclosure to parents to protect Andrea, and oppose disclosure to the school to maintain professional responsibility and duty.

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Beech, M. (2007). Confidentiality in health care: Conflicting legal and ethical issues. Nursing Standard, 21(21), 42-46.

Griffith, R. (2008). Patient confidentiality: Rights and duties of nurse prescribers. Nurse Prescribing, 6(3), 116-120.

Nathanson, P. G. (2000). Bioethics On Nbc’s ER: Betraying Trust or Providing Good Care? When is it okay to break confidentiality? Web.

White, L., Gena, D., & Baumle, W. (2009). Foundations of Basic Nursing. Mason, OH: Cengage Learning.

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