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Ethical Decision Making in Health Care

Confidentiality in health care carries a duty of care and a legal obligation to the patient (Beech, 2007). According to Beech, the legal requirement to uphold patient confidentiality is not always explicit. In other words, there is no explicit obligation for the health care staff to either divulge, or fail to divulge, the information given to them by their patients in full confidence. Health care staff are required to maintain confidentiality for a number of reasons. First, breaching confidentiality can force the patient to be skeptical about divulging full information to nurses or doctors in the future. Secondly, breach of confidentiality is seen as lack of respect for autonomy rights and individual patient privacy (Kearney & Penque, 2012). Thirdly, by maintaining confidentiality in medicine, health care practitioners earn patients’ trust in privacy and confidentiality.

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Nurse Hathaway is facing a dilemma of whether she should disclose the health status of the two girls to the school and their parents, or whether to maintain the confidentiality that she had promised them. Nursing & Midwifery Council (2005) indicates that each midwife, health visitor, or registered nurse ought to report to the relevant authorities any circumstances likely to hinder the provision of suitable and safe care to the patient. Fullbrook (2007) also states that public safety is crucial in health care and as such, it could be another basis for overriding confidentiality. Considering the duty of care that health care providers have for their patients, sometimes it is necessary to break confidentiality in an attempt to ensure that the patient’s overall wellbeing is safeguarded.

Although confidentiality is regarded as a very important aspect of health care, there are instances when a patient’s right to confidentiality might be overridden by the prevailing circumstances. For instance, the law requires that physicians report cases of infectious diseases to the concerned health authorities. About the case study in question, Andrea has been diagnosed with cervical cancer. Although Nurse Hathaway had promised to keep the information that her patients had divulged to her in confidence, she has an obligation to inform Andrea’s parents that their daughter has been diagnosed with cervical cancer.

A nurse is duty-bound to act professionally and to always remember that she is legally, professionally, and ethically obligated to hold information given to him/her by a patient in confidence (Nursing & Midwifery Council, 2005). A breach of trust or confidentiality usually carries legal charges (Fowler, 2010). The General Medical Council does however protect a health practitioner if he/she broke the confidentiality for the benefit of the general public.

Hathaway’s breach of confidentiality would be justified for two reasons. First, Andrea is a minor and as such, Andrea’s parents need to give their consent before their daughter can receive treatment for her condition. Before they can give this consent, they need to be made aware that Andrea has been diagnosed with cervical cancer. Secondly, Andrea has been diagnosed with HPV, a sexually transmitted disease of public health concern (Nathanson, 2000). Nurse Hathaway would also be morally right to inform the school of the ‘sex parties’ that have been going on involving their students as this is definitely an issue of public interest Edge, 2006).

Several frameworks can be used as an alternative to the dilemma facing nurse Hathaway. One such framework starts with problem identification whereby the issues and uncertainties of the dilemma are identified. Next, both objective and subjective data relevant to the dilemma are gathered. Information on policies and relevant federal and state laws is also obtained. It is also important to identify ethically justified methods to overcome the dilemma such as care, consequences, or virtues. The relevant rights, values, and duties of the patient should also be elucidated, along with any ethical issues or dilemmas involved. Next, you need to spell out the relevant nursing and professional codes of ethics. The relevant sources that need to be consulted such as the ethics committees, lawyers and colleagues should also be identified. Priorities should also be made on the plan of action to take, which should be morally justified. Such a plan of action also needs to be executed and evaluated both in the short-term and long term.

In trying to determine whether Nurse Hathaway’s action to break her patients’ confidentiality was ethical, the ethics committee would find the utilitarianism theory useful. The theory of utilitarianism tries to assess whether an action was evil or good, based on the consequences of the action (Kearney & Penque, 2012). In addition, the ethics committee could also find the ethical principles of nonmaleficence and beneficence useful too. The principle of nonmaleficence entails ensuring that harm does not happen. On the other hand, the principle of beneficence involves promoting benefits. In this case, the two principled would help the ethics committee to decide whether Nurse Hathaway’s values and commitment compromised her professional ethics, and whether there was any justification in doing so.

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Reference List

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

Edge, R.S. (2006). The Ethics of Healthcare. The Ethics of Health Care. Washington, D.C.: Thomson.

Fowler, M. (2010). Guide to the Code of Ethics for Nurses: Interpretation and Application. Silver Spring, MD: ANA.

Fullbrook, S. (2007). Specialist healthcare law. Legal principles of confidentiality and other public interests: part 1. British Journal of Nursing (BJN), 16(14), 874-875.

Kearney, G. & Penque, S. (2012). Ethics of Everyday Decision Making. Nursing Management, 19(1), 32 – 36.

Nathanson, P. G. (2000). Betraying Trust or Providing Good Care? When is it okay to break confidentiality? Web.

Nursing & Midwifery Council. (2005). Guidance on professional conduct for nursing and midwifery students. Web.

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