Moral dilemmas are ones of the most problematic and complicated aspects in the careers of medical workers. Obligations and confidentiality have started their existence in ancient times. Over the generations, these rules were developed and changed, yet the initial concept remained the same. Medical workers are obliged to keep the secrets their patients do not want to be revealed to the publicity. In many cases, these rules put doctors and nurses into very contradictory positions where any of the possible decisions could harm one of the sides taking part in a contradiction. Modern experts have worked on several various moral principles and theories of medical work. They are intended to help the medical workers to find proper ways out of the difficult situations. The main difficulty is that these principles and theories explain only how to make decisions, but they never give any more or less precise answers as to which decisions the doctors should make in various situations.
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Confidentiality between doctors and patients exists for a reason. This rule is of high importance in the whole process of medical treatment and the relationship between a patient and a doctor. First of all, confidentiality provides the patients with a feeling of security so that they could share all the necessary details about their conditions with the doctors, even though these details are embarrassing, secret or unpleasant. The patient is more likely to be honest with the doctor if they are sure that all the information they reveal will stay confidential. Due to this honesty, a doctor has better chances of addressing the illness and treating it successfully. The ruination of this balance would lead to lack of trust from the side of patients and lack of information about the diseases for the doctors, which is a very dangerous situation that can create serious threats to both sides. Besides, the breach of confidentiality may result in moral discomfort or important ethical issues for the patient, their family, or other people involved in the conflict. Often, it is highly problematic for a medical worker to decide which decision is correct, and when it is necessary and possible to break confidentiality.
Mark Siegler believes that the principle of total secrecy between a doctor and a patient is not quite the same as it was before, because confidentiality between the patient and a doctor was used as a means of approaching the patients in earlier times when intimacy and personal subjects were highly complicated issues and revealing certain details could create major social issues for the patients (1982). Today doctors are believed to be responsible not only for the life of their patient but also for the lives and safety of other people. This is why, in a situation, when the information revealed by one patient can help save more than one life, it has to be uncovered and used immediately. In cases when the doctor is required to reveal the confidential information according to the principles of law and justice, such act would not be considered as a breach of confidentiality (Tarasoff vs. Regents of the University of California 1976). What complicates the decision-making process for the doctors is the presence of a moral side to the conflict. Often, following the principle of justice and revealing confidential information, the doctor risks jeopardizing life or future of the patient (Beauchamp & Childress 1994). We observe such situation in the case with nurse Hathaway that has to choose between betraying a young girl and creating big problems with family and society for her and saving lives and health of other teenagers (Nathanson 2000).
To my mind, the best way to approach the dilemma of nurse Hathaway is to share confidential information with the experts. In the case with two fourteen-year-olds revealing information about “sex parties” happening among the school children and exposing kids to cervical cancer, HPV and many other sexually transmitted diseases a medical worker is dealing with a public health issue that endangers lives of dozens of people. Appropriate measures and the intrusion of doctors and social workers in such a situation are necessary. When so many children are endangered, this is no longer a question of morals and ethics. This is a question of justice and medical responsibility to save lives. I also think that the girl’s parents have to know that their daughter has cancer. Such serious fact should not be hidden from them, especially in a situation when the child is younger than eighteen.
The ethics committee has to inform the schools about the issue; special health care policies have to be introduced to society. The school administration may decide to inform parents, and this is why the hospital may want to keep the name of the first two patients confidential as the nurse Hathaway promised it. To my mind, this is the best way to have all the involved sides informed and to minimize the moral damage for the young girls.
Beauchamp, T. L. & Childress J. F. (1994). Principles of Biomedical Ethics (4th Ed.). Oxford University Press, 418-429.
Nathanson, P. (2000). Betraying Trust or Providing Good Care? When Is It Okay to Break Confidentiality?
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Siegler, M. (1982).”Confidentiality in Medicine: A Decrepit Concept”, New England Journal of Medicine 307(24), 1518-1521.
Tarasoff vs. Regents of the University of California (1976). Pacific Reports 551(2), 334-361.