Patient confidentiality is part of the Nursing Code of Ethics and it is a nurses duty to uphold confidentiality of patient information (American Nurses Association, 2012). However, there are certain situations in which a confidentiality breach is acceptable, such as when a patient voices harm to themselves or others and certain sexually transmitted diseases STDs). The following is a breakdown of the ethical implications of a breach of confidentiality, the ethical theory, the alternatives to breaching confidentiality using the framework of ethical decision making and the role of the ethics committees.
Ethical Implications of a Breach of Confidentiality
A confidentiality breach is when patient information is disclosed to a party that is not a direct part of the patients healthcare team without obtaining the appropriate patient consent (American Medical Association, 2012). It is important for the nurse to maintain confidentiality to gain the patients trust, except in situations that are required by law to be reported. When confidentiality is breached many ethical implications arise.
Some of these implications are losing a patients trust and disclosing information to parties that is not required by law, which could cause harm to the patient. In the article Bioethics on NBCs ER: Betraying Trust or Providing Good Care? When is it OK to Break Confidentiality? the nurse did the right thing by breaking patient confidentiality in revealing to the parents that their minor child had cervical cancer. This breach in confidentiality was warranted by the fact the parents needed to know to ensure medical care was provided to the child. However, the nurse revealing the information to the school was not warranted as it had no benefit to the child, and could lead to more harm to the child.
The ethical theory that best describes this situation is utilitarianism. In utilitarianism, an action is correct if it brings the most balance of advantages over burdens, in other words, it is to provide the greatest benefit to the most number (Purtilo & Doherty, 2011). The nurse made the decision to breach confidentiality and inform the minors parents in order for her to obtain the medical care needed. If the parents were not informed, there would be the chance the minor would not get the care needed, do to consent issues, and the minor could die of cervical cancer. Although it was not ethical of the nurse to reveal the information to the school, one can argue that the information needed to be disclosed about the sex parties in order for the students to be educated on the potential risks this behavior carries.
Alternatives to a Confidentiality Breach Using the Framework of Ethical Decision Making
The model of ethical decision making presented by Uustal provides steps to reach a morally acceptable solution in an ethical dilemma (Grand Canyon University, 2012). The first step is to recognize the problem. The problem in the above referenced case was the nurse was not sure if she should breach confidentiality by informing the parents their child had cervical cancer and informing the school of the same. The second step is to identify ones own personal values as they relate to the identified problem. The nurse wanted to respect the minor patients rights, but felt the parents needed to be informed to help the patient get proper treatment. She also felt that informing the school would prevent the students from participating in sex parties that could lead to further medical issues, such as STDs. The third step is to consider factors that relate to the problem and produce alternatives to resolve the dilemma. The factors involved in the dilemma were the nurse breaching confidentiality to help the minor patient or keeping quiet about the situation and risk the patient not getting the appropriate care.
An alternative would have been for the nurse to talk with the patient and explain the importance of her telling her parents in order to get treatment. The fourth step is to review and categorize all alternatives and to determine which ones are consistent and which ones are inconsistent with ones personal values. Allowing the patient to tell her parents herself or the nurse informing the parents are consistent with the nurses values. Not telling them is inconsistent. The fifth step is to predict the possible outcomes of the acceptable alternatives. The patient informing her parents would not breach confidentiality and harm the nurse patient relationship. The sixth step is to list the acceptable alternatives from most acceptable to the least acceptable. The most acceptable alternatives are the patient informing her parents or the nurse informing the parents. The least acceptable alternatives would be to not inform the parents at all and informing the school.
The seventh step is to develop an action plan. If the minor insists on not informing her parents then an ethics consult should be called to either assist the patient in informing her parents or assisting the nurse in the right direction. The eighth step is to implement or act on the plan. The plan is for the nurse to assist the minor in telling her parents or the nurse telling the parents herself. The final step is to evaluate to action plan. In this case the nurse breached confidentiality and informed the parents, which was appropriate, however disclosing the information to the school was not beneficial for the patient and was unethical.
Role of an Ethics Committee
The purpose of ethics committees are to support the patient rights, promote combined decision making amongst clinicians and patients, promote just policies that enhance the ethical tone of healthcare clinicians and institutions, and to maximize achieving excellent, patient-centered outcomes (Pearlman, 2010). The committee accomplishes this by meeting with the parties involved in the situation, reviewing the medical records and holding a meeting to discuss the case specifics and facilitate communication between the healthcare team and the family. The committee will then write a recommendation based on the case information (Pearlman, 2010). In the previously referenced case, an ethics committee would have guided the nurse in making the best decision possible for all parties involved, which would have excluded the nurse from disclosing the information to the school.
Nurses often find themselves in ethical dilemmas. It is important for a nurse to know how to resolve these dilemmas with the least harm caused to the patient. Breaching confidentiality is unethical and goes against the Nursing Code of Ethics, however there are times that breaches are beneficial to patients. This paper discussed the ethical implications of a breach of confidentiality, the ethical theory of utilitarianism, the alternatives to breaching confidentiality using the framework of ethical decision making by Uustal and the role of the ethics committees.
American Nurses Association (2012). Code of ethics for nurses with interpretive statements. Nursing World. Retrieved May 9, 2012, from, http://www.nursingworld.org/MainMenuCategories/EthicsStandards/CodeofEthicsforNurses/Code-of-Ethics.pdf Grand Canyon University (2012). Ethical decision making lecture 3. Retrieved May 9, 2012, from, http://angel05.gcu.edu/section/default.asp?id=1235855 Pearlman, R.A. (2010). Ethics committees and ethics consultation. University of Washington School of Medicine. Retrieved May 8, 2012, from, http://depts.washington.edu/bioethx/topics/ethics.html Purtilo, R. & Doherty, R. (2011). Ethical dimensions in the health professions (5th ed.). Retrieved April 25, 2012, from, http://pageburstls.elsevier.com/books/978-1-4377-0896-7/outline/Root