Breach of Trust
The patient needs the assurance that whatever private/personal information communicated to the nurse will be kept in confidence and will not be divulged to a third party in order for him/her to feel free to open up the complete information regarding the case at hand. In fact, the confidentiality is a crucial right of a patient and it is very much related to the notion of privacy.
Hence it is unlikely for a patient to be comfortable to discuss matters related to the sex life, habitual drug use, and other issues that are considered to be taboos in the society, if they are not sure about the fact that their information would remain confidential. The purpose of this paper is to examine the concept of confidentiality in nurse-client relationship in the context of Nurse Hathaway’s dilemma, and describe author’s perspective on the concept of maintaining or breach of confidentiality while providing good care to the patient.
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Ethical Implications of Breach of Confidentiality
A breach of confidentiality is a release to a third party, without the permission of the patient or an order from a court, private information that the nurse has collected within the ambit of nurse-patient relationship. The legal base for enforcing obligation of confidentiality is more far-fetched than the ethical parameters, which demands the morally right thing to do. If the confidentiality is breached patients will be uncomfortable to open up to a physician or nurse about the true story of the problem/case, and they may even be reluctant to seek care and treatment for the problem.
In the case of Andrea, the breach of confidentiality is a very sensitive issue as she is a teenager who is very vulnerable to social and public reactions, and the chances of her resorting to undesirable actions as a result of such a breach of trust are very high. Applicable Ethical Theories and Ethical Principles In the case of Andrea, in my opinion, Hathaway did not have many choices. She had to breach the confidentiality in view of the age of the patient, nature of the diagnosis, complications of negative influence of the patient’s behavior on others, and the urgency for treatment.
Hathaway had to inform the parents about the situation and enlist their cooperation for further urgent treatment for Andrea. Though Andrea’s human papillomavirus (HPV) infection is not a mandatory case that needed reporting, yet in view of the sex-behavior and the dual diagnosis of cervical cancer with HPV infection, it becomes an ethically right thing to inform/report to the parents for further treatment and preventing further harm to others.
The ethical principles that are at play here are: (1) beneficence, which is kind-heartedness and doing good to help others; (2) non-maleficence, which is to avoid effecting harm or hurt to others; (3) justice, which is equality and fairness to others based on the analysis of merits and demerits of a decision; and (4) paternalism, which means that the healthcare professional in good faith makes decisions for the good of the patient.
The major ethical theories that are of relevance to substantiate this standpoint are: (a) deontological theory which places high values on duties and obligations based on the intrinsic qualities of the action, regardless of the consequences. In this case, Hathaway had the ethical right and obligation to breach confidentiality and inform Andrea’s parents; and (b) utilitarian theory which validates action on the basis of its consequences. The goal is to maximize the overall good, intending ‘greatest good to maximum people’. Alternatives to address the Ethical Dilemma
One alternative to deal with the dilemma is to maintain confidentiality in the fullest sense, which in fact would have facilitated to strengthen the trust of the patient to Hathaway. This would result the patient to return home without the needed treatment and also would cause to spread infection to others by her sexual activities, and eventually Andrea’s death would happen due to cervical cancer and other diseases soon. However, such a position would have far-reaching consequences, especially since in this given situation Hathaway had the obligation to breach the confidentiality as per the legal mandate resulting from Tarasoff v.
Regent of University of California and other laws of the land like Health Insurance Portability and Accountability Act, 1996 (HIPAA) etc. Another possible alternative, which is also a breach of confidentiality, is to inform the school of the girls’ behavior. But, in this case, it does not seem to be a good decision as an exposure would likely to create intolerable humiliations for the girls and that could even cause them to commit suicide or any other drastic steps.
Ethics Committee and Collaborative Approach An ethics committee might approach the situation differently since there is a dilemma and uncertainty in making a right decision. As the ethics committee is a group of medical staff, including doctors and nurses, social worker, chaplain, and others to help patient and others, there is scope for considering the matter from multiple angles and perspectives. This gives ample opportunities to reach the best possible conclusion about the final decision.
The ethics committee hold consultation meetings and discuss the issue threadbare and evaluate various alternatives one after the other, considering the best and appropriate ethical framework applicable in the situation, and finally reach at an acceptable solution to the dilemma. Conclusion Confidentiality is a crucial aspect that influences significantly the process of building trust and confidence in the professional relationship between a patient and nurse. It is only when a patient has trust in a nurse, he/she would feel comfort to share all the relevant information. The nurse has a duty and responsibility to maintain the confidentiality.