Ethical Dilemma Analysis
The nurse that promised confidentiality now faces an ethical dilemma: if she keeps her promise to the girl, she may not get the proper follow up care and support to treat her illness, and if she breaks her promise, she has violated the ethical principles of fidelity, and autonomy (Nathanson, 2000). This paper will discuss the ethical implications of breaches of confidentiality, and how the ethical theory of teleology helps to determine the best course of action.
Using the 6-step process of ethical decision-making from Purtilo and Doherty as a guide, this paper will also explain the process of how a breach in confidentiality can still elicit the ultimate goal of ethical practice: a caring response. The ethical theory of teleology is focused on the outcomes of decisions. The end result is the deciding factor in all choices in teleologic ethics (Purtilo & Doherty, 2011). The girl in the above scenario would be unfortunate indeed if the nurse kept her promise.
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The decision to not tell the parents clearly places the minor in a position to decide the outcome of her own fate. This is a huge burden to place on an immature mind regardless of the right to autonomy, or the respect for the nurse-patient relationship and its promise of confidentiality. Neither keeping the promise to the girl, nor breaking it, is ideal. The duty of confidence requires the nurse to “disclose information if they believe someone may be at risk of harm” (Edwards, 2010, p. 14).
In this situation the nurse works through the 6-step process of ethical decision-making and uses teleology theory to help her choose the path that will bring about the best outcome for the girl. According to Purtilo and Doherty (2011) the 6-step method provides the nurse with a logical, clear way to decide which course of action to take, and what options are available to her. Gathering relevant information, asking questions, paying attention to the details in step 1 gives the nurse insight as to why the girl might not want her cancer and HPV diagnoses revealed.
Step 2 identifies that this is clearly an ethical dilemma. The girl needs follow up care that only her parents will be able to provide since their consent is needed because she is a minor. Step 3 examines the situation through the use of ethics theory, in this case teleology, and brings the focus back on what is most important, what is best for the girl. Step 4 discusses possible alternatives. Diligent thought about possible alternatives is important in order to choose the best one (Purtilo & Doherty, 2011). In collaborating with other health care workers the nurse has a broader view of what options are possible.
One possible alternative to not telling the parents is to allow the girl to leave, and think about it, give her information to review, and elicit a promise to return to discuss with the nurse any questions or concerns. This would allow the girl to be more autonomous but would not treat her underlying cancer if she does not speak with her parents, or if she fails to return to the ED. A second alternative would be to involve social services to help with counseling, to be a support and a presence in addition to the nurse, while the parents are told.
A third option would be to disregard the promise made and call the parents without any discussion with the girl. This last option would be least desirable since the girl would likely be angry and upset that the nurse went behind her back and broke her promise to her. At this point the dilemma has been thought about and the alternative options examined. Step 5 is acting on the best alternative. The nurse decides to call the parents and speak with the girl that her wishes are heard and respected but in her best interests the promise to not tell must be broken. In teleology ethics, the focus is on the best outcome.
The outcome of good is greater than the bad even though some bad will result from the decision (Purtilo & Doherty, 2011). Step 6 is evaluation and reflection of the chosen decision. The nurse knows that her ultimate goal is what is best for the girl in her treatment of her cancer, considering her age. She acted in the correct manner to elicit the best possible outcome and she did it in a caring way. Ethics committees, with their multi-disciplinary grouping, can also help in ethical dilemmas if time allows for a meeting to be called. Diverse views are shared and presented, and the best possible path is chosen.
Limitations of ethics committees is the time needed to come to a decision since ethical dilemmas often need to be made quickly. “The duty of confidence is not absolute” (Griffith, 2007, p. 531). On occasion, confidence must be broken in order to provide ethical care. Organized thought processes such as the 6-Step method written about by Purtilo and Doherty, and using an appropriate ethical theory to guide help nursing determine the best course of action to take to elicit the ultimate goal of ethical nursing, a caring response. References Edwards, M. (2010). An introduction to confidentiality.