When is it OK to Break Confidentiality? Confidentiality is central to trust between doctors, medical team and patients. Patients have a right to expect that information about them will be held in confidence. The birth of the Hippocratic Oath in the fourth century started the responsibility of physicians to preserve the privacy and confidentiality of their patients. One of the provisions of the Oath lays the ethical foundation for the physician’s duty of confidentiality even beyond the circumstances of medical care.
The Florence Nightingale Pledge, which was composed in 1893, was a modification of the “Hippocratic Oath,” a statement of the ethics and principles of the nursing profession. Included in the pledge is to hold in confidence all personal matters. Today we have the Health Insurance Portability and Accountability Act (HIPAA), which was passed by Congress in 1996. One of the regulations requires protection and confidential handling of protected health information.
We also have the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) who takes an active role against potential violations in patient confidentiality (Oram M. , 2008). This paper will consider the ethical implication of a breach of confidentiality with ethical principles. An alternative will be to address the dilemma in a clinical setting. Lastly, the author will address how an ethics committee might approach the dilemma using ethical principles, theories, and a team effort to ethical decision-making.
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Respecting and protecting our patients medical, personal and private information is a great responsibility. At times it can be very challenging and there are times in healthcare where specific issues are encountered and personal and private information must be shared. It is the position of this author that preserving confidentiality is of the up most importance. Confidentiality is defined as preserving the privacy of the persons that you are caring for. This would include all information verbal or from the patients medical records to be used by the medical team to care for the patient (Oram M. 2008). It is important to retain trust in the nurse patient relationship and maintain confidentiality unless disclosure can be justified. The personal Nightingale Pledge taken upon graduation supports this author’s belief. The Nursing Code of Ethics also guides this author, which states the importance of nurses upholding their duty to maintain patient information in confidence regardless of who they are (American Nurses Association, 2013). This author also adheres to the HIPAA laws and JCAHO.
Confidentiality is at the heart of the code of ethics for healthcare. Dealing with confidentiality can be very confusing at times, like in the example of the NBC ER episode 2000, called “Betraying Trust or Providing Good Care. ” The healthcare professional at any given time may have to ask themselves to breach confidentiality or not to breach? Another question that the healthcare professional may ask is do I provide good care or betray my patient and their trust? The good new is there are ethical codes to guide and help the health care professional.
In the ER episode the nurse Hathaway was faced with an ethical dilemma of breaking confidentiality or keep her fidelity. Hathaway had promised to help a 14-year-old patient, Andrea, and swore confidentiality in order to gain the girl’s trust. Sadly, Andrea was diagnosed with Human papillomavirus (HPV), a sexually transmitted disease which led to cervical cancer. Andrea was also involved in risky sexual behavior with classmates. However, if Hathaway contacts the parents or speaks to the school officials this decision would come at a cost of betraying her patient—a breach of confidentiality.
To keep the promise to Andrea was concerning because Andrea would need the consent from her parents for medical treatment for the cervical cancer because she was under age. Hathaway’s concern is that Andrea gets the medical care she needs. There also was the concern for Andrea’s classmates who should be screened for HPV or other sexual transmitted disease. As already stated, it is vital that healthcare workers keep their patents confidentiality, although there are those times when the healthcare team will come to the conclusion that they need to breach their patients confidentiality.
According to the American Medical Association (AMA, 2013) and the ethical principles of fidelity, veracity and autonomy nurses or physicians should let the patient know about the restrictions of confidentiality protection and after disclosure have them sign a release record form to authorize the disclosure of the information given (AMA, 2013)). There are circumstances when keeping your patients confidentiality might cause more harm then revealing the information (Edwards, 2008). Such is the case in the ER episode where it was explained to Andrea why her parents and authorities had to know what was going on.
There would be more harm done to patient and classmates if her secret was kept. Hathaway has the obligation to tell Andrea’s parents of her health condition and break confidentiality. Hathaway should first encourage Andrea to tell her parents herself and if she is unable or refuses then Hathaway needs to step in and tell the parents. The author believes that breaching confidentiality and telling Andrea’s parents was the right thing to do. It could be said that Hathaway did breach confidentiality when giving the information about Andrea and the “sex parties” to the school authorities.
The information could have been shared with no names mentioned. There was no benefit to Andrea but harm because after she found out that the school knew she tried to commit suicide. When the medical team or individual is faced with an ethical dilemma there is an ethical committee that can be consulted. The committee is a group of people who will collaborate and are specially qualified and trained in laws and theories. The members will have diversified outlook about the dilemma based on ethical principles, beliefs and values. Utilizing the ethical committee will help guide the medical team to the right action.
However, the ethical committee is not always authoritative but should be used as a guide. Hathaway should have notified the ethics committee before notifying the school. Most likely Hathaway would not know the legalities about which diseases are reportable. Had Hathaway checked and learned that HPV need not be reported, it would have saved Andrea a lot of pain and emotional trauma. It is the author’s belief that no names should have been mentioned when talking to the school. Confidentiality is at the heart of the code of ethics for healthcare.
Dealing with confidentiality can be very confusing at times. Reviewing the episode of ER helps to examine the ethical dilemma with breach of confidentiality. It is important as a nurse to have knowledge about ethical principles and theories so as to know if you are breaching confidentiality or not. A nurse also must be aware of who she can go to talk to about ethical dilemmas. While this will be an ongoing challenge during a nurse’s career, it is important that she is aware of both the importance of confidentiality and to whom she can rely on in a ethically difficult situation.
References American Medical Association. Confidentiality. Retrieved from http://www. ama-assn. org/ama/pub/physician-resources/legal-topics/patient-physicians-relationship-topics/patient-confidentiality. page Edwards, K. A. (2008). Confidentiality. Ethical in Medicine: University of Washington School of Medicine. Retrieved from http://depts. washington. edu/bioethx/topics/confiden. html Oram M. 2008. Maintaining Confidentiality Course 117. Retrieved from www. jcaho. org/confidentiallyHerb
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