The principle of patient confidentiality allows patients to confide information in health care professionals that they may not otherwise reveal. This implicit trust provides a bond between the patient and the professional. However, health care professionals may need to breach this bond in rare cases. There are legal implications associated with broken confidentiality; however, a health care professional must also recognize the significant ethical ramifications.
The ethical implications of breaching privacy include violating a patient’s autonomy. Adult, competent patients deserve the right to determine how and when they want their information revealed. Autonomy refers to the right of a person to exercise self-determination and self-choice. The principle of autonomy remains one of the most sacred beliefs in health care today. Also, once a health care professional violates a patient’s trust, the patient’s health may suffer long term. The patient likely will not trust future health care professionals. Therefore, the health care professional needs to determine that this violation to protect the patient or the public warrants the future risk of harm. If the current risk to the patient or the public outweighs the potential for future risk, a health care professional may breach confidentiality. However, the professional should only disclose the least amount of information needed to protect the patient or the public (Kjervik&Brous, 2010, pp. 28-31).
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In the case of Nurse Hathaway, for true autonomy to exist, the patient neededto understandfully the implications of a cancer diagnosis as a minor. For Nurse Hathaway’s patient, this likely would require counseling for the patient to understand her condition. The patient deserved the right to this counseling before any breach of her confidence. Health care professionals have an obligation to offer the patient all necessary information for the patient to make an informed decision. If after this, the patient still chose not to inform her parents, I would have broken her confidence. I believe the parents needed to know their daughter had a cancer diagnosis. The parents needed to assure the provision of cancer treatment, as well as the necessary societal and emotion support for the patient. Without this, the patient may have died. However, Nurse Hathaway committed a serious ethical breach when she informed the school. This harmed her patient. The patient lacked a disease which could be traced by partners. While there is an ethical issue concerning the reporting of communicable diseases, this disease cannot justify the harm the reporting creates. A health care professional must consider the harm principle. Nurse Hathaway would exercise power and yet not likely prevent harm. However, she did create harm. If the disease could be traced, the situation would be different (Gostin, 2010).
There are ethical theories to support the breach of confidence in these cases. According to the principle of utilitarianism, consequences matter. This theory believes that we should take the action that creates the greatest amount of happiness for everyone. In this case, significant unhappiness to conceivably large groups of people would result from the cancer death of the patient. This outweighs the unhappiness of the patient over the breach in trust. Therefore, utilitarianism would support this breach. Virtue ethics may or may not be used to defend this. While the virtue of trust is broken, the virtues of caring and compassion are upheld. Also, Nurse Hathaway needs courage to breach this confidence. Ideal observer theory does not address this problem adequately. In order to be an ideal observer, a person must remain neutral. Only the health care professionals would be aware of the dilemma; I do not believe a health care professional could properly remain neutral in this situation. A cancer diagnosis in a young girl would likely create tremendous emotions for a person (Kjervik&Brous, 2010, pp. 25-29).
Nurse Hathaway did not need to breach the trust as far as she did. Nurse Hathaway could have conceivably informed the parents of the cancer diagnosis without any mention of the STD or why the patient came to the Emergency Department. In doing so, Nurse Hathaway would preserve some of the confidentiality. It is likely the parents would discover the cause of the cancer; however, it would not consist of a complete breach. This approach would allow the patient additional time to open up to her parents concerning her sexual history. The patient also could choose to not tell her parents. If her parents researched the disease of cervical cancer, they may realize their daughter is sexually active. However, Nurse Hathaway would not need to tell them about the sex parties. While the patient may be unhappy that any trust was broken, she likely would be unhappier if the complete trust was broken. According to utilitarianism, the goal is to create the least amount of unhappiness. Nurse Hathaway also could have informed the school that there were sex parties without any detailed information. She could have informed the school nurse that she was aware of this information from a patient. Another nurse would understand the confidentiality of this information. Nurse Hathaway also could have discussed sexual education issues with the school; this issue clearly indicated a lack of education for the students. This approach would not create any additional unhappiness for the patient. If increased sexual education prevented future STDs, it would create happiness. This happiness may not be known to the individual, but it would exist in theory.
Ethics committees consist of individuals from a variety of backgrounds. This includes medicine, spiritual, philosophy, committee leaders, legal, financial and management. This diversity allows a collaborative approach guaranteed to consider a wide swath of ethical implications. Nurse Hathaway could have asked for an ethics committee. They would have considered the ethical concepts of autonomy, justice, beneficence, and common good. They also would have discussed the legal implications of a confidentiality breach. Individuals on the ethics committee would consider how this breach violates various ethical frameworks and also, how it could be justified by ethical frameworks. Based upon the discussion, they would make a recommendation (Pearlman, 2013).
Ethical decisions in the medical field are seldom easy; this is the reason for an ethical committee. My recommendation and choice would be to consult the ethical committee. The patient clearly needed cancer treatment. However, telling the school created a significant breach that I could not justify.
