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Applying Ethical Frameworks in Practice

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Introduction

Confidentiality refers to the right of a patient to have his or her personal and identifiable medical information kept in private. However, such information should be accessible to the physician who keeps the patient’s record and any other relevant health care and insurance personnel when required. Patient confidentiality means that when a patient gives his or her personal or medical information to a health care provider, then, this information should not be disclosed to anyone unless the patient gives his or her informed consent (Petrila, 2000). Nevertheless, it is important to note that patient confidentiality is becoming exceedingly difficult especially in this era where medical records are electronically kept, and third-party insurance payers are involved.

What is involved in Patient Confidentiality?

According to Groves (1994), it is always the duty of all physicians to ensure that their patients are confident to speak about their personal and medical conditions. By extension, it is also the duty of a physician to ensure that he or she does not disclose any medical or personal information revealed to him/her by a patient, or which he/she has discovered in the course of treating the patient. The American Medical Association’s code of medical ethics, for example, states that any information disclosed to a physician by a patient during their interaction should be kept confidential to the utmost level. The main reason as to why such information should be kept confidential is to allow the patient to feel free so that he or she can make a complete and honest disclosure of information, without the fear that the physician will reveal the nature of this information to anyone. On the other hand, a complete disclosure of information enables the physician to diagnose the patient properly and administer the appropriate treatment. In return to the patient’s frankness, the physician is generally required not to reveal such information to anyone, unless given express consent by the patient, or if the law requires that the information be revealed. Nevertheless, there are several exceptions to the rule of patient confidentiality, such as in cases where a patient threatens to harm him/herself or another person (Annas, 1988).

What is a breach of confidentiality?

A breach of confidentiality refers to a situation where a patient’s information is disclosed to a third party without his/her consent or the approval by a court order. This disclosure can be in the form of an oral or written message, or through health information networks, or electronic communication such as the use of e-mail (McCarty, 1967). Even though the medium is somehow irrelevant, there are some special security requirements that may need to be applied to the electronic media. It is important to note that the legal framework for imposing liability for a breach of confidentiality is far-reaching than the ethical guidelines which utter the morally correct action which needs to be done.

Professional implications of a breach of confidentiality

Even though many medical associations encourage physicians to guard their patients’ privacy regardless of the extensive use of electronic health records, unfortunately, patient confidentiality has almost completely eroded, nearly becoming entirely dominated by health maintenance organizations and other forms of third-party payers (Petrila, 2000). It is therefore the responsibility of medical professionals to ensure that their patients’ right to confidentiality is maintained. Patient confidentiality is imperative for the purpose of developing a healthy relationship between the patient and the physician.  Some of the consequences that might arise due to a breach of confidentiality include: loss of reputation of the practitioner, loss of client, loss of revenue, embarrassment and breach of legal/ethical/ moral obligation.

According to this article, nurse Hathaway made a promise to the two girls that she would keep the results of their tests confidential, thus encouraging them to undergo the STI tests. As such, unless serious situations which may threaten to cause some harm to Andrea (the girl who is diagnosed with cervical cancer), or which might cause some harm on the community arise, Hathaway should keep to her promise. One probable breach of confidentiality according to the article might occur if Hathaway informs Andrea’s parents of her infection. This situation would harm Andrea, unless if her parents are already aware of it. On the other hand, Hathaway must follow up on Andrea so as to ensure that she gets appropriate care for her illness. Nevertheless, she cannot do it alone and so she needs the assistance of Andrea’s parents since Andrea is a minor. In addition, the health care system requires that Andrea’s parents give their consent before she starts receiving the treatment for cervical cancer. Therefore Hathaway has both the right and compulsion to breach her patient’s confidentiality so as to protect her from additional harm. Another probable breach of confidentiality might occur if Hathaway decides to inform the school about Andrea’s behavior.

The dilemma that is facing nurse Hathaway might be approached by an ethics committee using a collaborative approach to ethical decision making. First and foremost, it is important that Andrea receives adequate counseling and support so that can decide to disclose her situation to her parents about her condition on her own without any external conviction. Hathaway should only do it if Andrea completely refuses to be persuaded to do so. On the other hand, there is no need for Hathaway to reveal this information to the school because it might even cause more harm to Andrea. She might even decide to commit suicide if she finds out that the whole school is aware of her situation. Alternatively, Hathaway may inform the school that she believes there are ‘sex parties’ going on without explaining how she came to know about it.

Conclusion

This article enables us to survey many reasons why policies relating to confidentiality are significant in health care. It also enables us to explore situations under which confidentiality may or may not be breached especially when dealing with young adults. Nevertheless, it is worth to note that even with very delicate situations where confidentiality is imperative, physicians must look at the possible health and life risks before revealing or withholding confidential information.

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