Patient Confidentiality

Technological advances in healthcare have altered the recording and retrieval of medical information. Databases nowadays are computerized, health care practitioners are using internet to store and deliver information about their work and clients. Health care workers are thus entrusted with protecting the privacy and confidentiality of their patients to ensure that the health worker-patient relationship is not compromised and quality of care is maintained.

In NBC’s ER, Nurse Hathaway promises the two 14 year old patients that no matter what they tell her, she would not disclose that information to any one including their parents. However, one patient, Andrea, has Human Papillomavirus, HPV, which in most cases leads to cervical cancer. The nurse gets confused on whether to breach the promise of confidentiality for the girl to get medical care and support from her parents.

Health care providers have an obligation and duty to respect a patient’s right to confidentiality. Confidentiality should be maintained in health records and other individually identifiable health information, such as, mental health therapy notes, clinical research records, and genetic information. The only information to be disclosed is that which is relevant to a patient’s treatment and welfare. Patients fear that wrongful release of personal health information may lead to job discrimination, stigma, loss or denial of health insurance, or embarrassment (Ulrich et al., 2010).

Scott, (2006) asserts that instances of breach of patient confidentiality destroys the level of trust and respect accorded to health care professionals. Health care workers often face an ethical dilemma on what is right or wrong in regard to patient confidentiality. Upon breach of a patient’s confidentiality, a health care provider is subject to disciplinary action by their employer. An action for damages may be taken against the health care provider and his or her employer, or the health care provider may undergo a disciplinary proceeding in accordance with the health professionals’ regulatory statute. Moreover, breach of confidentiality may attract a fine, for instance, the Health Insurance Portability and Accountability Act imposes administrative penalties and monetary fines of up to $250,000 per violation in addition to a possible ten year imprisonment (Scott, 2006).

Beauchamp and Childress, (2001) note that ethical principles in health care determine the decisions and actions to be taken by practitioners. These ethical principles are; respect for autonomy, non-maleficence, justice, and beneficence. Respect for autonomy requires nurses to respect the decision made by patients who are competent and informed. This is because individuals have control over their personal lives and information without undue interference from third parties.

The principle of beneficence balances the benefits of treatment against the costs and risks involved. Failure to disclose the state of Andrea’s health to her parents could result in advancement of cancer thus endangering her life, in which case the nurse might be held accountable. Justice is the moral obligation to accord benefits, risks and costs fairly without harming the patient while non-maleficence bars heath care givers from actions that may harm or injure the confidentiality of a patient (Beauchamp & Childress, 2001).

Disclosure of confidential information should be done upon patient’s consent, unless there is potential harm to the patient or another person, or there is a legal obligation to disclose such information. The seriousness of injury to another person or to the patient far outweigh the mere harm of breaching confidentiality (McGowan, 2012). Thus, to prevent the cancer from progressing to terminal stages, the obligation of confidentiality has to give way. This means that Callaway has a right to inform Andrea’s parents about her condition and school, though such action would override the principle of non-maleficence as it would lead to embarrassment, hostility, or discrimination from her schoolmates, hence the suicidal threats. However, the principles of justice and beneficence are to Andrea’s benefit because she would get proper medical attention at the right time. 

The school administration would learn that their students are engaging in inappropriate behavior such as “sex parties” and help in counselling them and avoid spread of HPV in the future, though Callaway should not disclose how she found that out. In addition, once the girl leaves the ER, the nurse has no way of knowing whether she would seek medical attention, hence informing her parents would ensure proper care to her. As a minor, the responsibility of medical follow-up lies with her parents and not herself and as a result it would be difficult for the girl to get medical attention for cancer without the consent of her parents (McGowan, 2012).

Health care providers, under beneficence, are obligated to protect and act in the best interest of their patients. The challenge to an ethics committee occurs when there is a conflict between ethical principles and rules conflict. Under the code of conduct, Callaway had no right to disclose information to Andrea’s parents or school administration though it helps Andrea get medical attention. An ethics committee would expect Callaway to first determine why Andrea does not want the information diverged. Then she should assess the girl’s understanding of the dangers of cancer and the consequences if she does not seek proper care under the guidance of a specialist and her parents. Minors under the age of 16 are considered legally competent if they are mature and knowledgeable enough to understand what is being proposed about their health (Ulrich et al., 2010). 

Decision making in health care should be efficient and ethical. Health care workers should be held accountable and responsible for their actions and need to improve and maintain the standards of care. Nursing morals and values are crucial in decision making and thus nurses should weigh the advantages and disadvantages of the decisions and counsel the patients on necessity of breach of confidentiality.  



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