Introduction
Practitioners in the nursing profession encounter several problems that are linked to law and ethics. One of the problems encountered in the nursing profession is conflict between nursing ethics and law. Conflicts between nursing ethics and law involve issues related to confidentiality, malpractice, consent, and relationships with patients (Beech, 2007). In these areas, professionals encounter obstacles that put them in positions to decide the best decisions to make.
Nurses use several means to handle these conflicts. Some nurses make decisions based on ethics, others make decisions based on requirements of law, while the rest combine ethics and law. For example, professionals who facilitate assisted suicide act based on ethics. They consider what is in best interest of patients. In many cases, law prevails over ethics because ethics bases on personal values and ideals. Conflicts between law and ethics are unavoidable. Therefore, practitioners should find ways to use both approaches to make appropriate decisions.
Confidentiality
Confidentiality is both a legal and ethical issue in the nursing profession. Patients have the right to have their medical information kept confidential by practitioners. Revealing a patient’s information can lead to adverse effects on the patient’s autonomy and welfare in the community (Beech, 2007). The Health Insurance Portability and Accountability Act (HIPAA) contains rules that govern release of patient information. The act contains provisions that determine patient information that can be revealed and information that cannot be revealed. For example, health insurance companies are not supposed to gain access to certain information regarding a patient’s health.
However, nurses are compelled at certain times to defy law and release patient information. When concealment of patient information poses a threat to a second or third party, then nurses can reveal information. Information release aims to safeguard the welfare of people who are likely to be affected if the information is not released (Beech, 2007). In such cases, nurses should evaluate the situation and determine potential dangers to all parties involved in order to make the best decision. It is unethical for a health care practitioner to expose healthy people to risk of infection because of failure to divulge certain information.
Consent
Under nursing ethics, nurses are not supposed to treat patients without their consent. According to the Journal of Surgery, nurses encounter conflicts between law and ethics when treating adolescents. For example, a professional might assume that it is morally right and legally acceptable to inform parents about the health status of their child. However, that is contradicts law. In the state of California, a 12-year-old can legally decline medical care or treatment related to a drug or substance abuse problem (Njozing et al, 2011). On the other hand, a professional treating the child is legally bound to observe confidentiality regarding revelation of information related to the child’s problem.
However, a professional may disclose information under certain circumstances such as possible risks to other people. Conflicts between law and ethics are unavoidable because both play different roles. For example, divulging information about the child’s problem to parents would facilitate development of ways to help the child cope with the problem. However, due to legal restrictions, the child’s situation may deteriorate because parents might never know that the child has a problem.
Right to health care decisions
The Patient Self Determination Act gives patients right to make decisions regarding their health care (Njozing et al, 2011). As such, a patient can decline surgery or medical treatment at will. Self-determination is a legal right that gives patients authority to direct treatment and health care. However, it conflicts with nursing ethics because a patient might decline treatment as a way of committing suicide (Back et al, 2012). On the other hand, a patient might be endangering lives of other people by declining treatment. For example, if a patient declines treatment for a communicable disease he risks infecting other people he/she might meet (Njozing et al, 2011).
Case studies
In past years, nurses have encountered situations that created conflicts between nursing ethics and law. One of the challenges that professionals encounter is physician-assisted suicide. The law illegalizes physician-assisted suicide. However, it may be the will of a patient to get assistance from a physician in order to speed up death. Some patients prefer to die rather than withstand pain and suffering. As such, they seek physician’s assistance to speed up death or initiate death.
In such situations, physicians decide whether to obey the law or the wish of the patient. In 1999, a health professional, Dr. Jack Kevorkian was imprisoned for between 10 and 25 years on accusations of murder (Njozing et al, 2011). Kevorkian had assisted a patient to speed up death upon request. However, because federal law does not allow assisted-suicide, he was imprisoned. In such cases, it is wise for professionals to follow the law because law prevails above nursing or personal ethics.
Nurses are bound to provide quality care to patients despite their race, gender, religion, or socio-economic class. Certain situations are very challenging especially when law and ethics create conflicts. For example, nurses that were responsible for treating the suspected bomber during the Boston marathon encountered patient privacy issues. Nurses are legally bound to keep all information regarding patients’ health care and treatment private. Nurses assigned to Dzhokhar Tsarnaev, the suspected terrorist bomber marathon had tough time concealing information. The media and the FBI demanded for information regarding the health condition of Tsarnaev.
However, because of ethical reasons, they could not divulge any information. Nurses acted professionally even though they encountered many challenges. For example, there was a public uproar regarding the suspect’s treatment and care. Some law enforcement agencies and members of the public argued that the terrorist had no right to receive health care similar to victims of the bomb attack (Back et al, 2012). However, the nurses withstood pressure from the public and provided high quality health care and treatment to the terrorist.
A Californian health care professional is under investigation for allegedly defying patient privacy. Kaiser Permanente is under investigation for hiring a private contractor to organize more than 3000,000 patient files that were under his custody. He requested files from the contractor that were emailed in several instances without encryption to ensure privacy (Back et al, 2012). The files contained patients’ information such as their names, ages, social security numbers, and days of birth. The issue has legal implications for the physician even though he did not intend to expose patient information by hiring a private contractor to organize the files.
Many nurses have been punished in the past for revealing patient information to the public. For example, in 2011, a contract nurse and three health care workers were found guilty of revealing patient information to the social media (Back et al, 2012). After the 2011 shooting incident in Arizona, the nurse assessed information belonging to the shooting victims even though they were not under her care. The healthcare workers and the nurse were fired for violation of patient privacy.
Treatment of HIV/AIDS patients presents serious privacy issues to nurses. Patients have a legal right to privacy. However, nurses are ethically obliged to make right decisions regarding consequences of concealing certain information. For example, ethics and law conflict as to whether a practitioner should reveal results of a HIV or Tuberculosis test of one partner to the other partner (Njozing et al, 2011). A common challenge that nurses encounter is how to disclose information to a patient’s partner without violating the patient’s privacy. The law does not allow disclosure of a patient’s medical information.
However, nurses should find ways to disclose information to partners of patients to ensure their safety (Stone et al, 2008). In such cases, nurses should counsel patients and teach them the importance of disclosing test results to their partners. Disclosure of such information to patient’s partners is necessary in order to avoid infection of spouses in case they have not been infected (Stone et al, 2008). It is ethical to improve the safety of healthy people by disclosing information about their partners’ health if they are at risk of infection.
Conclusion
In the nursing profession, conflicts between ethics and law cause challenges that are difficult to solve. Examples of these conflicts include problems related to confidentiality, patient consent, and relationships with patients. In all these cases, professionals encounter obstacles that put their professionalism to test. For example, the law does not allow physician-assisted suicide. However, it may be the right decision to make in cases where a patient makes a request. On the other hand, confidentiality is an issue in the nursing profession especially in cases that involve release of information related to diseases such as Tuberculosis and HIV/AIDS.
Patients that have partners decline to disclose information to their partners thereby exposing them to risk of infection. In such cases, it is in the best interest of the partner for nurses to find ways to disclose such information. It is the duty of nurses to prevent, control, and cure diseases. Therefore, disclosing information to partners of infected individuals is one way of preventing infection of healthy people by communicable diseases.
References
Back, A., Wallace, A., Helen, M., and Pearlman, A. (2012). Physician-assisted suicide and euthanasia: patient requests and physicians responses. The Journal of the American Medical Association, 275(12), 919-925.
Beech, M. (2007). Confidentiality in Health Care: Conflicting Legal and Ethical Issues. Nursing Standard, 21(21), 42-46.
Njozing, B., Edin, K., and Hurtig, A. (2011). If the patients decide not to tell what can we do? TB/HIV counselors’ dilemma on partner notification for HIV. BMC International Health & Human Rights, 11(6), 225-267.
Stone, M., Redsell S, and Ling, T. (2008) Sharing Patient Data: Competing Demands of Privacy, Trust, and Research in Primary Care. British Journal of General Practice, 55 (519), 783-789.