The Ethical Implications of a Breach Of Confidentiality
There are four basic principles that govern confidentiality; autonomy, beneficence, non-maleficence and justice (Beauchamp & Childress, 2001). Patients ought to be allowed to make independent judgments regarding their medical conditions. If a patient has a terminal illness, he should declare whether the condition can be made public for more assistance, such as the establishment of a caregiving dyad. The patient’s best interest must always be considered by the health practitioners (Ridley, 1998). The patient has a right to choose what is acceptable for him.
Furthermore, medical practitioners must be aware of treatments that can harm patients. This helps them to counter the effects of hazardous treatments such as chemotherapy, with benefits of regular treatment such as therapy. Therefore, medical practitioners should never do harmful practices such as euthanasia, commonly known as “mercy killing”. Preservation of human life should always be their first priority (Purtilo, 1999). On the issue of justice, it is advisable for medics to avoid discrimination while dealing with patients. It is beneficial to achieve maximum satisfaction for each patient, and avoid segregation of patients on the basis of color, race, gender or social class. This brings about equity and enhances the relationship between a patient and a medic. Professionals should maintain their clients’ confidentiality at all times (Penslar, 1995). However, sometimes it seems prudent to violate this ethical principle. The following conditions can lead to violation of confidentiality.
- Determination that the client may hurt some people around him
- Difficulties in treating a patient’s condition
- Requirement for personal information by an insurance company
- Investigation of sexual abuse
- Requirement of confidential information by a court of law
Ethical dilemma
The ethical dilemma presented in the article involves moral negotiators versus moral strangers (Beuchamp & Childress, 2001). It shows a situation whereby medical professionals have to take care of people, who are not fully aware of the moral principles that govern them. Consequently, some medical professionals take advantage of such people and often partake in breach of confidentiality. Nurse Hathaway is in a dilemma and does not know whether to inform the 14 year old girl’s parents about her cervical cancer disease. In most cases, children below 18 years are minors whose social needs including medication are parents’ responsibilities. Hathaway had vowed not to tell anyone about the girl’s condition, yet the girl cannot meet all treatment expenses (Nathanson, 2000). This situation would require counseling and this means that the girl’s condition must be known by therapists. Furthermore, upon knowledge by the mother, she might request for investigation by the police to determine whether her daughter underwent sexual molestation. Hathaway, genuinely needs help on this issue of confidentiality.
A Framework for Ethical Decision Making
This framework was developed at the Markkula Center for Applied Ethics at Santa Clara University (Velasquez et al, 2012). It requires a step-by-step analysis of ethical approaches such as the virtue approach, which urges people to uphold virtues such as honesty, truth, fidelity, fairness and prudence. Common good approach came from the views of ancient Greek philosophers, and it urges people to do good at all times, so as to maintain healthy societal relationships. Justice approach treats all people equally (Velasquez, 2012). Rights approach is a favourable ethical model that protects the rights of all people. Utilitarian approach is a principled ethical relationship which supports doing of righteous things, while reducing effects of harm. The step-by-step analysis is as follows;
- Recognition of an ethical issue
The medic assesses the legal situation, effectiveness and impacts of a situation. Hathaway knows that HPV is rarely reported to legal institutions, and she ought to evaluate the impact of breaching confidentiality. - Exploration of facts
The medic learns about relevant facts, identifies the options for making a decision, consults the beneficiaries and learns about the concerns of the subjects. The nurse must ask the girl whether to inform her parents, but if she declines, Hathaway dilemma will increase. - Evaluating alternative actions
The medic identifies the options that will lead to less trauma and more robust, considering all approaches and weighing them to choose the best according to the situation. Hathaway may offer to meet all the girls’ expenses and pretend that it was a slight illness. - Making and testing a decision
After considering the various approaches, the medic chooses the one that will best suit the issue under scrutiny, considers the reaction of other people such as peers, colleagues and the public, if they get to know about the decision. When Hathaway, sits down to think about the issue she will come up to a conclusion. - Action and reflection on outcomes
The medic considers how the decision undergoes implementation without causing harm to any patient. Eventually, the medic evaluates the outcome of the decision and lessons learnt from it. Hathaway will look into the outcome of the decision that she makes to reveal its impact.
Approach of the dilemma using ethical theories, principles and an integrated approach
In order to solve the ethical dilemma presented in the article, an ethics committee can use ethical theories such as utilitarianism, deontology, natural law and the virtue theory (Ridley, (1998). Utilitarianism will ensure that the committee focuses on achieving the best result out of the girl’s condition. Natural law states that everyone has a human nature, and they should live according to it. Thus, the committee should empathize with both Hathaway and the girl. Deontology suggests that human beings have an obligation to do right to fellow human beings. The ethics committee ought to do what is right, like following the due process, to safeguard Hathaway’s career. There are certain rules that guide lives and they should never be broken.
The committee can also use the virtue theory which traces its roots to early political philosophers like Aristotle, Thomas Aquinas and Plato. It urges people to empathize with others at all times. Each of the approaches described above falls short of achieving satisfactory ethical standards in biomedics, on its own. This minimizes the problems that arise from one approach, while maximizing the benefits of all approaches. Ethical principles also come in handy.
In essence, incorporation of ethical theories, principles and approaches from the above framework will enable an ethics committee to improve the relationship between biomedics and patients. Integration of these approaches will be of substantial help to Hathaway.
References
Beuchamp, L. & Childress, J. (2001). Principles of Biomedical ethics. Erlanger Medical Ethic Manual. Section 5, 1-12.
Nathanson, P. (2000). Betraying Trust or Providing Good Care? When is it okay to break confidentiality? The American Journal of Bioethics, 3: 8-15
Penslar, R. (1995). Research Ethics: Cases and Materials. Bloomington: Indiana University Press.
Purtilo, R. (1999). Ethical dimensions in the health professions. Philadelphia: Saunders.
Ridley, A. (1998). Beginning Bioethics. New York: St. Martin’s Press.
Velasquez, M., Moberg, D., Meyer, M., Shanks, T., McLean, M., Depose, D. André, C., & Hanson, K. A Framework for Ethical Decision Making. n.d.Web.