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Ethical Frameworks in Practice 1 Running Head: ETHICAL FRAMEWORKS IN PRACTICE Ethical Frameworks in Practice Catherine Gilmartin Grand Canyon University: NRS 437V October 14, 2011 Ethical Frameworks in Practice 2 Introduction The article by Pamela Nathanson, Bioethics on NBC’s ER: Betraying Trust or Providing Good Care? When is it OK to Break Confidentiality, presents a dilemma that some nurses may experience in their careers.

In the episode, Carol Hathaway assures two young patients who are reluctant to enter into care that no matter what they tell her, she will not divulge any information to the patient’s parents or to anyone else. Unfortunately, when it turns out that one patient has a severe medical problem, Hathaway faces the dilemma of breaking her promise of confidentiality in order to ensure proper medical care and support for her young patient. This dilemma raises issues about the nature of confidentiality in health care, and the possible reasons why confidentiality may be broken. 2000). I have never experienced the dilemma of breaking confidentiality before but in the case mentioned above I believe the right thing to do would be to tell the parents and get the patient the care needed to ensure good health. Ethical Implications of Confidentiality According to The American Heritage Stedman’s Dictionary confidentiality is defined as the ethical principle or legal right that a physician or other health professional will hold secret all information relating to a patient, unless the patient gives consent permitting disclosure. (n. d. ).

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There are many reasons why it is important to maintain confidentiality. If a patient is not assured that their information is treated confidentially they may not be forthcoming, honest and open with their healthcare providers which could delay care or put off receiving care. “Breaches of confidentiality are disrespectful of individual privacy and autonomy rights. Fidelity of the physician patient relationship requires respect for confidentiality. When patients enter into a relationship with a medical professional, an implied promise of confidentiality is made.

The Ethical Frameworks in Practice 3 patient’s expectations of privacy and earn patient’s trust,” (Nathonson, 2000). The federal Health Insurance Portability and Accountability Act (HIPAA) clearly states that a breach of this sacred trust by any member of the health care community is subject to serious repercussions, including civil and criminal penalties. There are instances, though, when sharing information is appropriate and in the best interest of patient care.

In the United States there are laws that state a physician has an obligation to report certain infectious diseases to public health authorities, in order to protect the health of the community. (Nathonson, 2000). Ethical Theories In the article presented the patient is a fourteen year old girl, Andrea, who has had a promiscuous past and shows up in the emergency room to be tested for a sexually transmitted disease (STD). It comes out that her and her friends have been having sex parties with multiple partners. She is promised that her history will not be mentioned to her parents.

The STD test shows she has HPV and the results of the ensuing Pap smear results show she has cervical cancer. What is Nurse Hathaway to do? According to the Code of Ethics for Nurses, the rights, well being and safety of the individual patient should be the primary factors in arriving at any professional judgment concerning the disposition of confidential information received from or about the patient. ”Duties of confidentiality, however are not absolute and may need to be modified in order to protect the patient, other innocent parties and in circumstances of mandatory disclosure for public health reasons,” (Burkhardt and Nathaniel, 2008, p. 00. ). My position on confidentiality would allow for a breach in confidentiality based on the fact that Andrea is a minor who is facing a diagnosis of cancer and needs to receive treatment in order to return to good health. Ethical Frameworks in Practice 4 Framework of Ethical Decision Makin I believe that confidentiality in this case should be broken under the ethical framework of the Utilitarianism perspective which would allow a breach in confidentiality. First of all, Andrea is a minor and cannot sign consent for treatment of cervical cancer.

That alone is reason for her parents to be told, and secondly, since she has had multiple partners they should be informed as well as the school so they can educate the students on the risks of promiscuous sexual behavior and how to protect themselves. An alternative framework utilizing the deontology views would require that confidentiality be maintained no matter what the consequences and that is not a view that I believe is justified in this circumstance since Andrea can not sign consent for cancer treatment herself, she would not be getting the treatment she needs in a timely manner.

Her sexual partners would not learn that she has an STD and they would not get treatment and the school would have no idea what their students were doing sexually and would not have the opportunity to specifically educate them on preventative measures and the dangers of unsafe sex. A law thought to be ethical by a utilitarian might be considered unethical by a deontologist. (Burkhardt and Nathaniel, 2008). Ethics Committee In the coming together of differing experiences, educational backgrounds and unique perspectives, the committee as a whole can produce a well-balanced discussion of alternatives.

In addition, these committees can provide recommendations intended to advocate for patient’s rights and promote shared decision making, even in the face of the most challenging of ethical dilemmas. While the alternatives and recommendations offered by an ethics committee do not Ethical Frameworks in Practice 5 have the weight of law, they make a significant influence on decision making at the bed side and have the power to influence a judge or jury during any deliberation involving patient rights. Grand Canyon University, 2011). I feel that the ethics committee would approach the dilemma by reviewing the facts of the case. Andrea presented to the ER because she thought that she might have an STD. After being tested it is discovered that she has HPV and an ensuing Pap smear reveals hat she has cervical cancer. After being assured that what she has told the healthcare providers would be taken in strictest confidence, she is now being informed that she should tell her parents.

Andrea is a minor who can’t sign consent for cancer treatment and in the eyes of the law; her parents are the only ones who can consent for possible life saving treatment. In addition, due to sexual promiscuity, her multiple partners could be at risk for an STD. Using the ethical theory that confidentiality can be breached to protect the patient or the community and the Utilatarianistic framework which implies that a breach in confidentiality is for the good of many, the ethics committee would have to find in favor of telling the parents.

Conclusion Ethical dilemmas occur when there are conflicting moral claims. Nurse Hathaway’s best intentions turned into a huge ethical dilemma for her. Assuring confidentiality to a patient in order for that patient to feel comfortable enough to open up about a problem and get help seems to be the right thing. Telling the parents of a minor patient that the child has cervical cancer and needs to be treated also seems to be the right thing. What is the right thing? Every ethical dilemma is unique and should be looked at as such.

All the facts need to be looked at and Ethical Frameworks in Practice 6 different alternatives need to be addressed before a decision can be made. Ethics committees, with their diverse backgrounds and perspectives are in a unique position to sift through all the information and come to an acceptable, ethical conclusion. References Burkhardt, Margaret A. & Nathaniel, Alvita K. (2008) Ethics & issues in contemporary nursing (3 ed. ). Clifton Park, N. Y. : Delmar Cengage Learning. Confidentiality. (n. d. ).

The American heritage stedman’s medical dictionary. Houghton Mifflin Company. Retrieved October 14, 2011 from http://www. dictionary. reference. com. Grand Canyon University. (2011). Ethical decision making. (PDF document). Retrieved October 12, 2011 from Lecture notes online website. http://angel03. gcu/section/default. Nathanson, Pamela G. (2000). Betraying trust or providing good care? When is it okay to break confidentiality? Retrieved October 14, 2011 from http://angel03. gcu. edu/section/default. asp.

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