Applying Ethical Frameworks in Practice
In an episode of ER in 2000, a nurse named Carol Hathaway makes promises to two 14 year old girls who enter the ER and are hesitant to allow care for themselves. Nurse Hathaway tells the girls that she will not disclose any information to their parents or anyone else if they will agree to care. One of the girls Andrea is tested positive for Human Papillomavirus (HPV) an extremely common Sexually transmitted disease (STD) although later is diagnosed with cervical cancer. Nurse Hathaway speaks to the ER physician who told her that she needs to report these diagnoses to Andrea’s parents and to her school because the girls were involved in sex parties with other students at the school. This is where Nurse Hathaway struggles with the ethical dilemma.
The purpose of confidentiality between patient and medical staff is to gain trust of the patients and to respect their privacy. Patients need to trust the individuals that are taking care of them so they will not hold back any imperative information that could negatively affect their care. All patients have the right for privacy and keeping as much as possible will only add to the trust that a nurse will receive in return. Any information about a patient should never be passed along to someone else that is not involved in the care of that patient (Purtilo & Doherty, 2011, p. 208). If somebody says something regarding medical care and it is private information is disclosed then this would qualify as a breach of confidentiality. Nurse are advocates for their patients and in this case nurse Hathaway felt that in order for the patient to receive care the parents needed to be involved and she did by informing them first.
Nurse Hathaway had no choice but to break her promise and to tell Andreas’s parents about the diagnosis, I believe that without the parents knowing that 14 year old minor would and could not receive the treatment she needed for a diagnose of cervical cancer. Ethical theories and principles are important in the health care world for resolving ethnical conflicts fairly. Both ethical theories and principle approaches provide you with the framework for diagnosis communication and problem solving ethnical questions you encounter in your clinical practice (Purtilo & Doherty, 2011, p. 67). Beneficence is a particular principle that guides the ethnical theory to do good, Nurse Hathaway was trying to do good for patient and knew that not involving her parents and her being a minor would only cause harm to the patient.
Ethnical theories and principles bring significant characteristics to the decision making process (The American Nurses Association, 2012, p. 4). Uustal’s model could be used in this ethical dilemma because it follows the nursing process and has the framework to aid in ethical decision making. The biggest ethical dilemma I see in this case is if Nurse Hathaway should inform the girl’s school about the diagnosis. In this episode Nurse Hathaway does inform the school of the diagnosis of Andrea, but was that the right thing to do? Using the Uustal’s model to identify another alternative would be significant because, HPV is not a mandatory reportable disease and informing the school does not benefit the patient. Uustal’s model follows steps to help the decision making process for this dilemma first identify the problem which is the question if the nurse should breach confidentiality or not. The next few steps involve understanding the important values and examining the alternatives. If Nurse Hathaway did not tell Andrea’s parents of the findings how would a minor deal with such devastating news alone or seek treatment is she decided to? The model next step is predicting all possible outcomes and to develop a plan, what would happen to Andrea if the nurse did not tell her parents about the cervical cancer? If Andrea did not seek treatment or continued to infect others what would her quality of life look like years from now? Last steps involve implementing a plan and evaluate the actions; Andrea probably would not be able to understand the consequences of not treated cervical cancer and could continue to have unprotected sex. This framework is important to use with ethical decision making because there will be a greater chance of reaching a fair moral outcome by breaking the problem up into small pieces that are easier to work though.
The purpose of ethnics committees in a hospital are to improve health care delivery and patient outcomes through recognition of the needs, interest and rights of patients and all participants in the delivery health care ("The American Nurses Association," 2012, p. 1). Ethnics committees might approach this dilemma by using Uustal’s model or ethnical theories to determine their course of action. The ethical principles would help for this case because it would make the members of the committee take another look at the possible courses of actions and best possible moral decision. Having an ethnic committee is helpful when dealing with tough ethnical conflicts, having a collaborative approach is helpful in health care because not only one person makes decisions about an individual’s care it is a team effort approach.
Nurse Hathaway thought she was doing what was best for her patient and as nurses face tough ethnical decisions that continues to be the most important part. Ethnics committees are put into place, to help so that not one person alone has to deal with the stress of deciding what is a correct decision to make regarding ethnical decisions and the best possible outcome for their patients.