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Applying Ethical Framework in Practice

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Applying Ethical Framework in Practice
Adele Wolf, RN
Grand Canyon University
Ethical Decision Making in Health Care
NRS 437V
Charlene Cowley, MS, RN, CPNP
February 26, 2011

Applying Ethical Framework in Practice Confidentiality is the right of an individual patient to have personal, identifiable medical information kept private; such information should be available only to the physician of record and other health care and insurance personnel as necessary. The only time information should be disclosed is with informed consent, with concern for the safety of other specific persons, or in concern for public welfare (K. Edwards, 2008). This paper will discuss the choices made by one nurse who cared for teenage girls in an episode of ER in 2000. Did she make the correct choices? Is it ever the right thing to do when confidentiality is broken? We will explore this case with the choices that can and should be made in this situation. In this episode of ER, the nurse is Carol Hathaway, she promises two young patients who are reluctant to enter into care that no matter what they tell her, she will not divulge any information to their parents or to anyone else. Test result for Andrea, one of the 14 year olds, is positive for human papillomavirus-(HPV) an extremely common sexually transmitted disease (STD). There are over 85 types of HPV infection and 95% of all cervical cancers are linked to HPV infection, which makes HPV the first sexually transmitted cancer. When found early cervical cancer can be treated with very high survival rates. Andrea is also diagnosed with cervical cancer. The ER nurse struggles with the ethical dilemma and talks to an ER physician who told her that she should report this to Andrea’s parents and to her school because the girls admitted to sex parties with school mates, and the school should be warned of the risk. If confidentiality is breached, patients will not be so eager to disclose information to health care professionals. In order for medicine to be practiced and therapy to be effective patients must be able to trust their health care provider. For example, a patient of Dr. Edgell was a prisoner in a secure hospital following conviction for killing five people and wounding several others. He made application to a mental health tribunal to be transferred to a less secure unit. Dr. Edgell was asked to provide a confidential expert opinion that they hoped would show that the patient was no longer a danger to the public. However Dr. Edgell was of the opinion that in fact this patient (W) was still very dangerous. W’s application was withdrawn. Dr. Edgell, knowing that his opinion would not be included in the patient’s notes, sent a copy to the medical director of the hospital and to the Home Office. The patient brought an action for breach of confidence. The court of Appeal held that the breach was justified in the public interest, on grounds of protection of the public from danger. The Court Judge said the risk must be ‘real, immediate and serious’ (Beauchamp & Childress, 2001). There are ethical and legal implications for a confidentiality breach. After reading this article it was evident that this nurse had choices when she decided what to say to these girls. To gain their confidence she should have told them that nothing done or said in the ER will go anywhere unless the results would cause considerable harm to someone else or endanger the life of an individual. The girls wanted to be tested without parents finding out, but if they couldn’t agree to being tested with the stipulation mentioned above, they should have been able to decide whether or not they would be tested. The very definition of an ethical dilemma is the choice between equally undesirable alternatives, but if this were mentioned to the girls in the beginning they would accept it better than being told after results were in. Using the Uustal steps would have shown the not so obvious choices that could be made in this situation. There was no need for the nurse to report the diagnosis of the girl to the school. As the author mentions, she could have just mentioned that she knew of sex parties with students from that school. But the fact is that this was not causing real, immediate, and serious danger to anyone but Andrea at the moment, and the diagnosis should only have been to protect her at that time. If her parents didn’t know the diagnosis it could mean the end of Andrea’s life, but telling the school as the nurse did caused her to want an end to her life by trying to kill herself. An ethics committee would address this dilemma using ethical theories following the ethical guidelines for medicine and nursing. There is doubt that a committee would have reported the incident and diagnosis to Andrea’s school, but because of her health concern of cervical cancer they would have no choice but to involve her parents because of her age of 14. In this case a committee should have been involved to protect Andrea, emotionally, physically, and psychologically. In conclusion, as mentioned in our lecture “Ethical dilemmas are not solvable, but rather resolvable”. A solution would mean the problem was fixed. A resolution means that a decision has been made to determine a course of action in the situation. The nurse should ask herself before it becomes an ethical dilemma; what ought to be done? Who should be involved in the decision making process? Who has the right to make the final decision? Why? (GCU, 2011). Had this nurse put more thought into what she said to these girls she would have told them upon admission what she would and would not do in respect to the results of Andrea’s test results.

References
Beauchamp, & Childress,(2001). Principles of biomedical ethics.(5th ed.) p. 303. Oxford University: Oxford University Press.
Edwards, K. A. (2008, April 11). Confidentiality. Ethics in Medicine University of Washington School of Medicine. Retrieved from http://depts.washington.edu/bioethx/topics/confiden.html
Grand Canyon University (2011). Ethical decision making. Lecture NRS 437V Module 3.
Nathanson, P. G. (2000). Bioethics on nbc’s er Betraying trust or providing good care? When is it okay to break confidentiality?. Retrieved from www.bioethics.net

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