Nursing Ethics of Patients - Case Study Example

NURSING ETHICS CASE STUDY Introduction: Health related professions entail a very high end contact and involvement level with the patients. This paper would analyze the given study that probes into ethical considerations in a healthcare setting and would attempt to shed light on its aspects of confidentiality and its implications. Along with that, the paper would also discuss how the issue of conflicting ethical situations can be resolved and what are the considerations in this regard that have to be kept in mind. The paper would also elaborate the influence that the cultures have over confidentiality values. And lastly, an ethical decision making model will be discussed keeping in view the given scenario. Importance of Ethical Theory to Nursing: Ethical theories form the bed rock on which the guiding principles of the nursing profession are based. They are responsible for providing a structural approach to moral reasoning in this profession (Med India, 2011). Most often than not, health care professionals are faced with situations that require the employment of such ethical theories for the purpose of moral reasoning so as to conclude the moral value of a judgement under consideration (Registered Nurse Canada, 2009). Example of the employment of such theories include, granting the right to the patients to be able to make their own treatment related decisions. Confidentiality: This term refers to the right of an individual to keep the medical information and records private. The information under its clause can only be trusted to the healthcare professionals dealing with the patient and is not to be made public or even given to someone else without the consent of the patient (Fullbrook, 2007). Even though confidentiality is something that is to be valued and respected, there are situations in which that does not seem like the best thing to do, as is the scenario in the given case. In such cases, it is considered that one establishes a domain of certain reasonable limits. It would somehow restrict the boundary to which the confidentiality principle is to be respected (Wolfe, 1962). However, in cases where the confidentiality aspect endangers the prospective patient it becomes an ethical dilemma for the healthcare professionals that are then torn between upholding the confidentiality and informing others of the condition for treatment (Corey & Callanan, 1998). Even though confidentiality is a vital practice in the medical profession, just like all the other factors, it is not absolute. (Wynia, 2007). There are times when this principle of confidentiality has to be breached. Most often the rationale for such breach of the principle is that there might be some imminent danger posing to the patient who is reluctant to share out information or is unwilling to take the treatment or precaution. In such scenarios, medical intervention becomes essential as giving confidentiality an upper priority in such situations is likely to endanger the life of the patient. This goes in hand with the concept of reasonable limits as well that sets boundaries to the extent to which confidentiality is to be maintained and allows to be breached provided the situation of the patient worsens. Resolving Conflicting Ethical Principles: When faced with ethical dilemma, a person is usually fixed in a situation where two or more ethical principles come into conflict in whatever decision s/he makes (Loyola Marymount University, 2009). In such a scenario, one has to set the priorities of the situation at hand. It should be analyzed that what is at the highest priority or what is the ultimate goal is to be achieved by dealing with the situation. Then different approaches and their implications should be considered and through their analysis one should then decide on what should be done and which principle is to be given a higher value. Ethical Principle in Conflict with Broken Confidentiality: In the scenario where confidentiality is to be breached, the one ethical principle that would be in conflict with the decision would be the rights theory. Though, the confidentiality principle is usually breached in context of the utilitarian theory that advocates working for the end and greater good, the rights theory advocates the preservation of the individual’s rights without any regard to the outcomes of such a scenario (Edwards, 2003). Ethical Theory to support Confidentiality Decision: As mentioned above, confidentiality is usually breached in context of the Utilitarian theory. Utilitarian Theory is a normative moral theory that sets the locus of what is right and what is wrong solely at the end results of choosing one policy over the other policies instead of looking at the means that were used to achieve that end (Andre & Velasquez, n.d.). An action is taken to be ethically right only if it yields the highest utility, compared to any other available alternative solution. Utility is considered to be the absence of pain and pleasure. The action is regarded as it results in the least pain and the greatest amount of pleasure (Cavalier, 2002). Influence of Culture on Confidentiality Values: Cultural background has quite a significant role to play in all the behaviour and perceptual attributes of the people. Cultures that are more closed and members are more interdependent lead to households that do not much prize the factor of confidentiality. On the other hand, cultures that are more individualistic tend to promote the factor of confidentiality and privacy as well. In the given scenario, Mrs. Z is in a fix because she comes from a closed cultured background where family involvement in personal decisions is quite high. She however, is reluctant to share the information regarding her information with the family as she might not be able to exert full right to make treatment decisions that she is already reluctant to take. On the other hand, the doctors are facing a serious ethical dilemma because they are bound to follow in the confidentiality rule but they also feel the need to inform the family to convince the patient to take the requisite treatment. In this scenario the probable nursing intervention can be that to get the patient at least convinced to receive the treatment. Another approach can be to convince her to disclose the situation to the family as that they can help her reach a better decision. Ethical Decision Making Model: The proposed ethical decision making model for the given scenario is Potter Box Model for Ethical decision making. In the light of this model the first step is to define the situation in terms of the ethical dilemma being faced (Patterson & Wilkins, 2010), which for the given case is that the doctors are not sure whether to uphold the confidentiality principle and maintain privacy of the Mrs. Z’s condition or to intervene and inform the family so that requisite treatment can begin. The next step is to identify the values (Christians et al, 2005), which for the healthcare professionals is the safeguard of their patients. Next comes the part of choosing loyalties (Patterson & Wilkins, 2010). In this scenario, though the loyalties of the doctors are with the patient, however the defence of confidentiality is likely to result in major consequences for her. The fourth step is to identify the principles. In this case the most prudent principle that should be considered is that of Utilitarian Theory. This is because at the end of the day, it is the safeguard of the patient’s life that matters the most to the healthcare professionals. The last step is of making the decision (Patterson & Wilkins, 2010). In the given context, as using the model we have come to the decision that utilitarian approach is to be applied, hence the end result of getting Mrs. Z to take treatment is only by informing her family about it as her ailment is quite serious and is not to be taken lightly. However, the best way would be to convince her to tell the family herself so that they realize the seriousness of the situation and motivate her to consider treatment options. References: Andre, C. & Velasquez, M. (n.d). Calculating Consequences: The Utilitarian Approach to Ethics. Santa Clara University. Retrieved on 8 December 2011 from http://www.scu.edu/ethics/publications/iie/v2n1/calculating.html Cavalier, R. (2002). Utilitarian Theories. Online guide to ethics and moral. Retrieved on 5 December 2011 from http://www.phil.cmu.edu/Cavalier/80130/part2/sect9.html Christians, C., Rotzoll, K., Fackler, M., Mckee, K., Woods, R. (2005). Media Ethics. India: Dorling Kindersely Corey, C. & Callannan, P. (1998). Ethical Practice Management. Issues and Ethics in the Helping Professions. Edwards, C. (2003). An Assessment of Rights Theory in a Specific Healthcare Context. Foolbrook, S. (2007). Legal Principles of Confidentiality and other Public Interests. British Journal of Nursing. 16(14), 874-5. Loyola Marymount University. (2009). Resolving an Ethical Dilemma. Retrieved on 8 December 2011 from http://www.lmu.edu/Page27945.aspx Med India. (2011). An Introduction to Biomedical Ethics. Retrieved on 8 December 2011 from http://www.medindia.net/education/familymedicine/biomedical-ethics-theories.htm Newham General Hospital. Retrieved on 8 December 2011 from http://www.pantaneto.co.uk/issue11/edwards.htm Patterson, P. & Wilkins, L. (2010). Media Ethics Issues and Cases. NY: Tata McGraw Hill. Registered Nurse Canada. (2009). Ethical Theories and Moral Reasoning in Nursing Practice. Retrieved on 8 December 2011 from http://www.registered-nurse-canada.com/ethical_theories.html Wolfe, N. (1962). Setting Reasonable Limits on Behaviour. The American Journal of Nursing. 62(3). Wynia, M. (2007). Breaching Confidentiality to Protect the Public: Evolving Standards of Medical Confidentiality for Military Detainees. American Journal of Bioethics. 7(8). 1. Read More