Health Care Professionals' Ethical Dilemmas - Protection of Confidentiality of the Patient, Honest Communicating, Ethically Valid Informed-Consent - Case Study Example

Ethical Dilemma: Case Analysis Institution Name Introduction Ethics is a branch of philosophy that depicts a systematic approach to understanding, analysis and identification of what is right or wrong. Nurses constantly experience ethical issues due to the changing scenarios in healthcare (Rich and Butts, 2010). This paper presents an analysis of a case study that present complex nursing scenario that reflects how health care professionals must consciously cultivate ethical habits and use theoretical knowledge when navigating through underlying ethical dilemmas. The ethical issues raised in the scenario are discussed and what the patient and the nurses should do is also discussed. The paper also discussed those that need to be advised and pertinent issues relevant for their actions, which may be in breach of professional standards. What ethical issues does this scenario raise? Several ethical issues can be deduced from the case study. Essentially, nurses have four key obligations when it comes to ethics. By addressing their ethical obligations, the nurses are able to fulfil the contract between nursing and the public. The four key ethical areas include respecting the privacy of the patient and protection of her rights, honest communication on all aspects of the patient’s treatment, diagnosis and prognosis, undertaking ethically valid process based on informed consent and advocating for the interests of the patient. Protection of confidentiality and privacy of the patient Maintaining the Ellen’s privacy is a critical ethical obligation that both Kylie and Claude should observe. Respecting the patient’s privacy implies refraining from invading her privacy. By commenting on the patient to a friend, despite not acting out of malevolence, would amount to failing to show the virtue of integrity and respect. The patient has the right to expect that the healthcare professionals treat her prognosis, diagnosis and personal history in confidence. In the case, Ellen’s privacy and confidentiality rights are violated. It is possible that Claude must have discussed her diagnosis with a friend called James. This assumption is made based on the scenario where Kylie saw James’s Facebook status update that alludes to Ellen’s pregnancy. Communicating with honesty The ethical principle of communicating with honesty can also be inferred from the case. Indeed, analysis of the case shows various aspects of honesty, including veracity. Veracity refers to the ethical principle that requires the nurse to tell the truth. According to Lachman (2008), in some circumstances, the truth may be painful for the patient and his family. Despite this, honesty should be a core virtue, except for specific circumstances. Communicating with honesty may often present dilemmatic situations as reflected in the present case scenario. For instance, Ellen has asked Kylie to keep her likely pregnancy a secret. Kylie’s decision to honour Ellen’s request would amount to respecting her privacy and confidentiality. At the same time, she has to be honest to Ellen’s mother, since Ellen is a minor. Such a situation reflects a dilemmatic situation (Lewis et al., 2012). Ethically valid informed-consent Nurses should adhere to the principle of informed consent. They have the obligation to ensure the ability of the patient to make informed care on her health. In which case, the patient’s cognitive abilities may oscillate due to surgery, medication, disease or unfamiliar surroundings. According to Lachman (2008), scenario is specifically relevant when the patient is a minor or has incapacitated reasoning capacity due to the underlying affective conditions. These issues are reflected in the case. Ellen and her mother have to be informed on the course of the treatment. Additionally, they have the right to determine what course of treatment should be taken. They should also be provided with complete, accurate and comprehensible information in a way that promotes informed judgment. Advocating for the patient’s best interest A nurse has an ethical obligation to position herself as the patient’s advocate. This implies choosing to act with courage, involving supporting the professional obligation or generally doing what is right for the patient. According to Rich and Butts (2010), advocacy is usually hindered by institutional bureaucracy. Therefore, the nurses are at liberty to engage in advocacy roles, otherwise, the patient’s autonomy and self-determination may be lost in the quagmire of nurse timidity or rules and regulations. This situation is reflected in the case, where Claude and the supervisor agree to let a female nurse to attend to Ellen, in order to respect the interest of the patient. This happened during the standard admission process when Claude asks Ellen questions on menstruation and the possibility of pregnancy. Ellen’s mother disproves of this. Later, Claude and his supervisor agree to delegate Kylie to take over Ellen’s care. Advocating for the patient’s best interest also relates to autonomy, which refers to respecting the patient and her family’s right to self-determine or a course of action, as well as supporting their independent decision-making is a critical ethical issue (Husted & Husted, 2008). This is since ethically, the nurse's primary commitment is to the patient, whether it is the family. In the case, Ellen’s mother is determined to have a female nurse attend to her daughter, as she is uncomfortable with a male nurse. This reflects a case of respecting the patient and her family’s autonomy. In the case, Ellen’s mother is viewed to be a competent person capable of making decisions for her daughter who is aged 15 years, hence a minor. What Ellen, RN Kylie and RN Claude should do RN Kylie’s proposed actions Kylie faces dilemma, including the conflict of interests by maintaining her loyalty to her friend Claude or primacy of Ellen's interests. Kylie should however act on unquestionable practice, based on the theory of deontology. This would imply reporting the matter -- after Claude publicised Ellen’s clinical information through his Facebook update -- to appropriate supervisory authority at Tinytown Hospital. In nursing, her primary commitment is to the wellbeing, health and safety of the patient in all settings, where Ellen's healthcare needs are addressed. Therefore, as an advocate for the patient, Kylie must take appropriate action on any instances of unethical practice by the healthcare team that place the patient's health and wellbeing in jeopardy. This is since it can be assumed that when Ellen and her mother discover James's Facebook update, it could put their emotional health in jeopardy. She should therefore report Claude to the appropriate authority within Tinytown Hospital. Critically, based on the theory of deontology, the morality of Kylie’s actions should be based on the action’s compliance with the rules. According to the theory, the intentions behind the actions of decisions are what determine whether the actions or decisions are ethical. In this regard, deontology does not primarily view the consequences of an action. Rather, it examines a situation for its essential moral worth. Rich and Butts (2010) show that, in nursing, deontology is based on the duties, rights and respect to the patient. It also puts significance on the intentions of the nurses, rather than the outcome of the action by focusing on the obligations, rules and duties. In the case, Kylie has obligation to respect the privacy and confidentiality rights of the patient. Additionally, she has an obligation to advocate for Ellen’s interests. Kylie is duty bound to adhere to these fundamental requirements. Consistent with this argument, Lachman (2008) opined that deontology requires complete adherence to these obligation and therefore acting in line with the prescribed duties is perceived as acting ethically. Noureddine (2001) commented that the major problem of applying deontological approach unfailingly is that it can contribute to conflict of interest between the nurses. Indeed, this may happen since Kylie and Claude are friends, and Kylie is faced with the dilemma of remaining loyal to her friend, which would however be interpreted as being unethical based on deontological approach. RN Claude’s proposed actions Claude should promote, advocate for and safeguard Ellen's rights of privacy and confidentiality. This will enable him to overcome the feelings or moral suffering, leading to unethical practices, including violating the patient’s rights to privacy and confidentiality. For instance, his Facebook status update shows a breach of Ellen's right to privacy and confidentiality. It is possible that Ellen's emotional wellbeing could be jeopardised and the trust between her and the nurses in the hospital destroyed. Hence, Claude should consider Ellen's well-being, rights and safety as the primary factors in reaching a professional judgment relating to the disposition of information he received from the patient. Indeed, the standard of nursing practice, as well as, the nursing obligation requires that relevant data be shared only with members of the health care system who have the need to know. Claude should therefore maintain and implement standards of professional nursing practice (Avasthu et al., 2013). Indeed, it is evident that Claude experiences a disquieting feeling of distress called moral suffering. Moral suffering occurs when the nurses seek to sort out their emotions in situations where they find themselves morally deficient or in situations where forces that are beyond their control deter them from changing the situation. According to Rich and Butts (2010), suffering may happen since nurses since the nurses may believe that they need to assuage their suffering. Claude's moral suffering may have been caused by his belief that he should disagree with the way Ellen's mother made patient care decision after demanding that a female nurse should attend to her daughter. Rich and Butts (2010) point out that the need for care or moral suffering does not rationalise unwarranted intrusion into the patient's life. In this regards, Claude has the duty to maintain confidentiality of Ellen's diagnosis information. Ellen’s proposed actions Ellen should let Kylie intervene in informing her mother of her pregnancy. In the case, Ellen’s request that information on her likely pregnancy be kept a secret keeps Kylie in dilemma. Consequently, Kylie is torn between keeping practicing the principle of fidelity and paternalism. Either way, she will have to select between the two. The principle of fidelity means that Kylie has to be loyal to the patient, based on the virtue of caring. On the other hand, paternalism means that the decisions Kylie makes must be the best decision regarding the diagnosis of her patient. The decisions should also be in the best interest of her patient. Ellen’s decision should however be based on utilitarianism or consequentialism ethics, which proposes that the right moral response relates to the outcome based on the need to maximise the ‘greatest food for the greatest number,” By letting her mother know of her pregnancy, the greatest good would be accrued by Ellen herself and her family. It should also be argued that it is in the best interest of the patient when the information is revealed to her parent. This calls for the virtue of veracity, where the honest truth is delivered in a compassionate manner. However, for Ellen to make that decision, Kylie needs to provide her with the right information on the situation and why it is in her best interest to inform her mother (Klung, 2001). Kylie should assist Ellen to get the physical context right, find out what the mother already knows and determine how much the mother wants to know. She can afterwards communicate the information in a straightforward yet sensitive manner. Who needs to be advised Ellen needs to be advised Based on the principle of beneficence, Ellen should be advised to let Kylie inform her mother about her pregnancy. In nursing, beneficence requires that nurses make decisions or take actions that benefit the patients and promote their overall wellbeing (Jansen, 2013). The conscious overruling of Ellen's autonomy in this case would amount to paternalism. In taking a paternalistic action, Kylie should advise Ellen that informing her mother about her health condition is judicious. In doing this, Kylie will demonstrate that she is aware that Ellen wants to wait a little longer to inform her mother but must insist otherwise. Kylie should also discuss with Ellen to help her understand that it is truly in her interest and safety that her mother knows. This should be based on feminist theory, which requires that the context of the situation is examined to reach a moral conclusion and how it would affect the patient and the family. Rich and Butts (2010) argue that justified paternalism relates to patient's safety. Claude needs to be advised On the other hand, Claude should be advised based on virtue ethics theory. The idea behind the theory is that when people are confronted by intricate challenging or complex situations, they should choose the right course of action as undertaking the right decision originates from their moral character (NursingWorld, 2010). Examples of the relevant virtue would include truthfulness and compassion. From the case, it is clear that Claude is experiencing moral suffering as he has not been able to sort his emotions, after being forced to let Kylie attend to Ellen, based on the wishes of her mother. He should be made to understand that the action was based on primary commitment to the patient and his family, as well as the need to avoid conflict of interests for the nurses. Based on the incident of the Facebook update, concern should be expressed to Claude on such questionable practice. At this juncture, attention needs to be called on the likely detrimental impacts on Ellen's mental and physical wellbeing or best interests, in addition to the integrity of the nursing practice. Kylie has the responsibility of assisting Claude due to the potentially questionable practice of discussing the patient's health information to parties outside Ellen's treatment circle (NursingWorld, 2010). Is Claude in breach of any professional standards? Claude is in breach of professional standards as he failed to respect Ellen’s privacy and confidentiality. As a registered nurse, he has the duty to maintain confidentiality of Ellen's patient information (Ivanović et l. 2013). As indicated in the case, Kylie looked onto Facebook and saw status update from Claude describing Ellen’s pregnancy and how Ellen’s mum had demanded that a female nurse attends to her daughter. Ellen further ridiculed the patient by speculating that the mother’s boyfriend may have been responsible for the pregnancy. The standard of the nursing practice set out that the responsibility of the nurse in providing quality care requires that relevant data be shared only with the members of the healthcare team who need to know, or within the circle of the patient's treatment plan. The standards also require that only information that relates to the patient's treatment or welfare is shared to those who are directly participating in the patient's care, as well as other innocent parties in the circumstance (NursingWorld, 2010). Conclusion The four key ethical issued inferred from the case include respecting the privacy of the patient and protection of her rights, honest communication on all aspects of the patient’s treatment, diagnosis and prognosis, undertaking ethically valid process based on informed consent and advocating for the interests of the patient. Claude is in breach of professional standards as he failed to respect Ellen’s privacy and confidentiality. As a registered nurse, he has the duty to maintain confidentiality of Ellen's patient information. Kylie faces dilemma, including the conflict of interests by maintaining her loyalty to her friend Claude or primacy of Ellen's interests. Kylie should however act on unquestionable practice by reporting Claude to appropriate supervisory authority at Tinytown Hospital. Based on the principle of beneficence, Ellen should be advised to allow Kylie inform her mother about her pregnancy. In nursing, beneficence requires that nurses make decisions or take actions that benefit the patients and promote their overall wellbeing. Claude should promote, advocate for and safeguard Ellen's rights of privacy and confidentiality. This will enable him overcome the feelings or moral suffering, leading to unethical practices, including violating the patient’s rights to privacy and confidentiality. 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