Breach of Trust

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Grand Canyon University: NRS-437v
Instructor: Amy Salgado

The concept of confidentiality in nursing is founded on the philosophy and principles laid out by the Hippocratic Oath and Nightingale Pledge. The ethical need for confidentiality emerges from the need for establishing a trustful relationship between the patient and the nurse. The patient needs the assurance that whatever private/personal information communicated to the nurse will be kept in confidence and will not be divulged to a third party in order for him/her to feel free to open up the complete information regarding the case at hand. In fact, the confidentiality is a crucial right of a patient and it is very much related to the notion of privacy. Hence it is unlikely for a patient to be comfortable to discuss matters related to the sex life, habitual drug use, and other issues that are considered to be taboos in the society, if they are not sure about the fact that their information would remain confidential. The purpose of this paper is to examine the concept of confidentiality in nurse-client relationship in the context of Nurse Hathaway’s dilemma, and describe author’s perspective on the concept of maintaining or breach of confidentiality while providing good care to the patient. Ethical Implications of Breach of Confidentiality

A breach of confidentiality is a release to a third party, without the permission of the patient or an order from a court, private information that the nurse has collected within the ambit of nurse-patient relationship. The legal base for enforcing obligation of confidentiality is more far-fetched than the ethical parameters, which demands the morally right thing to do. If the confidentiality is breached patients will be uncomfortable to open up to a physician or nurse about the true story of the problem/case, and they may even be reluctant to seek care and treatment for the problem. In the case of Andrea, the breach of confidentiality is a very sensitive issue as she is a teenager who is very vulnerable to social and public reactions, and the chances of her resorting to undesirable actions as a result of such a breach of trust are very high. Applicable Ethical Theories and Ethical Principles

In the case of Andrea, in my opinion, Hathaway did not have many choices. She had to breach the confidentiality in view of the age of the patient, nature of the diagnosis, complications of negative influence of the patient’s behavior on others, and the urgency for treatment. Hathaway had to inform the parents about the situation and enlist their cooperation for further urgent treatment for Andrea. Though Andrea’s human papillomavirus (HPV) infection is not a mandatory case that needed reporting, yet in view of the sex-behavior and the dual diagnosis of cervical cancer with HPV infection, it becomes an ethically right thing to inform/report to the parents for further treatment and preventing further harm to others. The ethical principles that are at play here are: (1) beneficence, which is kind-heartedness and doing good to help others; (2) non-maleficence, which is to avoid effecting harm or hurt to others; (3) justice, which is equality and fairness to others based on the analysis of merits and demerits of a decision; and (4) paternalism, which means that the healthcare professional in good faith makes decisions for the good of the patient. The major ethical theories that are of relevance to substantiate this standpoint are: (a) deontological theory which places high values on duties and obligations based on the intrinsic qualities of the action, regardless of the consequences. In this case, Hathaway had the ethical right and obligation to breach confidentiality and inform Andrea’s parents; and (b) utilitarian theory which validates action on the basis of its consequences. The goal is...
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