Grand Canyon University: NRS 437V
March 28, 2013
When is it OK to break confidentiality?
A teenager presents to an emergency department (ED) and is promised no information will be divulged regarding her treatment. This teenager is subsequently diagnosed with cervical cancer and human papillomavirus (HPV) (Nathanson, 2000). The nurse that promised confidentiality now faces an ethical dilemma: if she keeps her promise to the girl, she may not get the proper follow up care and support to treat her illness, and if she breaks her promise, she has violated the ethical principles of fidelity, and autonomy (Nathanson, 2000). This paper will discuss the ethical implications of breaches of confidentiality, and how the ethical theory of teleology helps to determine the best course of action. Using the 6-step process of ethical decision-making from Purtilo and Doherty as a guide, this paper will also explain the process of how a breach in confidentiality can still elicit the ultimate goal of ethical practice: a caring response. The ethical theory of teleology is focused on the outcomes of decisions. The end result is the deciding factor in all choices in teleologic ethics (Purtilo & Doherty, 2011). The girl in the above scenario would be unfortunate indeed if the nurse kept her promise. The decision to not tell the parents clearly places the minor in a position to decide the outcome of her own fate. This is a huge burden to place on an immature mind regardless of the right to autonomy, or the respect for the nurse-patient relationship and its promise of confidentiality. Neither keeping the promise to the girl, nor breaking it, is ideal. The duty of confidence requires the nurse to “disclose information if they believe someone may be at risk of harm” (Edwards, 2010, p. 14). In this situation the nurse works through the 6-step process of ethical decision-making and uses teleology theory to help her...