A 14-year-old child accompanied by her mother presents a complaint of nausea and vomiting for two weeks to a medical practitioner. After her mother leaves the room, she admits to being sexually active and tells the practitioner that she has had unprotected intercourse recently with her boyfriend and missed a period. Her parents do not know their daughter is sexually active, and she does not want them to know that a pregnancy test is being done or the result of that test. The pregnancy test returned positive, presenting an ethical dilemma for the physician, as the patient requested that her confidentiality be respected (Seattle Children’s Hospital, 2019). The physician must balance this with their duty to protect the patient.
The ethical dilemma or challenge presented in this case is the conflict between the patient’s request for confidentiality and the physician’s duty to protect the patient. The patient has requested that her mother not be told about the pregnancy test, but the physician may need to inform the parent about the results to ensure the patient’s well-being. The physician must balance the right to confidentiality and the duty to protect the patient’s well-being (Seattle Children’s Hospital, 2019). Moral awareness involves recognizing the ethical dilemma and determining the principles, values, and interests at stake. In this case, the patient is requesting confidentiality, so the physician must consider the ethical principles of respect for autonomy, trust, and the value of maintaining privacy in the medical setting. The physician must consider the possibility of harm to the patient and others if confidentiality is broken. The physician must decide whether breaking confidentiality is necessary to prevent damage to the patient or others. Ethical behaviour involves acting based on the decision made in the moral judgment stage. In this case, if the physicians decide it is necessary to break confidentiality, they must do so in a way that respects the client’s autonomy and protects trust in the physician-patient relationship. It may involve notifying the patient of the intention to break confidentiality by explaining why it is necessary and offering the client the opportunity to make the revelation themselves.
In this case, the primary factor contributing to the ethical problem is the patient’s request for confidentiality. The patient did not want her mother to know that a pregnancy test was being done or the result of that test. It necessitated a decision from the physician on whether to respect the patient’s confidentiality or to break it to protect the patient from potential harm (Seattle Children’s Hospital, 2019). The patient’s age also contributed to this ethical dilemma, as adolescents are often more likely to seek healthcare if they know their confidentiality will be respected. The potential for harm to the patient or others if privacy is violated was also a factor, as in cases of child abuse or when someone says they are going to hurt someone else. Breaking confidentiality may be necessary to prevent harm to the patient or others. In the case presented, the physician must weigh the ethical principles of respect for autonomy, trust and the value of maintaining confidentiality in the medical setting when deciding to break the patient’s confidentiality. In this case, the primary factor contributing to the ethical problem was the patient’s request for confidentiality (Ott, 2014). The physician must consider the possibility of harm to the patient or others if the secret is broken and decide whether breaking confidentiality is necessary to prevent damage. Applying the key principles from the Jennifer case, the physician must respect the patient’s autonomy and trust and consider the potential for harm to the patient or others before deciding to break confidentiality. Furthermore, suppose the physician determines it is necessary to break confidentiality. In that case, they must do so in a way that respects the patient’s autonomy and protects the patient’s trust in the physician-patient relationship (Ott, 2014).
The healthcare professional in the case study communicated with the patient, the patient’s mother, and other healthcare professionals to obtain the necessary information and provide the appropriate care. The professional communicated effectively with the patient by allowing her to speak openly and honestly about her situation and respecting her wishes for confidentiality. It was done by actively listening to the patient and providing a safe, non-judgmental environment for her to share her concerns. The professional also communicated effectively with the patient’s mother by providing her with the necessary information without revealing the confidential information that the patient had shared (Seattle Children’s Hospital, 2019). The professional should have avoided communicating in a way that was judgmental or dismissive of the patient and her mother, which could have further alienated the patient from the healthcare provider and may have led to the patient not seeking care in the future. Similarly, the professional should have avoided sharing information in a way that assumed the patient was lying or her concerns were invalid (Ott, 2014).
In this case, effective communication approaches allowed the patient to feel comfortable sharing her confidential information with the professional. On the other side, the professional was in a position to provide the necessary care while respecting the patient’s wishes for confidentiality. The healthcare practitioner was presented with an ethical dilemma regarding the patient’s request for confidentiality. The patient was a 14-year-old who had requested that the professional not tell her mother that a pregnancy test had been sent. The professional was tasked with respecting the patient’s wishes for confidentiality while still providing the necessary care. The professional responded to the ethical dilemma by discussing confidentiality and privacy violations. The professional then discussed the moral basis for a rule of confidentiality and the obligation to maintain confidentiality when the patient is an adolescent. The professional also discussed potential exceptions to the management of confidentiality, such as public health considerations, child abuse, and situations where someone may be in danger of harming themselves or others.
The practitioner effectively managed professional responsibilities and priorities to resolve the problem by strategizing a plan with the patient, informing her of the potential consequences if her mother were to find out, and allowing her to make an informed decision on how to proceed. The nurse also communicated effectively with the patient and her mother by providing them with the necessary information without breaking the patient’s confidentiality (Seattle Children’s Hospital, 2019). Developing a plan with the patient to protect her privacy requires the professional to apply the ethical principles of moral awareness, moral judgment, and ethical behaviour. Regarding moral understanding, the professional must be aware of the ethical implications of breaking the patient’s confidentiality and the potential consequences of doing so. The professional must also be mindful of the patient’s right to autonomy and to make decisions about their health care.
In addition, the professional must also use their moral judgment to determine the best course of action, which includes weighing the potential risks and benefits of maintaining the patient’s confidentiality versus breaking it. It requires the professional to consider alternatives to violating the patient’s privacy and whether or not there is a strong likelihood of significant harm. Finally, the professional must also demonstrate ethical behaviour by respecting the patient’s wishes for confidentiality and by informing the patient of the potential consequences if her mother were to find out. The professional must also adhere to the ethical principles of confidentiality and only break the patient’s confidence if there is a strong likelihood of significant harm. By doing so, the professional demonstrates respect for the patient’s autonomy and commitment to providing the best care possible.
Developing a plan with the patient to protect her confidentiality makes this professional more effective in building relationships across disciplines within the organization. By creating a project with the patient, the professional demonstrates respect for the patient and their wishes. This level of concern is essential in building trust between the patient and the professional, which is necessary for effective communication and collaboration across disciplines (Seattle Children’s Hospital, 2019). Furthermore, by allowing the patient to make an informed decision on how to proceed with her care, the professional demonstrates that they value the patient’s autonomy and right to make decisions about their health care. It proves to other healthcare team members that the professional can effectively manage professional responsibilities and priorities to provide the best care possible for the patient.
The proposed solution is likely to foster professional collaboration. By developing a plan with the patient to protect her confidentiality, the professional demonstrates respect for the patient and their wishes. This level of care is essential in building trust between the patient and the professional, which is necessary for effective communication and collaboration across disciplines. Furthermore, by allowing the patient to make an informed decision on how to proceed with her care, the professional demonstrates that they value the patient’s autonomy and right to make decisions about their health care. It will likely make the patient more willing to collaborate with the professional and other healthcare team members, as they will feel respected and valued. Finally, by effectively managing professional responsibilities and priorities to provide the best care possible for the patient, the professional demonstrates to other healthcare team members that they can effectively collaborate with them. It will likely make other healthcare team members more likely to cooperate with the professional.
References
Seattle Children’s Hospital. (2019). Case discussion: Confidentiality and adolescents. Retrieved from Seattle Children’s Hospital website: https://www.seattlechildrens.org/research/centers-programs/bioethics/education/case-based-teaching-guides/confidentiality/case-discussion/
Ott, M.A. (2012). Teen Pregnancy and Confidentiality. AMA Journal of Ethics, [online] 16(11), pp.884–890. doi:10.1001/virtualmentor.2014.16.11.ecas3-1411.
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