INTRODUCTION
Working in healthcare may be rewarding and challenging at times. Every day, healthcare providers, families, and patients must weigh legal and ethical considerations related to patient care. A nurse caring for a patient will often face challenging situations while deciding how much information to share with the patient’s loved ones and figuring out who has access to sensitive medical records (Noroozi et al., 2018). One of the most challenging situations nurses encounter is dealing with loved ones who want more than just an update on their loved one’s health and are insistent on learning private information about the patient. As a nurse, it is my duty to safeguard my patients’ privacy by not disclosing any information about them to anybody who does not have the patient’s explicit permission to do so, even if doing so causes distress to the patient’s loved ones. According to the Nursing and Midwifery code of conduct (2015), nurses and other healthcare workers have a legal obligation to protect the privacy of their patient’s medical information. If they fail in this duty, they may be subject to disciplinary action or even a lawsuit from their patients. To illustrate the difficulties nurses face on a daily basis, I used the hypothetical case of Eva, a 40-year-old woman who, invoking her right to privacy, asked the nurse to keep her medical records from being discussed with her husband. The privacy of the patient and the patient’s ethical and legal rights are at issue here. Hence, this essay will provide a critical analysis of the situation, taking into account ethical theories and the legal components we have covered so far in class, while also giving contrasting viewpoints and arguments.
Critical Analysis and Discussion of Scenario
The confidentiality of patients and their legal rights to privacy are crucial factors in this circumstance. In the hypothetical situation involving Eva, the patient requests explicitly the nurse not to tell her husband the medical outcome, citing her right under the law to privacy. Eva has the right to make choices about her care and privacy, and the nurse should respect that right, but the nurse should also be guided by the law and the nursing code of ethics when deciding whether or not to maintain confidentiality or share the information with Eva’s spouse. Eva’s care, her husband’s, and the public’s safety all depend on the outcome of this hypothetical situation analysis. Having the chance to reflect on ethical and legal rules pertaining to patient confidentiality and rights is equally essential for a nursing profession that often deals with ethical difficulties.
Patient confidentiality is presented in a variety of ways by various professional groups and organizations, but they all boil down to the same thing: patients have a right to privacy while dealing with their healthcare providers. In the words of the British Medical Association (2020), “all identifying patient information stored by a healthcare practitioner in whatever form” must be kept private. Confidential patient information includes both clinical data and any additional details that may be used to determine a patient’s identity, either directly or indirectly. Hence, it is the responsibility of every nurse to safeguard their patients’ privacy by never disclosing their personal information to other parties unless required by law or with the patient’s express agreement. Confidentiality must be maintained in order to protect both the patient’s health and the public’s faith in the doctor-patient relationship (Medical Protection 2015). Each healthcare provider has a duty to protect patient’s privacy and confidentiality in accordance with the National Medical Care Act of 2015, which includes sharing relevant information about a patient’s care and treatment with them. As a nurse caring for Eva, I am bound by the NMC code of conduct to protect her anonymity and the privacy of her medical records. The patient, the nurse, and the community all benefit when confidentiality is maintained. Sharing information on a patient might put them or their loved ones at risk and could even lead to a nurse being disciplined or sued for violating patient rights (Price, 2015).
The NHS confidentiality code of practice, conversely, asserts that patients respect healthcare workers and permit them to gather sensitive data regarding their health as well as other concerns as a component of treatment and that patients communicate this information with healthcare professionals in the assurance that they will adhere to their confidentiality and behave ethically. When receiving medical care, Eva may have confided in the nurse about herself and her situation in a way that she would have never told anyone else, not even her husband. The nurse must protect Eva’s privacy and keep the information secret in accordance with the NHS’s code of practice on confidentiality. It is reasonable for patients to assume that their healthcare practitioner would protect the privacy of their personal health information (Tariq and Hackert, 2020).
The Data Protection Act (2018), the United Kingdom’s implementation of the EU’s General Data Protection Regulation (GDPR), protects the privacy of patients by regulating the collection, storage, and disclosure of personal information. Data protection principles are outlined in the act, and anybody who intends to use personal data must do so in a fair and legal manner and only for the reasons for which it was collected. The legislation strengthened the legal safeguards protecting patients’ health information, and it states that patients’ right to privacy in their medical and social service records is crucial to protecting their privacy and the dignity of those who utilize such services (Spencer and Patel, 2019).
Confidentiality from an Ethical Perspective
A nurse’s duty is to uphold a patient’s right to confidentiality and privacy (Davis 2020). Professional standards of behaviour encourage nurses to make ethically sound judgments, including maintaining patient confidentiality. The duty-based approach indicates that actions are good or bad based on an explicit set of criteria (NHS, 2018). For this reason, in my capacity as Eva’s caregiver. It is my obligation and the correct thing to do to keep the status of her medical treatment a secret, as she asked. The utilitarian approach to ethics, on the other hand, assesses a decision in terms of its repercussions and outcomes and elaborates that if one is given the opportunity to make a choice, the right choice is the one that results in the most significant amount of good for the greatest number of people (NHS, 2018). As a nurse, I have a responsibility to weigh the interests of all parties involved in scenarios like Eva’s and make my choice based on who stands to suffer the least and gain the most. Whether I may ultimately agree with Eva or her husband, I must first take into account the fact that Eva made the independent choice that her husband does not have access to her medical records. Nonetheless, Eva is a mature, legally competent adult who can make her own judgments and who cannot be forced to do anything against her free will, but she may be helped in making decisions that are in her best interests. This necessitates the implementation of the Mental Capacity Act, which states that everyone older than 16 years old has the right to make their own choices and is assumed to have the mental ability to make decisions about their care and health until proven otherwise. As Eva’s nurse, it is my responsibility to determine whether or not Eva is competent to make choices about her care and health, and if she is, to make a decision in her best interest based on that evaluation.
Given Eva’s current state, her choice to seek medical attention to determine the source of her rapid weight loss and intense weariness may be ethically defended as autonomous, because she is seen to possess full authority over her own life and decisions. In contrast, the duty-based perspective may cause some problems with Eva’s privacy since it emphasizes the nurse’s need to make a choice that is ethically right regardless of the possible adverse outcomes. Although it is the correct thing to do ethically to respect Eva’s choice not to disclose her medical information to her husband, I think it is essential to constantly consider the potential implications when making such important decisions. The duty-based view, it would appear, does not take into account the outcome of the choice but instead focuses on the moral obligation of the service provider, in this case, not telling the spouse the medical conclusion. Utilitarianism, on the other hand, emphasizes outcomes above moral obligations when making choices. Under this idea, the goal is to maximize benefits; hence if an activity or decision has just a little positive impact, it is immoral (Bauer, 2020). Using the utilitarian principle, I, as Eva’s nurse, must decide who, between Eva and her husband, would suffer the most minor damage as a result of my choice about her privacy. Although hiding the facts from the spouse might do him more damage than telling him would, concealing the information from Eva would violate my code of conduct as outlined in the NMC code (2015).
Because it is my job to maximize benefits while minimizing damage, I need to know how much of an adverse effect sharing Eva’s medical history will have on the spouse before I take any action. Can Eva’s spouse and the public benefit from a breach of her medical records? What if breaking confidentially causes Eva even more hurt and mistrust? If I know the answers to these questions, I can make a choice as a nurse that maximizes the good for the patient and minimizes the bad for the patient who will not benefit from the action.
In addition, Eva’s situation places me, as a nurse, under the need to behave in accordance with my own sense of what is right and wrong. If I am a nice person, I will keep Eva’s information private; if I am terrible, I will break her trust. I try to do the right thing according to the rules and regulations set out by the ethical community, but the virtue ethics theory also gives me the freedom to act according to my own sense of what is right and wrong (Numminen et al., 2017). The emphasis of virtue ethics is on my moral fibre as a nurse, putting to the test my ability to behave in accordance with my best principles. When Eva requested me to keep her medical records private, she was putting her faith in me as a nurse, and I had a moral obligation to honour that trust as a nurse who practices virtue ethics. Respecting a patient’s right to privacy is essential to developing a solid rapport with the patient and fostering productive nursing care (Allinson and Chaar, 2016). Confidentiality is the cornerstone of the trusting connection between a nurse and patient, which is why people look for healthcare professionals that respect their right to privacy (Tegegne et al., 2022).
Confidentiality from a Legal Perspective
While dealing with patient’s private information, nurses, like all other professionals, must act legally (GMC, 2021). The common law has always taken the view that it is improper to reveal private information without the agreement of the person who provided it if the circumstances surrounding the disclosure raise reasonable suspicions that a duty of confidence exists. Consequently, regardless of the patient’s age or mental health state, nursing practice implies that no information about the patient should be released without the patient’s informed permission. Nurses are allowed to reveal patient information under certain conditions, such as when they have the patient’s informed permission when doing so is necessary to protect the patient (Eva), others (Husband), or the public interest, or when there is a legal responsibility, such as a court order. The patient has the right to sue the nurse who disclosed their information if the disclosure was not authorized by common law (Pierce, 2014). Despite the fact that confidentiality is generally upheld by law, there are circumstances in which nurses are permitted to break patient confidentiality. The legislation recognizes exceptions to patient confidentiality and permits disclosure in some circumstances; hence, confidentiality is not absolute. Thus, patient confidentiality in the United Kingdom is qualified by some overriding societal situations that must be both morally and legally justified. For instance, if maintaining patient confidentiality would put the patient’s health, the health of others, or the public at risk, the nurse would be required to break confidentiality (Collier, 2023).
Confidentiality in the nursing profession is seen as a crucial ethical and legal obligation by the General Medical Council (GMC), although it is not absolute (Rimmer, 2017). So, a nurse or other health practitioner may share patient information in exceptional social conditions without breaking the obligation of confidentiality. In the event that Eva is found to lack the ability to provide informed consent, I, as her nurse, must disclose her medical history to her husband. Equally, the Human Rights Act of 1998 states that everyone has the right to the confidentiality of their personal information; however, this right is not absolute and may be overturned in certain circumstances. Although it is true that Eva has the right to privacy with regard to her medical records, as a nurse, I am legally compelled to provide this information to her husband even if doing so goes against my professional ethics if I believe that he may be harmed by knowing about Eva’s condition. So, with regard to Eva’s circumstance, because she did not agree to share her medical records with her husband, I, as a nurse, cannot break the confidentiality obligation since the common law only permits violating duty when a patient grants informed permission.
And as it has not been shown that protecting Eva’s privacy would put her, her husband, or the general public in danger, breaking the obligation of confidentiality will be against the law. Consequently, the common law permits a breach of confidentiality if there is a court ruling allowing the disclosure of patient info; and since this doesn’t really relate to Eva’s scenario, she is shielded by the Human Rights Act of 1998, which supports upholding patients’ right to privacy which would include private details. Nurse-patient confidentiality is protected by the Mental Health Acts of 1983 and 2007, except in limited situations, like if a patient lacks the ability to think for themselves and make their own choices regarding their treatment and health. Nonetheless, the Human Rights Act of 1998 ensures the patient’s rights are respected, and the patient’s wishes are given due weight. Since Eva is entitled to protection under the Human Rights Act of 1998 and the Mental Capacity Act of 2005, I am obligated to uphold her plea for confidentiality regarding her medical records, even though it was not possible to determine whether or not her mental capacity to make personal choices was present (Legislation.gov.uk. 2016). Given the legal perspective of Eva’s scenarios, it is clear that Eva has unconditional confidentiality, and unless further inquests prove otherwise, any activity that challenges to violate her confidentiality obligation might lead to litigation or lawsuits against me as the nurse as well as other care providers in the nursing profession (Pierce, 2014).
Implication for Nursing Practice
Patient confidentiality and legal rights indeed remain crucial in nursing practice, notwithstanding the difficulty nurses and other health professionals confront when presented with ethical problems like Eva’s. Nurses are held to a high standard of ethics and are tasked with making judgments that are both ethically sound and in the patient’s and the public’s best interests (Pettersson et al., 2018). The nursing practice may find it easier to make well-informed judgments regarding ethical dilemmas when they are informed by principles of medical ethics. Easing the difficulty of dealing with ethical issues may be achieved in nursing practice by emphasizing the four often utilized ethical principles: autonomy, beneficence, justice, and non-maleficence (Bollig et al., 2015). These principles have been widely regarded as a trustworthy and practical framework for identifying and addressing ethical dilemmas in healthcare settings, despite its not-without-challenges nature. The concept of autonomy asserts that individuals, and especially patients, should be given the freedom to make decisions based on their own preferences so long as such decisions do not violate the rights of others or the common good (Bollig et al., 2015).
Healthcare providers that respect patients’ autonomy will treat patients in a way that takes into account their values and avoid doing anything that goes against the idea of patient autonomy. The healthcare provider will acquire the knowledge that the patient’s perspective must be taken into account while making ethical decisions. Although the concept of non-maleficence directs nurses and other health professionals to avoid harming patients in their care, it is also important that their actions not negatively impact other parties or the general public (Bollig et al., 2015).
As a result, nurses and other medical professionals may do what is suitable for their patients and their communities if they have a firm grasp of the concept of non-maleficence. Additionally, the principle of beneficence states that a healthcare provider must behave for the benefit of the patient by respecting the patient’s right to confidentiality and not contravening the patient’s confidence; keeping patient information private makes nursing a better profession, improving the relationship between patients and their doctors (Alkhalifah et al., 2022). Ultimately, the principle of justification is crucial for nursing practice because it directs nurses to do what is legally acceptable in the interest of the patient and society. This principle aids nursing practice in carrying out appropriate steps to prevent causing discomfort for patients and the general population.
Ethical theories, including the utilitarian theory, the virtue ethics theory, and the duty-based theory, are also essential for nursing. Nurses may benefit from virtue ethics because it encourages them to develop moral character, which is essential when making decisions. This theory states that people, especially health care providers, should be evaluated according to their character rather than their moral responsibility (Edmonson, 2015). This approach improves nursing practice by encouraging an atmosphere of excellent conduct among healthcare workers, which is crucial in inspiring nurses to make judgments that are right and moral and to treat patients with dignity and respect. The nursing practice relies heavily on utilitarianism as an ethical framework because it encourages nurses to consider the public good rather than their own personal convictions when making decisions (Mandal et al., 2016). In the case of Eva, for example, the ethical thing to do is to protect her privacy. Yet, doing so can bring damage to the public, and so the nurse is instructed to consider the potential adverse outcomes of protecting her privacy. As a result, incorporating this theory into nursing practice is vital since it broadens the lens through which healthcare practitioners examine ethical challenges, going beyond the simple moral obligation.
As applied to nursing practice, duty-based ethical theory aids nurses and other healthcare providers in meeting their moral obligations, chief among them the obligation to consider the patient’s perspective and act in a way that is in the best interest of the patient (Rodger and Blackshaw 2017). While this approach might be beneficial in fostering confidence between patients and medical professionals, it disregards public interest by placing more weight on the moral obligation to the patient than on the repercussions to others and the public at large. The legal considerations of Eva’s case inform nursing practice through GMC perspectives that confidentiality is a vital legal as well as ethical component but not unconditional, helping nurses understand that they are permitted by law to violate the duty of confidentiality on the basis of inevitable circumstances. Since nurses and other medical professionals are no longer constrained by a precise understanding of upholding moral responsibility but are instead free to act lawfully in the public interest, the quality of nursing care has improved.
Conclusion
Every day, nurses and other medical professionals are put in a position where they must decide what is ethically and morally appropriate for their patients. The ethical obligation of a nurse includes protecting the privacy of their patients and honouring their autonomy. Notwithstanding the NMC code of conduct’s mandate that nurses treat patients with dignity and confidentiality, nurses’ actions are occasionally informed by theories of ethics such as duty-based ethics, utilitarianism, and virtue ethics. The British Medical Association (BMA), the Mental Capacity Act (MCA), and the National Health Service (NHS) are just a few of the sources nurses look to for guidance when deciding what steps to take in order to minimize damage to patients and the public. In addition, nurses use the Human Rights Act of 1998, the Mental Health Act of 1983 and 2007 under the common law, and other legal viewpoints to make legally sound choices and prevent legal action from patients. Hence, the critical analysis of Eva’s situation relied heavily on applying these legal and ethical viewpoints, and their incorporation into nursing practice is likely to enhance the quality of care provided to patients, other people, and the public at large.
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