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Medical Ethics in Prison in the US

Introduction to Ethical Dilemma

Healthcare professionals must negotiate with prison officials to provide essential and appropriate care in the prison system, which is an arena of unending ethical conflicts. Confidentiality is one of the specific areas of conflict. Prisoners have the right to expect their personal health information (PHI) to be kept private and out of public attention (Hurst et al., 2019). However, in a prison setting, real confidentiality is impossible. For example, prisoners have no constitutional right against disclosure of their information relating to HIV status. In such circumstances, disclosure is warranted by legal requirements. Therefore, a prisoner’s rights violation must be logically connected to a valid penological cause (Hurst et al., 2019). This report aims to analyze the ethical conflict of confidentiality from a utilitarian perspective, present a pro view of the conflict, discuss ways to prevent or minimize conflict and ways to deal with it once it arises, determine whether today’s healthcare organizations view the ethical conflict as important, and assess how it might affect nursing patient care.

Analysis of the Ethical Dilemma Using the Utilitarian Approach

Utilitarianism is a moral philosophy that favors actions that promote satisfaction or pleasure while opposing actions that inflict dissatisfaction or harm. The utilitarian justification for maintaining PHI confidentiality is based on assessing the impact of confidentiality or disclosure on the patients’ behavior (Isaila & Hostiuc, 2022). In the case of incarcerated patients, this assessment is usually predicated on beliefs about how incarcerated patients are expected to act and how patients’ behavior changes when faced with varying levels of confidentiality.

On the one hand, maintaining confidentiality is vital since it increases inmates’ autonomy and strengthens their trust in medical professionals and the prison healthcare system. However, disclosure practices significantly undermine the inmate’s right to autonomy and erode their trust in the medical staff and the prison healthcare system (Jones, 2003). However, disclosure may be justifiable if there is reason to suspect that patients may be unwilling to disclose potentially detrimental information if subsequent disclosure is expected. Furthermore, disclosure may be justifiable in decreasing risk to a third party (Elgerab et al., 2015). In these exceptional situations, disclosure is justifiable since the overall benefit would be higher than the benefit of maintaining confidentiality.

Pro View of the Issue

Prisoners are satisfied when their confidentiality is upheld since it demonstrates that their medical professionals—including nurses—value it. The primary justification for maintaining confidentiality may be viewed as fostering autonomy. The patient controls their PHI thanks to confidentiality (Elgerab et al., 2015). It is a type of ownership right in which the patient “owns” their PHI and may control how it is used. Therefore, health providers may be obliged to honor patients’ trust in protecting their PHI.

Additionally, the value of keeping a prisoner’s PHI confidential during a medical consultation until consent to disclose the information is given by the incarcerated patient outweighs the benefits of disclosure in the interest of protecting third parties. For instance, disclosure without consent will almost certainly discourage some inmates from seeking treatment, whereas maintaining confidentiality encourages prisoners to seek medical treatment (Delogu et al., 2017). Consequently, the nurse, except for those instances when it is legally obliged, must protect a patient’s confidentiality by not disclosing their medical history, diagnosis, and treatment, which solidifies the patient’s trust in the nurse and the correctional healthcare system.

Strategies to Prevent or Minimize Conflict and Strategies Applied if Conflict Arises

Every prison medical professional knows how complicated it is to establish and uphold medical confidentiality, but it is crucial for inmate patients’ trust. Several strategies effectively prevent or minimize ethical conflict around confidentiality and disclosure. First, suppose a law enforcement officer must be present during a consultation for safety and security reasons. In that case, the officer should remain out of the patient’s hearing and vision range of any subjective and objective assessment. Second, only medical officers bound by the rules of medical confidentiality should have access to inpatient files and records of diagnostic tests. Third, prison medical officers should not authorize the disclosure of PHI to the correctional facility’s administration without the patient’s explicit consent. However, there are two exceptions to this rule. First, a court order may require the medical officer to transfer PHI directly to the judge. Second, in rare cases, the medical officer must decide to breach confidentiality to protect basic human rights like the right to life of other people. The incarcerated patient must be informed accordingly about these exceptions (Pont, 2006).

If the ethical conflict as to whether to maintain confidentiality or practice disclosure arises, the healthcare provider should evaluate the possible alternatives to determine the best course of action. This evaluation should be guided by key federal privacy laws such as the HIPAA Act of 1996 and The Privacy Act of 1974, which have provisions that affect how health information sharing occurs in healthcare or federal settings, such as correctional settings (Macleod et al., 2020). If maintaining confidentiality ultimately results in a greater good than disclosing inmates’ PHI, then it should be done accordingly. However, disclosure would be justified when it would ultimately be more beneficial than keeping the information confidential.

Whether the Ethical Dilemma is Considered Important in Today’s Health Care Organizations

Confidentiality is one of the most crucial elements for developing trust in the doctor-patient relationship. Confidentiality protection is regarded as a right of the patient. HIPAA deems confidentiality as absolute, but this excludes legal reasons. Legal disclosure rules for healthcare professionals occasionally apply, notably when a disease poses a risk to others. For example, the nurse may breach confidentiality without permission for certain diseases, notably communicable diseases, infectious diseases, and nationwide notifiable diseases (Rorvig & Williams, 2021). Therefore, despite efforts to protect the confidentiality, there may be situations when it is inevitable but not necessarily unethical to disclose PHI, creating an ethical dilemma over which action is ethical under what conditions.

How the Ethical Dilemma Might Alter Patient Care in Nursing

The ethical practice serves as a cornerstone for nurses who face ethical concerns daily. While nurses are caring for patients, ethical problems arise. These dilemmas might occasionally be at odds with the nurses’ nursing ethical code or individual beliefs. For example, a nurse may have competing choices regarding whether to keep a certain patient’s PHI confidential or not. Inappropriate management of confidentiality dilemmas by staff nurses in prison settings could result in an intentional and legally questionable breach of patient confidentiality, which would harm patient care, cause tension among care providers in the correctional clinic, and cause ethical distress (González-Gálvez et al., 2018). Therefore, nurses must ensure that all appropriate and moral decisions are taken while honoring their patients’ requests and keeping their best interests in mind.


The presented ethical conflict topic is focused on whether disclosing inmates’ PHI outweighs the benefits of protecting their confidentiality in certain scenarios. According to the utilitarian approach, confidentiality guarantees the patient autonomy over their PHI. Furthermore, the benefits of maintaining a prisoner’s PHI private until they give explicit consent to disclose information outweigh the benefits of disclosing to protect the interests of third parties. However, disclosure is justified in special circumstances since the overall benefit would be greater than the benefits gained from maintaining confidentiality. It is critical to have law enforcement officers staying out of a hearing and vision range of any subjective and objective assessment of the patient, have only medical officers who are bound by the rules of medical confidentiality access inpatient files and records of diagnostic tests and seek the explicit consent of the patient before authorizing the disclosure of PHI to the correctional facility’s administration. Exceptions to this rule include situations involving court orders or the critical need to save the health or life of another person. The best course of action should be taken if an ethical dilemma occurs. Since maintaining a patient’s confidentiality is seen as a patient right, confidentiality ethical dilemmas are still relevant in today’s healthcare organizations. An ethical dilemma leads to tension among care providers in the correctional clinic and causes ethical distress. Therefore, nurses must ensure that all appropriate and moral decisions are taken while honoring their patients’ requests and keeping their best interests in mind.


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Elgerab, B. S., Handtkea, V., & Wangmoa, T. (2015). Informing patients about limits to confidentiality: A qualitative study in prison. International Journal of Law and Psychiatry, 41(1), 50-57.

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Hurst, A., Castañeda, B., & Ramsdale, E. (2019). Deliberate indifference: Inadequate health care in US prisons. Annals of Internal Medicine, 170(8), 563-565.

Isaila, O.-M., & Hostiuc, S. (2022). Malpractice claims and ethical issues in prison health care related to consent and confidentiality. Healthcare, 10(1), 1290-1301.

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Macleod, A., Nair, D., Ilbahar, E., Sellars, M., & Nolte, L. (2020). Identifying barriers and facilitators to implementing advance care planning in prisons: a rapid literature review. Health & Justice, 8(1), 22–29.

Pont, J. (2006). Medical ethics in prisons: Rules, standards, and challenges. International Journal of Prisoner Health, 2(4), 259–267. doi:10.1080/17449200601069643

Rorvig, L., & Williams, B. (2021). Providing ethical and humane care to hospitalized, incarcerated patients with COVID-19. American Journal of Hospice & Palliative Medicine, 38(6), 731–733.


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