Running head: Ethical Analysis of Patient Privacy

Ethical Analysis of Patient Privacy

Brooke Thompson

James Madison University

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Introduction

In the clinical setting, there are many instances where patient confidentiality and privacy can be

jeopardized. Healthcare providers are at the forefront of protecting and advocating for their

patients, which can often bring about an array of ethical dilemmas. Nurses protect their patient’s

right to privacy regarding their status, treatment, and personal decisions about their care. As

stated by the Patient Confidentiality and Advisory Group of Europe "access to identifiable data

must be only on a “need to know” basis; patients must be told what happens to their information;

they may refuse disclosure outside the immediate care team" (Chalmers & Muir, 2003). It is

clear that healthcare professionals are presented with ethical decisions every day, and many

concern patient confidentiality (ANA, 2001). It is our responsibility as nurses to make sure that

our patients information is kept confidential, and that only direct members of the healthcare team

have access to patient information. The patient has the right to autonomy and it is their decision

what information is shared (Chalmers & Muir, 2003). As a nurse, we are the true advocates in

the protection of our patients right to safe, quality, effective, and private health care (Malin,

Karp, Scheuermann, 2010). This fundamental relationship between the healthcare team and

patient privacy is examined for further evaluation.

Background

Recently during my medical surgical clinical I witnessed a situation that I considered a breach in

ethics and patient privacy. I overheard two nurses discuss a patient’s detrimental diagnosis aloud

in the hallway. The diagnosis of the patient was new and the prognosis was unfortunately going

to lead to death. The nurses spoke the patients name, room number, and specific facts about the

diagnosis aloud where other hospital staff, visitors, and even some of the patient’s family were
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nearby. In this situation I recognized that this information was confidential, but I did not

intervene on the nurses discussion or confront the issue.

This situation was morally distressing for me because I knew that the conversation

between the nurses was wrong and violated patient privacy. I felt uncomfortable and nervous

telling the more experienced nurses that what they were talking about violated the patients’ rights

to privacy and confidentiality. I feared they would become agitated with me or make the

remainder of my clinical hours challenging. I thought that they would not look at me the same,

think I was judgmental, and that they would not welcome me to participate in their patients care.

Methods

In order to further analyze this ethical dilemma, I used James Madison’s Eight Key Questions for

guidance. These standards were created by the university to act as a resource that can be used in

the ethical decision-making process. The Eight Key Questions include: fairness, outcomes,

responsibilities, character, liberty, empathy, authority, and rights (The Eight Key Questions,

2013).

“Fairness”, historically defined as “all men are created equal”, is the first of the eight

questions. I believe the nurses were not acting in the best interest of the patient and being unfair

concerning his autonomy and right to privacy. Specifically, I think they were not treating the

patient equally and were giving unnecessary negative attention towards the patient’s case.

“Outcomes” poses the question “what are the short and long-term outcomes for all involved?”

(The Eight Key Questions, 2013). Positive short-term outcomes for this situation include the

nurse’s recognition of their mistake and desire to prevent the situation from happening again.

Positive long-term outcomes include that the issue would bring this issue to the forefront and

bring awareness among other nurses and hospital staff about the possible negative implications.
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Both positive outcomes could be possible by bringing awareness to the error and include

discussion of ways to prevent it in the future. “Responsibility” can be defined as duties or

obligations that we owe to others. In this situation, the nurses failed to uphold their responsibility

to protect the patient’s right to privacy and confidentiality. “Character” most accurately describes

who I am as a person and who I want to be. I believe I am person that will advocate for my

patients’ rights and protect them from harm. I want to be a nurse that is thoughtful of others

experiences and always puts the best interest of the patient first. In the future, I plan to intervene

on similar situations and find solutions that benefit all parties involved. “Liberty” describes the

respect for freedom, personal autonomy and patient consent. In this case I believe that the

patients liberty is jeopardized because their medical condition was being discussed without

consent. There was no benefit to the patient while discussing the diagnosis, and their liberty to

personal autonomy and consent was breached. “Empathy requires that we put ourselves in the

shoes of others” (The Eight Key Questions, 2013). In this situation I felt empathetic because I

would not want this to happen to a member of my own family. I would feel embarrassed and

skeptical of hospital staff if I knew they were discussing my detrimental condition in an

unprofessional manner. In the future, I want to be more empathetic by helping the nurses to

realize their error, apply personal accountability, and help them think about how they would feel

if they were the patient. “Authority” includes when one “takes the advice, orders, or commands

given by apparent authorities or institutions that hold legitimacy” (The Eight Key Questions,

2013). The law requires me to protect the patient’s right to privacy and in the future I will better

find a solution to advocate for my patient. “Rights” asks what rights-innate, legal, or social-

apply. In this situation the patient’s personal rights were infringed upon due to the fact that their

private information was no longer confidential.

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The American Nurses Association guidelines provide further clarification of the nurse’s

role in the protection of the patient’s personal health information. Stated in Provision 3, “The

nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient”

(ANA, 2001). Nurses are ethically and legally responsible for strictly adhering to these

standards. Additionally, the provision clarifies that nurses must take appropriate action regarding

instances of unethical practice that involves the rights or safety of the patient (ANA, 2001).

When reflecting on these provisions, the most appropriate solution to this issue would be to

gently remind the nurses about our responsibility to protect our patients right to privacy in order

to maintain trust and integrity within our profession.

Conclusion

The responsibility to protect the patients right to privacy is one of the most important aspects of

our mission as healthcare providers. As a profession, it is extremely important that we hold one

another accountable in protecting our patients in every way possible. If we are not able to meet

these fundamental standards, a trusting relationship between the nurse and patient will be

compromised. After further analysis, I was able to determine how I would like to act in the future

if a similar situation were to arise. Looking back, I could have found an appropriate way to

approach the nurses or have spoken with my instructor to help create a solution. It is our

responsibility to stand up for what is right even in uncomfortable situations. As a nurse, we need

to respect the patients right to privacy and confidentiality continue to uphold the ethical

standards of the nursing profession. In the future, referring to the Eight Key Questions during an

ethical situation will help me further analyze the situation and provide me with the standards that

will help me be the nurse that I am determined to be.

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References

American Nurses Association. (2001). Code of ethics for nurses with interpretive statements.

Retrieved from http://www.nursingworld.org/ethics/code/protected_nwcoe303.html

Chalmers, J., & Muir, R. (2003, April 05). Patient privacy and confidentiality: The debate goes

on; the issues are complex, but a consensus is emerging. Retrieved November 14, 2017, from

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1125639/#!po=75.0000

Malin, B., Karp, D., Scheuermann, R., (Jan 2010). “Technical and policy approaches to

balancing patient privacy and data sharing in clinical and translational research” Journal of

Investigative Medicine. VOL 58 (1) 11-18; DOI:10.2310/JIM.0b013e3181c9b2ea

The Eight Key Questions. (2013). Retrieved November 14, 2017, from

https://www.jmu.edu/mc/Docs/131101%208KQ%20Handout%20Revision.pdf