Confidentiality, Veracity and Role Fidelity

For this assignment, consider the following case and then using the internet, course materials, and the Library, compose reasoned responses to the questions that follow.

In the mid 1970s, a nursing educator in Idaho had contact, through a student, with a female client who had chronic myelogenous leukemia. This form of leukemia can often be managed for years with little or no chemotherapy. The woman had done well for about twelve years and ascribed her good condition to health foods and a strict nutritional regime. However, her condition had turned worse several weeks before and her physician had advised her that she needed chemotherapy if she were to have any chance at survival. The physician had also advised her of the potential side effects of the therapy including hair loss, nausea, fever, and immune system suppression.

The woman consented to the therapy and signed the appropriate forms, but later, she began to have second thoughts. The nursing educator and student had given the patient one dose of the therapy when the woman began to cry and express her reservations about the therapy. She questioned the nurse about alternative treatments to the use of chemotherapy. The patient related that she had accepted the therapy because her son had advised her that this was the best treatment. She related that she had not asked about alternate forms of treatment as the physician had indicated that chemotherapy was the only treatment indicated. The nurse did not discuss the patient’s concerns with the physician, and later that evening, she talked to the patient about alternate therapies. In the discussion, rather nontraditional and controversial therapies were covered including reflexology and the use of laetrile. During the talk, the nurse made it very clear that the treatments under discussion were not sanctioned by the medical community.

The patient’s feelings toward alternate therapies were strengthened by the evening’s conversation; however, she continued with chemotherapy. The treatments, however, did not bring remission to her crisis and she died two weeks later. Upon hearing about the conversation between the off duty nurse educator and his patient, the physician brought charges against the nurse for unprofessional conduct and interfering with the patient-physician relationship. (In re Tuma, 1977).

1. What, if anything, did the nurse do wrong?

2. Had she moved beyond her scope of practice?

3. Could the nurse’s conduct be justified under the patient advocate portion of her role?

4. If you were a member of the state board for nursing and had to decide the issue of unprofessional conduct and interference with the patient-physician relationship, would you sanction the nurse?

Support your responses with evidence and cite your sources.

Length 4 pages not counting the case. At least 4 references; scholarly sources

COURSE MATERIAL INFORMATION

: Ethical Principles and Dilemmas of Confidentiality, Veracity, and Fidelity

Health care providers and patients both enter a health care relationship with a set of ethical principles and moral expectations. While both patients and providers are aware of underlying assumptions, the rules for practicing ethical health care can be conflicted, and at times, impenetrable. In this presentation, we focus on the ethical principles and dilemmas of confidentiality, veracity, and role fidelity as they are applied or emerge in modern health care.

Confidentiality and Veracity

Confidentiality, an important element of respect for persons, requires caregivers and executives to keep secret what they learn about patients and others in the course of their work. Patients have a right to expect that information regarding their care and treatment will be kept confidential. Information received by a physician in a confidential capacity relating to a patient’s health should not be disclosed without the patient’s consent although disclosure may be made under compelling circumstances (e.g., suspected child abuse) to a person with a legitimate interest in the patient’s health. In short, all health professionals who have access to medical records have a legal, ethical, and moral obligation to protect the confidentiality of the information in the records.

Truthfulness, like confidentiality, is an ethical principle that guides patient-provider relationships. In fact, truth-telling is at the core of the patient-physician relationship and crucial for the information exchange process. Patients generally have a right to accurate medical information. It is a rare occasion when lying to a patient is justified. Veracity, like confidentiality however, does not function well as a moral absolute. Telling the truth in the patient-physician relationship is not always in the best interest of the patient’s mental or physical health. Whereas providers are bound to veracity, they are also bound to nonmalefience.

Role Fidelity

A major problem with applied ethics is that many written and unwritten codes influence or guide human behavior. In the health professions of licensed caregivers, codes of ethics that define acceptable and unacceptable behavior are general with vague performance standards making enforcement difficult, if not impossible. Even vigorous enforcement, however, only guides those seeking to do the right thing but who need help determining what that is. Someone at the fringe of a profession is dissuaded neither by principles of ethical conduct nor by legal requirements. Discretion in this context is one who has the authority to act according to his or her judgment. The public trusts the licensed caregiver to not abuse his or her exercise of discretion and cause harm. Because the discretion that accompanies nurses, physicians, therapists, and other licensed caregivers in their jobs is most often under their control, they face a variety of ethical issues. These issues range from uncaring behavior, patient sexual abuse, self-referral, to permitting peers to practice medicine while impaired.