When a question of confidentiality arises because a person (in this paper, Mrs. Z) does not want her family to know about the cancer that a doctor has discovered, there must be a solution. And that solution must be measured based on the best possible outcome for the patient. This paper uses several ethical theories to bring into focus all the dynamics that are part of the search for the best ethical solution.
Advanced Nursing Ethics and Values
(b) Justify the importance of ethical theory -- provide one example: The use of virtue ethics, according to the peer-reviewed Business Ethics Quarterly, is a way of providing resources for "moral thinking"; and for nurses that understand and apply virtue to their work have the background and knowledge as to what to do (that is moral) in any situation (Audi, 2012, p. 273). The virtuous nurse must have beliefs that can be shared and learned by those around the nurse, and there are six dimensions to Audi's approach: a) in the field of work, virtue ethics emphasizes "how one reaches it"; b) the target for virtue ethics in nursing is the "well-being" of others; c) the beneficiaries of virtue ethics are those benefiting from nurses' professionalism; d) a good nurse is a leader with high levels of intellect; e) virtue ethics calls for a nurse's motivation to contribute to others' health; and f) the carrying out of virtue ethics is the grounding of conduct (Audi, 275).
(c) The principle of confidentiality vs. reasonable limits
ONE: Explain the elements of the principle of confidentiality: According to Nursing World the principles of confidentiality include: a) a patient's right to privacy regarding health information; b) a patient's right as to disclosure of -- and access to -- health information; c) a patient's right to supplement his or her health information; d) a patient needs to know how health records are used, and those records cannot be disclosed without patient consent; e) safeguards should protect the health information; f) violations of health information should have penalties; and g) federal legislation should be enforced to protect confidential health information (Nursing World).
TWO: Summarize the concept of reasonable limits: there are moral limits that are placed on individuals and nurses in a healthcare setting; at what point does the patient refuse medical intervention (even though it is intended for the patient's welfare) and at what point does the nurse make an autonomous decision notwithstanding the patient's resistance? (Fry, et al., 2010). THREE: A rationale for breaking confidentiality: There will be circumstances during which the professional nurse believes what the patient needs conflicts with confidentiality. If the patient's health is in jeopardy, as is the case in the scenario for this paper, confidentiality can be violated (Fry, 164). FOUR: Reasonable limits apply in most cases because laws require the healthcare sector to honor confidential patient information, but when a woman has breast cancer the healthcare professional is obliged to break confidentiality to save the patient's life.
(d) Identify how to solve conflict between two or more ethical principles
ONE: an ethical principle that is in conflict if confidentiality is broken is Moral Particularism (an action that involves the breaking of a promise is one that "counts against" morality in any given case) (Stanford Encyclopedia of Philosophy). TWO: an ethical theory that supports a decision to break confidentiality is Utilitarianism. In order to determine which course of action is right, using Utilitarianism (the policy that "…would bring about the greatest net benefits to society…" or, would provide the greatest good for the greatest number" of people), and the greatest good will come from letting the patient's family know that she has cancer. (Andre, et al., 2008).
(e) Discuss the influence of culture on values
ONE: The cultural values of Mrs. Z allow that when she is being attended by a female doctor, her family does not need to be in the room during the consultation. Mrs. Z fears the truth about her problem, and her family should know, but the American cultural (and legal) approach to healthcare decisions protects Mrs. Z's privacy in this matter. This presents a conflict of values based on different cultural approaches to values. TWO: Nursing interventions that could resolve this ethical conflict: Moral Particularism is a concept in which moral principles "…are at best crutches that a morally sensitive person…" does not in every instance require (Stanford Encyclopedia of Philosophy). In other words, confidentiality may be an ethical/legal value that applies in healthcare settings but when it comes to a question of life or death, and a woman is obviously hiding the truth from her family (and putting her life in jeopardy), the overriding principle for a nurse is to protect health and save lives.
A second intervention is found in the Clinical Journal of Oncology Nursing. The nurse is always responsible and accountable for practicing ethically, and she herself determines the "appropriate delegation of tasks, consistent with the nurse's obligation to provide optimum patient care" (Cohen, 2006). In other words, the nurse can, through "individual and collective action," intervene in a situation where life and death of a patient hang in the balance. Nurses face intense ethical challenges in order to live up to their professional duties, and some nurses do have "difficulty recognizing and articulating" those duties and responsibilities (Cohen). When there is moral uncertainty a nurse can and should determine the ultimate appropriate intervention to save lives, according to Cohen.
(f) Identify one model of ethical decision-making that a masters-prepared nurse would embrace while delivering healthcare services.
ONE: what are the steps in the ethical decision-making model? In a Nursing Ethics / PubMed article ("An integrated ethical decision-making model for nurses") the author presents six steps. These six steps are based on a careful review of twenty ethical decision-making models that the author critiqued and reviewed. They are: a) carefully identify the ethical problem; b) collect addition information in order to identify the problem from more than one perspective and begin to create potential solutions; c) come up with alternative solutions as a way to compare and analyze what should be done; d) select the best alternatives and be able to justify the selection of those alternative solutions; e) develop "…diverse, practical ways to implement ethical decisions and actions"; and f) from the careful evaluation of effects and from the "development of strategies" a masters nurse may then use those strategies to prevent a "similar occurrence" (Park, 2012).
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