Introduction
The case under analysis addresses a highly essential issue of ethics in medical settings. According to it, a new patient, Janine, is HIV positive and should be treated with full respect as prescribed by the ethical standards of the College of Nurses of Ontario (CNO). However, it was discovered that she had had a sexual relationship with the RPN’s close friend, who was unaware of her health condition. Therefore, the possibility of a man’s infection has become a disturbing problem. This paper explores the case’s ethical dilemma, the governing bodies’ approaches to it, the most appropriate course of action, and the RPN’s personal attitude to this situation within the framework of ethics and morality.
Ethical Dilemma
In general, an ethical issue occurs when a health care provider’s moral and professional values and principles conflict, creating an ethical dilemma. On the one hand, Janine should be treated in accordance with the ethical principles of beneficence and nonmaleficence (Varkey, 2020). In other words, healthcare delivery should respect the patient’s human rights and minimize potential harm.
In addition, one of the most significant ethical principles reflected in the CNO and the Canadian Nurses Association (CNA) codes of ethics that should be applied to this case is respect for a client’s privacy and confidentiality. According to CNO’s practice standards concerning health care providers’ ethical conduct, “all information relating to the physical, psychological, and social health of clients is confidential, as is any information collected during providing nursing services” (College of Nurses of Ontario, 2019, p. 7). Patient data may be shared with other team members who are responsible for the delivery of health care. However, a patient should be initially informed about the necessity of this decision, and all healthcare providers are obliged to keep information confidential as well.
Other governing bodies also address ethical implications related to patients’ confidentiality. Thus, according to the Code of Ethics for Registered Nurses (2017) issued by the Canadian Nurses Association (CNA), “nurses recognize the importance of privacy and confidentiality and safeguard personal, family and community information obtained in the context of a professional relationship” (p. 14). Therefore, in the case of Janine, the RPN’s professional obligations prescribe the provision of health care without the disclosure of the patient’s private information related to her HIV status to individuals who are not members of health care teams, including the clinician’s friend.
On the other hand, the ethical dilemma is created by the case’s personal moral obligations and factual peculiarities. Therefore, maintaining the confidentiality of data that may impact a close person’s life, especially if he has an intention to continue sexual relationships with an HIV-positive person, is morally wrong. In addition, the disclosure of Janine’s information may be justified by law as it may result in considerable physical and psychological harm to another person (College of Nurses of Ontario, 2019).
This rationale is supported by Section 40(1) of the Personal Health Information Protection Act, 2004, S.O. 2004, c. 3, Sched. A: “A health information custodian may disclose personal health information about an individual if the custodian believes on reasonable grounds that the disclosure is necessary for eliminating or reducing a significant risk of serious bodily harm to a person or group of persons” (Ontario, n.d., p. 30). In this case, the RPN’s friend should be aware of Janine’s HIV status and the possibility of infection.
The current ethical dilemma may be regarded as the conflict between deontological and consequential ethical theories. According to deontology, duties should be followed regardless of their consequences. Therefore, Janine’s HIV status should be confidential as prescribed by medical ethics (Biagetti et al., 2020). In turn, consequentialists believe that only the consequences of actions should be considered. In this case, information disclosure would be beneficial for all parties, as the friend would be aware of Janine’s and probably his own HIV status, and the woman would nevertheless receive necessary care.
Course of Action
Ethical situations in nursing require time-sensitive and efficient responses, as the consequences of issues may be detrimental for patients and others. CNO identifies several essential steps of ethical problem management, including assessment, plan, implementation, and evaluation (College of Nurses of Ontario, 2019). When an ethical dilemma occurs, healthcare providers should collaborate to examine all possible variants of actions, develop a course of action, apply it, and correct it in the case of inefficiency.
In the case of Janine, the RPN should initially inform the patient that information about her HIV status will be disclosed to healthcare team members responsible for healthcare delivery. At the same time, following ethical standards, her personal data should remain confidential. Subsequently, the healthcare provider should consult with other professionals and the clinic’s authorities, informing them about an existing ethical dilemma.
Clinicians should address ethical standards and Canadian legislation to define whether particular circumstances make information disclosure possible without a patient’s consent. However, this option may be considered emergent, and Janine’s informed consent is preferable. In other words, as a patient has a right to control her personal data, she may be allowed to disclose it to the RPN’s friend. In this case, an ethical dilemma will disappear.
Therefore, the next step should be a conversation with Janine, as she should understand why her permission is important. The consequences for her ex-partner’s health and the possibility of legal prosecution in the case of her intentional harm should be explained. The outcomes of this plan should be evaluated based on Janine’s response. If the patient agrees to disclose, the plan is efficient. Otherwise, the disclosure of HIV status without the patient’s permission should be considered.
Reflection
Analyzing this case, I clearly understood the significance of an ethical dilemma and its appropriate resolution. The RPN and my value system would be tested in the same situation. On the one hand, I realize the necessity to act professionally.
On the other hand, my personal values would not allow me to harm my close friend by keeping particular information confidential. At the same time, I am fully satisfied with the proposed solution as it allows healthcare providers to act both professionally and morally. I will apply the same algorithm of actions if I face the necessity of approaching similar situations in the future.
Conclusion
The case of Janine demonstrates an ethical dilemma in health care based on the conflict between moral and professional values. On the one hand, ethical standards prescribe respect for a patient’s confidentiality. On the other hand, this confidentiality may lead to emotional and physical harm to other people. Therefore, to stay professional and consider moral principles, health care providers should collaborate to examine the current situation and apply strategies to persuade the patient to give her permission for information disclosure.
References
Biagetti, M. T., Gedutis, A., & Ma, L. (2020). Ethical theories in research evaluation: An exploratory study. Scholarly Assessment Reports, 2(1), 1-9. Web.
Canadian Nurses Association. (2017). Code of ethics for registered nurses. Canadian Nurses Association. Web.
College of Nurses of Ontario. (2019). Practice standard: Ethics. College of Nurses of Ontario. Web.
Ontario. (n.d.). Personal Health Information Protection Act, 2004, S.O. 2004, c. 3, Sched. A. Ontario. Web.
Varkey, B. (2021). Principles of clinical ethics and their application to practice. Medical Principles and Practice, 30(1), 17-28. Web.