Description of Dilemma
The patient, Mr. Smith, is a 55-year-old male who visits the clinic with symptoms of a condition that is possibly life-threatening. After a thorough evaluation and the ordering of relevant diagnostic tests, the nurse provides Mr. Smith with the grave news that he has been confirmed to have terminal cancer. Upon receiving the diagnosis, Mr. Smith was visibly distressed and began to cry (Usberg et al., 2021). In the heat of his emotional anxiety, he trusts the nurse to convey his adamant desire to conceal this knowledge from his family, including his wife and kids.
On the one hand, the nurse recognizes Mr. Smith’s right to make health care decisions and respects his autonomy to control knowledge about his medical situation. On the other hand, the nurse is aware of the potential benefits of involving his extended family as caregivers, such as emotional support, assistance with decision-making, and coordination of services. In addition, the nurse acknowledges an ethical commitment to act in Mr. Smith’s best interests, which may entail informing his family members of his status.
As nurses struggle with this issue, they understand the deep ramifications of their choices. While fulfilling Mr. Smith’s request for discretion may relieve his suffering in the moment, it may also prevent him from accessing vital care systems and impede the establishment of a holistic care plan (Usberg et al., 2021). Conversely, disclosure of the diagnosis to his extended family members without his permission could compromise his trust and autonomy, which could be potentially detrimental to the ongoing therapeutic relationships.
Ethical Principle and the Law
Autonomy is an evolving ethical principle that emphasizes the right of human beings to decide on their own personal health care and to have their choices respected. In the present case, Mr. Smith’s autonomy is central to his medical decision-making (Usberg et al., 2021). He expressly stated his desire to hide information about his status from his family by arguing that he has the authority to control information about his condition and care.
There is also HIPAA, a federal law that sets guidelines for the security of health records and protects their privacy and confidentiality. In this scenario, disclosing Mr. Smith’s treatment to his family without his authorization would violate HIPAA’s rules on the confidentiality and security of patients’ health records (Moore & Frye, 2020). A violation of HIPAA’s privacy rules, such as disclosing Mr. Smith’s medical condition to his family without his authorization, could subject you to criminal penalties and civil fines (Moore & Frye, 2020). Depending on the gravity of the offense and related circumstances, the ramifications can range from civil enforcement, such as monetary penalties by the Department of Health and Human Services (HHS), to criminal prosecution if the offense is deemed intentional or flagrant.
Decision
To preserve integrity and avoid ethical and legal infractions, the FNP must prioritize open discussion with the patient and recognize their autonomy. Have a careful discussion with the individual, highlighting the importance of helping the family manage their disease and addressing any concerns they have about disclosing the diagnosis (Usberg et al., 2021). Request a meeting with the family, during which the person can independently disclose the condition with the assistance of the health care provider. The discussion and the patient’s decision-making should be documented in the patient’s health record to ensure HIPAA regulatory compliance.
Recommendations
It is important to provide continuous education and assistance to advanced practice nurses (APNs) in making ethical judgments. This education should involve learning about different ethical frameworks, guidelines, and practices relevant to clinical practice. Workshops, seminars, and online courses can offer APNs opportunities to enhance their ethical argumentation skills and examine ethical dilemmas in a supportive learning environment (Kleemola, 2021). Furthermore, making ethics consultations or briefings available enables APNs to seek direction and assistance from skilled research ethicists or coworkers when they encounter challenging situations. These sessions can help APNs process moral suffering, clarify ethical accountability, and identify spiritually sound responses to complex clinical settings.
Encouraging cross-professional communication is essential to addressing ethical issues effectively. By fostering collaborative partnerships with other health care professionals, such as caseworkers, ethicists, therapists, counselors, and chaplains, APNs can bring a wide range of perspectives and experiences to bear on complex clinical questions (McMichael & Markowitz, 2023). Multidisciplinary group meetings provide an opportunity for an APN to share ideas, gain input from colleagues with diverse backgrounds, and work together to develop holistic treatment programs that emphasize patient well-being while adhering to ethical guidelines.
Establishing clear organizational rules and directives is important for providing APNs with a foundation for ethical judgment and ensuring consistent practices. These statements should include key ethical values such as autonomy, compassion, benefit, and justice, and outline processes for managing confidential data, honoring patient agency, and adherence to legal and ethical principles.
Training classes and educational materials should be available to ensure that APNs are comfortable with the policy and aware of their ethical obligation in clinical settings (Kleemola, 2021). Furthermore, establishing ethical oversight arrangements, such as committees of inquiry or review committees, can provide APNs with the resources and support to address difficult ethical challenges and advance ethical integrity within the institution.
References
Kleemola, E., Leino-Kilpi, H., & Numminen, O. (2020). Care situations demanding moral courage: Content analysis of nurses’ experiences. Nursing Ethics, 27(3), 714-725.
McMichael, B. J., & Markowitz, S. (2023). Toward a uniform classification of nurse practitioner scope of practice laws. Medical Care Research and Review, 80(4), 444-454.
Moore, W., & Frye, S. (2020). Review of HIPAA, part 2: Limitations, rights, violations, and role for the imaging technologist. Journal of Nuclear Medicine Technology, 48(1), 17-23.
Usberg, G., Uibu, E., Urban, R., & Kangasniemi, M. (2021). Ethical conflicts in nursing: An interview study. Nursing Ethics, 28(2), 230-241.
