Ethical_Framework

Ethical Frameworks in Practice Jeananne S. Reed Grand Canyon University Ethical Decision Making in Health Care NRS437V Michelle Silvers, MS, RN, CEN July 17, 2011 Ethical Frameworks in Practice Being entrusted with information is honorable. But what if the promise of holding information could bring harm or deleterious consequences' This is an ethical dilemma frequently incurred by nurses. What are the implications when a decision calls to breach or not to breach' In the article: “Bitoethics on NBC’s ER: Betraying Trust of Providing Good Care When is it ok to Break Confidentiality',” Nurse Hathaway suffers such a dilemma when faced with exposing the cervical cancer diagnosis of a 14 year girl, Andrea, as well as “sex parties” reported to her by Andrea (Nathanson, 2000). Implications The implications of a breach of confidentially are many. Ethical principles such as fidelity: the duty to keep one’s promise, veracity: the duty to tell the truth, and confidentiality: the duty to hold entrusted information (Silvers, 2011) are plainly violated in a in a breach. The violations could result in detrimental clinical consequences such as failure to seek care by the patient in addition to showing disrespect for individual privacy and autonomy rights by the clinician. But perhaps no consequence is as detrimental as the feeling of betrayal affecting both the patient and the nurse. According to Julie Fitness, the feeling of betrayal is experienced at a visceral level not a cognitive one (Fitness, 2005). Other studies suggest pain and hurt are amongst the first and most acute emotional reactions to the awareness that one has been betrayed. Betrayal also instills guilt in the violator. Given the volatile emotional state of teenagers, a breach could alter any helpful interventions and effect positive outcomes. Theories and Principles In order to provide interventions that produce an amicable outcome a review of theories and principles can be addressed. First, a dilemma arises when there is a situation and another situation desires to be achieved. Theories and principles provide a “moral compass.” In this case, the patient is a minor. While most states recognize that minors may be cared for confidentially with regards to birth control, treatment for cases such cervical cancer requires parental consent (The Curators of the University of Missouri, 2011). Additionally, “sex parties” are high risk behaviors. A multitude of deleterious consequences could result from teen “sex parties” such as HIV, pregnancy, and even suicide. It is without a doubt that Hathaway needs to address the principles of beneficence: the duty to do good, veracity: the duty to tell the truth (to the parents and the school), and utility: the greatest good or least harm for the greatest number (Silvers, 2011). Reasonable Alternative Given that Hathaway did inform the parents, there is no reasonable alternative for this breach. There could be alternatives in processing the betrayal with Hathaway expressing her nursing position with sincerity and compassion. The decision making process involved in this alternative would be to involve Andrea in predicting and examining all of the consequences involved in not telling her parents verses telling her parents. This would allow Andrea to be treated with respect and perhaps alleviate the feeling of being betrayed. It could help Hathaway feel as if she had done the best she could, thus mitigating her guilt. In the case of the school, an alternative approach could be for Hathaway to address the “sex parties” issue. By bringing the issue to the school’s attention, Hathaway would be fulfilling her duty and obligations of utility. Alternatives of not telling could result in continued practice of the “sex parties” with harmful outcomes. A plan could be for Hathaway to organize a program target to this issue for the school to implement. Ethics Committee A plan targeted to the “sex party” issue may be one of the alternatives recommended by an ethics committee in this dilemma. While not informing the parents is really not a choice in this issue, informing the school is. Ethics committees are composed of different disciplines in the community (Burkhardt & Nathaniel, 2008). In this case, teachers and other representatives from the educational system might be on board. Since teachers are amidst the teenagers on a daily basis, their input on possible alternatives would be invaluable. By collaborating about who is involved, what alternatives are available, and exploring strategies, the committee could use their expertise in formulating reasonable recommendations. Being approached by an ethics committee with recommendations for a plan of action could serve to make the school accept that the problem exists and invoke the need to take action. Many middle schools regard student sexual issues as non-school responsibilities. In conclusion, ethical dilemmas such as the one discussed are unavoidable in nursing. Some of the dilemmas escalate to moral distress, moral outrage, and moral reckoning. As a means of anticipating and dealing with moral problems in the workplace, Burkardt and Nathaniel state “nurses should purposefully utilize nursing ethics (Burkhardt & Nathaniel, 2008 p.143).” Nurses are fortunate to have the tools of codes of ethics, ethical theories, and ethical principles to aid them in their decision making processes. If used, these tools can be a blessing in determining matters such as to breach or not to breach giving nurses more security and confidence throughout their journey in practice. References Burkhardt, M. A., & Nathaniel, A. K. (2008). Ethics & Issues in Contemporary Nursing (3rd Edition ed.). Clifton Park, NY: Delmar. Fitness, J. (2005, January 18). Betrayal, Rejection, Revenge, and Forgiveness: An Interpersonal Script Approach. Retrieved July 16, 2011, from Macquarie University. Nathanson, P. G. (2000, February 24). Betraying Trust of Providing Good Care When is it ok to Break Confidentiality' Retrieved July 16, 2011, from Bioethics.Net: hptt://www,bioethics.net/printer.php'aid=133 Silvers, M. (2011). NRS 437V Lecture Three. Retrieved July 16, 2011, from Grand Canyon University. The Curators of the University of Missouri. (2011, June 10). The Center for Health Ethics - University of Missouri School of Medicine - Treating Minors. Retrieved July 16, 2011, from Center for Health Ethics: http://ethics.missouri.edu/Treating-Minors.aspx