Ethical Dilemma Case Study: Patient Privacy

As Paul’s case manager, I would first and foremost feel sorry for Paul and his family. I would very much regret any embarrassment this unfortunate incident may have caused a young diabetes patient to experience through no fault of his own, especially when he is already experiencing issues with his health. There would also be remorse on my part because this would not have happened had I not sent out an abnormal email as a result of me being in a rush. The situation likely would have been avoided, or significantly mitigated, had I sent an email simply following the direct instructions of the physician. The doctor asked me to reach out to Paul’s family and ask them to come into the office to have an evaluation. In this scenario, even if Lilah still got ahold of the computer and forwarded the email, it probably would not have been nearly as embarrassing for the family to have their friends and colleagues read that they need to schedule a discrete and even potentially routine appointment with their doctor. Instead, there is the implication that Paul’s family is not doing the best that they can to manage their son’s health. Overall, I believe I would feel a significant amount of regret and responsibility for what happened, even if I was not the one who sent the email to the family’s mailing lists.

The overarching problem in this scenario is the violation of the patient’s privacy. Personal information regarding his care was distributed to an untold number of people without his and, perhaps more importantly given his age, without his parents’ consent. Furthermore, the nature of the information contained in the email creates an additional problem. The message reviewed how critical is for his parents to keep Paul’s diabetes in check, which may suggest to others not intimately familiar with Paul’s case that his care is being neglected. That suggestion is further implied by the mention that the family has not checked in with me as the case manager for longer than usual. Finally, the email makes mention of the family’s counseling sessions, which may have been something the family had been keeping private and not sharing with the members of their diabetic communities. Ultimately, the email’s contents were overwhelmingly personal, and the family had the right to expect their information to remain private.

There are several ethical principles at play in this scenario, including many which have seemingly been violated, albeit unintentionally. Caregivers are to respect the autonomy of their patients, allowing them the freedom to make decisions as they see fit; in this case, Paul’s family lost control over what information they chose to share with those in their community. Furthermore, caregivers must practice beneficence by doing right for their patients, and nonmaleficence in not harming their patients (Silva & Ludwick, 1999). While no physical harm was caused to Paul, there may be emotional repercussions he will have to contend with. Furthermore, both confidentiality and healthcare privacy have also been unintentionally violated.

To solve the problem, I would first collect all the pertinent facts and data about the situation as I examine the dilemma. Using the Ethical Model for Ethical Decision Making, I would figure out what I must decide: in this case, how to best solve the family’s problem. I would determine who else needs to be involved in the decision-making process to handle the issue, and I would find it pertinent to include the physician who is treating Paul and his family. Unfortunately, in this scenario, the damage has already been done and cannot be reversed, making it more difficult to determine how to go about generating the greatest good for those affected.

Two ethical principles of caregiving seem most appropriate for guidance in resolving this problem. First, I would use veracity and be very truthful and forthcoming with Paul’s family. I would explain exactly what happened and discuss the factors that led me to believe a lengthy e-mail with personal information was appropriate to send. I’d also use fidelity and show loyalty to the patients and hold myself accountable for my actions (The American Nurses Association, 2001). While the overall situation is not ideal, it does seem like the damages could be mitigated with honesty, responsibility, accountability and continued dedication to providing Paul with outstanding care to best manage his diabetes.

References

Silva, M.C. & Ludwick, R. (1999). Interstate nursing practice and regulation: Ethical issues for the 21st Century. Online Journal of Issues in Nursing, 4(2).

The American Nurses Association. (2001). Code of ethics for nurses with interpretive statements. Retrieved from http://www.nursingworld.org/MainMenuCategories/EthicsStandards/CodeofEthicsforNurses/Code-of-Ethics.pdf.