In regards of modern biomedicine, ethics in the course of professional activities of medical staff is complex and requires a high level of moral consciousness of every healthcare worker. Relationship of nurse with patients and colleagues should be built in accordance with the principles of biomedical ethics. Such a requirement is documented in international codes of nurses. The peculiarity of medical ethics is that all of its norms and principles are focused on the evaluation of a person’s health, its improvement and conservation. The expression of these rules was originally enshrined in the Hippocratic Oath - the starting point for creating other medical professional and moral codes. As a result, more than eighty years ago, the Nightingale Pledge was created. During her work, nurse encounters various ethical issues considering her relationship with colleagues, patients, and their relatives (Butts & Rich, 2013). However, the most important of them is the problem of medical confidentiality, which is closely connected to the rule of doing no harm to the patient, and is yet to be addressed to the full extent. Therefore, the following research is dedicated to the study of the ethical issue of medical confidentiality in nursing practice, definition of its impact on all the participants of the medical system and the proposition of a set of recommendations for addressing the problem.
Analysis
A Description of the Issue
Medical confidentiality as an integral and mandatory part of medical practice is one of the most important principles of professional medical ethics. Ethical norms of society suggest that everyone should keep a secret entrusted to him by another person. However, the concept of special importance of the “secret” is in the field of medicine, where the information about the patient, his present state of health and prospects, and often about his future are intertwined. In modern medical law, medical confidentiality concerns all information obtained from the patient or detected during treatment or medical examination that cannot be disclosed without patient’s consent. With the accordance to nursing code of ethics, nurse should keep secret the information about health of a patient, his diagnosis, treatment, prognosis of the illness, as well as the intimate life of a patient even after his death. She may disclose confidential information only with the consent of the patient. In all cases, the nurse (as well as the other medical workers) carries the personal moral and sometimes legal responsibility for the disclosure of professional secrets (Butts & Rich, 2013).
Impact on Healthcare Organizations
The issue of medical confidentiality is especially important for healthcare organizations since it serves as one of the pillars of their credibility. Therefore, there is a variety of measures aimed at the prevention of information leak. However, the content of medical confidentiality is different, depending on the subject to which it is known. For example, persons who directly provide health services to the patient possess the fullest information about him. Such subjects may access the greatest amount of medical data and information about private life of the patient (doctors and nurses). All other persons that are obliged to medical secrecy, as a rule, have largely limited information, isolated and disconnected facts, which, nevertheless, may be of a significant importance for the patient. For example, the driver of the ambulance car may know the diagnosis of the patient and his home address, and technical worker is aware that the patient is in a particular ward. Typically, healthcare workers who do not directly provide medical services to the patient know such medical data as diagnosis; diagnosis means seeking medical help in the establishment of a specific profile (McHale, 2003). As a result, controlling all the people who have access to confidential medical data is rather difficult and adds to the challenges healthcare organizations have to face.
Impact on Patients and Their Relatives
The issue of medical confidentiality has a significant impact both on patients and their relatives. Doing no harm is the main rule of any medical activity and nurses often have to keep the diagnosis of the patient in secret even from him (especially in the case of incurable illnesses), disclosing the false information. Such a practice is called “white lies” and is implemented in order to prevent the development of depression or the attempts of suicide. However, despite the large number of the cases of incurable or terminal illnesses, there is no clear opinion on disclosing the diagnosis to the patient. For example, the experience of work with cancer patients suggests that the problem of disclosure often relates not to a sick person, but to those who surround him/ her. As a result, many patients are worried not because they know their diagnosis, but due to the fact that it will be known to other people – wives, husbands, relatives or colleagues. These are the main recipients from which patients would like to hide it in order to avoid problems in the family life or relationships with people that are close to them (McHale, 2003).
Critical Evaluation of the Issue
There is no doubt that medical confidentiality must be strictly preserved by all healthcare workers. However, many ethical problems that arise due to the confidentiality of medical information are yet to be solved. For example, there is an issue of disclosure of the confidential information by medical worker if there is a threat to well-being or life of other people. In this regard, Tarasoff case that got its name by the name of a woman killed at the hands of the mentally ill person is of particular interest. Its history dates back to 1969, when a young man with an obsessive need to commit sexual homicide was observed by specialists, and, moreover, confessed his intentions to them. Despite the fact that police was notified of the possibility of a crime, the potential victim was not warned because of ethical issue of medical confidentiality. However, it is clear that ethics should never stand in the way of protection of the human life. Currently, a variety of laws in North American states leads to the fact that in one state, the nurse (or any other medical worker) is obliged to warn a potential victim of his patient of impending danger while the disclosure of confidential information can be punished (Fletcher et al., 1995). As a result, healthcare organizations are obliged to follow the letter of the law adopted in the area where they are engaged in medical activities.
Significance of the Issue
The issue of medical confidentiality is of paramount significance for the practice of healthcare administration as all healthcare facilities operate using the same principle of respect for the patient’s rights and dignity. Ethical requirements of doing no harm to the patient and preserving medical confidentiality are a manifestation of respect. As a result, everything that relates to the confidentiality of the fact of seeking medical care, health status, diagnosis and other information obtained during examination and treatment are among the fundamental rights of the patient. As it was already mentioned, nowadays, there are many subtleties and nuances in the legislation related to the issue of confidentiality, as well as many mistakes of the medical personnel; there is a tendency of their reduction, as healthcare organizations fear of losing credibility and prestige (especially private ones) and try to boost the confidence of patients in gaining access to medical facilities instead of conducting self-healing (McHale, 2003).
Recommendations
Therefore, it is possible to provide a set of recommendations to address the issue of medical confidentiality in the nursing practice.
First of all, it is important to create and maintain a trusting relationship between all parties engaged in medical activity. Nurses, as well as the other workers, must understand that compliance with medical confidentiality helps to create an atmosphere of trust in the relationship between health professionals, patients and their relatives. Any insincerity and disclosure of confidential information is a disregard for the confidence placed in health care workers to people applying to them for help (Butts & Rich, 2013).
The processes of differentiation and specialization in the field of medical science and practice, the implementation of new biomedical technologies, and computerization of medicine have affected the process of receiving, storing and transmitting information about the patient during treatment and diagnostic. In such circumstances, maintaining the secrecy of confidential information is possible only in the presence of a high level of responsibility and ethical literacy for all healthcare workers included in the diagnosis, treatment and rehabilitation processes (McHale, 2003).
Finally, it is important for the nurses to be familiar with the medical legislation of the state where they are engaged in medical activities in order to know how to act in the particular situation because, as it was mentioned before, the disclosure of medical confidential information may help in preventing a crime.
Conclusion
Medical confidentiality as a part of medical ethics has become a reality in daily nurse practice. Thus, whether or not the medical confidentiality is preserved, it is applied to the professional duty of the medical worker. Of course, legislation encourages and imposes stronger responsibility about medical confidentiality and privacy of the patient than internal promptings of healthcare personnel, both to moral and psychological detriment as huge responsibility lies on the shoulders of these people. However, as in the case of any ethical issue, the nurse should first listen to the voice of conscience.
References
Butts, J. B., & Rich, K. L. (2013). Nursing ethics: Across the curriculum and into practice (3rd ed.). Burlington, MA: Jones & Bartlett Learning.
Fletcher, N., Holt, J., Brazier, M., & Harris, J. (1995). Ethics, law and nursing. New York, NY: Manchester University Press.
McHale, J. V. (2003). Medical confidentiality and legal privilege. New York, NY: Routledge.
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