Ethical Interview 1

Running head: Toughest Ethical Experience

Toughest Ethical Experience

Sarah Janisse

St. Clair College – Thames Campus

PNR 313G SCC

Ethical and Professionalism

Prf. James Mears

Submitted: November 23, 2010

Toughest Ethical Experience

The Interview

M.B. is a recent graduate from a University in Michigan, U.S.A., with his BSN, RN. His

toughest ethical dilemma took place during his clinical studies at a local teaching hospital. M.B.

was caring for a middle aged man (Patient X) on a surgical floor, who just recently had

orthopedic surgery. While reviewing the patient’s health history with his preceptor, M.B. was

informed that Patient X is HIV (human immunodeficiency virus) positive, and that his wife and

loved ones are not aware of this fact. M.B was shocked, and asked if Patient X planned on

informing his wife of his condition, which by rights of marriage could very well be transmitted

to her. HIV is the predecessor of AIDS (acquired immunodeficiency syndrome), though it is no

longer considered the death sentence that it once was, it is still a life threatening chronic

communicable disease.

Health Insurance Portability and Accountability Act (HIPPA) states that M.B. is

restricted from disclosing Patient X’s confidential personal health information. This is not

limited to family members. HIPPA includes punishments (fines, suspension or revoking of

license, even jail time) for anyone caught violating patient privacy. This includes, interacting

with the patient’s family members in ways not authorized by the patient. (Taylor Lillis LeMone,

2005).
 Ethical Interview 4

M.B. felt torn between what he believed to be right (informing the wife) and what his

profession believes to be right (protecting patient confidentiality). This is what M.B. considered

to be his toughest or most difficult ethical experience. M.B.’s values are similar to his religious

beliefs (Catholic), in many ways he believes in the divine command theory but also incorporates

Socrates’ healthy soul, he believes in balance, and as a nurse he values life and the preservation

of it. The above situation impacted M.B’s ethical views because he had to make a choice. He

could either act deontologically (tell the wife the truth, even if it results in negative consequences

for himself, and his client) or be a utilitarian (say nothing to the wife, suffer through his moral

anguish, to move on, and continue on to a lucrative nursing carrier)

Assess the options

The choices M.B. felt he had are as follows:

1.) Inform the wife that she is at risk for contracting HIV from her husband. If she has not

already.

2.) Try to persuade /convince the husband to tell his wife that he is HIV positive. Though

this could lead to the patient believing his caregiver is bias feelings towards him, and may

not provide the most optimal care.

3.) Consult with preceptor, nurse manager / charge nurse on what course of action can be

taken lawfully, conduct research to support actions and thoughts; work with hospital

Ethics Committee to find a reasonable solution.

4.) Do nothing, and move on.

The Decision

M.B. chose to consult with his superiors to find a better course of action than doing

nothing. He reviewed the resources that were available to him: HIPPA and the American Nurses

Association’s code of ethics to see if he had any leeway in what information he could and

couldn’t divulge considering the parties and circumstances involved (appendix A). M.B. reported

this case, and what ethical information/resources he found to the hospitals ethics committee and

it was left in their hands to sort out. M.B. has never come across a situation that was similar to

this one before or after the incident. If he does he hopes that some amendments are made to

HIPPA to protect innocent bystanders like Patient X’s wife; allowing him to follow his own

moral code, without being fined, losing his title or job.

There are seven different ethical theories involved with this situation. The right to

autonomy was upheld for Patient X, he chose not to disclose pertinent information to his wife

and M.B. respected this right. Deontology was not used; M.B. did not tell the truth to the wife at

any cost; although this was a possible choice. Utilitarianism was carried out specifically act

utilitarianism, by not informing the wife it protected M.B.’s job and Patient X’s right to

autonomy. Had rule utilitarianism been a factor here M.B. would have informed the wife of her

husband’s HIV and possibly stopped the spread of a communicable disease, therefore resulting in

the greatest good for the greatest number with a long term aspect. M.B. fulfilled his duty and

complied with HIPPA. Though this was not a very good example of beneficence, when

considering the wife’s wellness. Virtue Ethics were evaluated in this situation, the virtue of M.B.

and Patient X were both explored, Patient X’s right to confidentially was abided. (McLachlan,

2010)
 Ethical Interview 6

When observing the options that M.B. had in this case and scenario and the different

ethical/professional obligations that were faced, it is easy to see why he states this situation, as

his toughest ethical experience. M.B.’s Locus of Control was pulled both internally: the fact that

he really wanted to be true to his own morals and values and tell Patient X’s wife that her

husband is HIV positive; and externally: M.B.’s obligations to his profession’s confidentialty

acts and standards. It was the external Locus of Control that ruled out in the end, M.B. did what

he could to support the wifes right to know if she is or could become HIV positive; without

faring any reporcussions including legal ramifications through HIPPA onto himself. (HIPPA,

1996)

If put in the same situation, initialy I would think of trying to convince Patient X to talk

to his wife, though now upon further evaluation, I would not want the patient to assume that I

may be bias towards him. The perfect senerio would be to work with the appropriate people to

have this exception added to HIPPA. But in reallity I would probubly come to the same

conclusion that M.B. did. Which goes against my moral fibre, and my goals of non-malifficence

and benifficance in my professional practice; but sometimes you have to make the best choice

out of two bad choices (Ethical Distress) and mine here, would be to do what is in my power to

help the wife, but ultametly self preservation.

Appendix A

American Nurses Association Code of Ethics

Code of Ethics for Nurses with Interpretative Statements:

“The standard of nursing practice and the nurse’s responsibility to provide quality care

require that relevant data be shared with those members of the health care team who have

a need to know. Only information pertinent to a patient’s treatment and welfare is

disclosed, and only to those directly involved with the patients care. Duties of

confidentiality, however, are not absolute and may need to be modified in order to protect

the patient, other innocent parties and in circumstances of mandatory disclosure for

public health reasons. (Nursing World, 2010)

Refrences

HIPPA. (1996). HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT of 1996.

Retrieved November 22, 2010, from HIPPA Public Law 104-191:

https://www.cms.gov/HIPAAGenInfo/Downloads/HIPAALaw.pdf

McLachlan, J. A. (2010). Ethics in action: making ethical decisions in your daily life .

Nursing World. (2010). Code of Ethics for Nurses With Interperative Statements. Retrieved

November 20, 2010, from Amarican Nurses Association: http://www.nursingworld.org/