CONFIDENTIALITY

- The American Nurses Association (ANA) believes that protection of privacy and confidentiality
is essential to maintaining the trusting relationship between health care providers and patients and
integral to professional practice. ANA supports legislation, policies and standards that protect
individually identifiable health information. The patient’s right to privacy of individually
identifiable health information, including genetic information, is established statutorily with
specific exceptions. Individuals retain the right to decide to whom, and under what circumstances,
their individually identifiable health information will be disclosed. Confidentiality protections
should extend not only to health records, but also to other individually identifiable health
information, including clinical research records, oral reporting, images and mental health therapy
notes. This protection should be maintained in the treatment setting and in all other venues.
- The use or disclosure of individually identifiable health information without an individual’s
informed consent is prohibited. Exceptions should be permitted only if a person’s life is
endangered, if there is a threat to the public or if there is an existing legal requirement. In the case
of such exceptions, information should be limited to the minimum necessary for the situation.
Individuals should be notified in writing of what information will be released, who is releasing the
information, who will be receiving the information and the purpose of revealing the information,
with the signature of the disclosing provider.
- Quality patient care requires the communication of relevant information between health care
professionals and/or health systems. The rapid evolution of communication, recording and
retrieval technologies poses challenges to maintaining the privacy, confidentiality and security of
this information. Breaches of health information can have serious personal and reputational
consequences for both patients and providers in addition to a financial and organizational impact.
Ensuring the integrity of the health information protection process is a shared responsibility of all
health care providers and is vital to the fiduciary relationship with patients. Nurses and other health
care professionals should contribute to the development and implementation of legislation, policies
and standards that protect patient privacy and the confidentiality of patient information.

CASE DISCUSSION:
A 14-year-old accompanied by her mother presents with complaints of nausea and vomiting for
two weeks. After her mother leaves the room, she admits to being sexually active and tells you
that she has had unprotected intercourse recently with her boyfriend and missed a period.
Her parents do not know she is sexually active, and she does not want her mother to know that a
pregnancy test is being done or the result of that test. Pregnancy test comes back positive. This
patient, a 14-year-old, has requested that you not convey to her mother that a pregnancy test has
been sent. In other words, she has requested that you respect her confidentiality.
JUSTICE

- The principle of justice could be described as the moral obligation to act on the basis of fair
adjudication between competing claims. As such, it is linked to fairness, entitlement and
equality. In health care ethics, this can be subdivided into three categories: fair distribution of
scarce resources (distributive justice), respect for people’s rights (rights based justice) and
respect for morally acceptable laws (legal justice) (Gillon, 1994). Justice is fairness. Nurses must
be fair when they distribute care, for example, among the patients in the group of patients that
they are taking care of. Care must be fairly, justly, and equitably distributed among a group of
patients.
The right to be treated equally, and in some cases equal access to treatment, can be found in
many constitutions, but in actual practice, a number of different factors may influence actual
access to treatment e.g. age, place of residence, social status, ethnic background, culture, sexual
preferences, disability, legal capacity, hospital budgets, insurance cover and prognosis. The
Swiss Academy of Medical Sciences

CASE DISCUSSION:
You have recently been speaking to your nursing colleagues about Mr. Goodwin, a patient from
the community to comes to hospital once per week to receive a nurse-administered medication.
You have been wondering whether it is appropriate to keep treating Mr. Goodwin in hospital,
given that he would be eligible for community care support to have his medication administered
in the home. The reason that he has continued to come to hospital to receive this medication is
that it is not covered by any Ministry of Health program, and the hospital absorbs the cost for
Mr. Goodwin at each treatment. You are not sure whether this is an appropriate use of resources
since there are significant wait times for other procedures, and cost savings initiatives are being
pursued in all other departments.

What are some of the ethical issues in this case?

 Why was the decision made to treat Mr. Goodwin in hospital in the first place?

 Can the hospital cover the cost of similar medications for other patients, or are there concerns

of justice/fairness?

 How are decisions regarding prioritization made organizationally? Are there agreed upon

frameworks or ethical principles that are used?