College of Nursing

NCM 108- Bioethics

Stephanie S. Esteban, RN, MAN
CASE#1

Joanna Salazar, a 20-year-old college student, made an appointment to be seen by Arlene Dela Cruz, M.D., one of the
partners at St. Mark’s Hospital. Joanna had been seeing the doctor for a few years. Dr. Dela Cruz was also the long-time
family practitioner for Joanna’s mom and older sister. On this visit, Joanna said she would like to get a prescription for birth
control pills. They discussed other contraception options, as well as the risk and benefits of each and decided that “the pill”
would be Joanna’s best option. After reviewing Joanna’s medical history and performing a brief physical examination, Dr.
Dela Cruz gave Joanna a six-month prescription for Ortho-Novum 10/11, along with educational materials on oral
contraceptives. She told her to schedule a six-month follow-up appointment over summer break. When Joanna checked out
with the front office, she told the billing office that she did NOT want this visit submitted to her mother’s insurance. Instead,
she would pay for the visit herself because she didn’t want her mother to know the reason for the visit. The billing clerk said
that she would send Joanna a bill because the practice’s billing system was undergoing a software upgrade. Joanna asked
that the bill be sent to her college address. About two weeks later, Mrs. Salazar had a routine appointment with Dr. Dela
Cruz. When she checked in, she stopped by the billing office and asked the insurance clerk to check a notice of claim
statement she recently received from her insurance carrier about a visit by Joanna. Mrs. Salazar said, “I know Joanna
hasn’t been here because she’s away at school.” The clerk said she’d check on the claim and should have information for
Mrs. Salazar by the time she was done seeing Dr. Dela Cruz. Mrs. Salazar was then taken back to an exam room for her
appointment. While seeing Mrs. Salazar, Dr. Dela Cruz inquired about the Salazar family and mentioned “Joanna has really
blossomed into a beautiful, intelligent young woman.” Mrs. Salazar thanked Dr. Dela Cruz and asked, “When did you see
Joanna?” Dr. Dela Cruz unthinkingly said, “Oh, a couple weeks ago when she was in for her appointment.” When Mrs.
Salazar questioned why Joanna had been seen, Dr. Dela Cruz realized she had said too much. She hemmed and hawed a
bit, and finally suggested that Mrs. Salazar talk to Joanna. Despite Mrs. Salazar’s insistence that she had a right to know
why Joanna was seen, Dr. Dela Cruz refused to provide additional details. Mrs. Salazar was clearly angry with that
response and stormed out of the exam room. On her way out, she stopped at the billing office, and the insurance clerk
confirmed that Joanna was in for an appointment on the day in question and that the claim was correct.

Questions for discussion:

1. What are the ethical and moral issues raised in the scenario? Explain each.

The ethical and moral issues raised are about privacy and confidentiality. Also the negligence, the concept of
deleontology, autonomy, and the withholding of integrity and fidelity.Privacy and confidentiality was invaded
because the physician forgot and just realized that she stated some clues that made Mrs Salazar think of
involvement of her daughter. This is also another form of negligence where as being physician should respond
properly and never think of her words to be spoken that she neglect her fidelity towards Joanna. Concept of
deleontology because the billing office responded she would send Joanna a bill because the practice’s billing
system was undergoing a software upgrade and that clerk also confirmed that Joanna was in for an appointment on
the day in response to Mrs Salazar’s question. Billing clerk also put notice of claim statement to insurance however
she might intentionally or unintentionally neglect Joanna when Joanna told that bill be sent on her college address
but still Mrs Salazar insurance received the bill statement. Autonomy was also shown on the other side of the story
because the physician gave Joanna a right to use contraceptives that also help her what is recommendable ones.
Withholding of integrity because the physician failed to fulfill her duty to protect the clients privacy unintentionally
because of her negligence. Withholding fidelity because Joanna never knew that the doctor broke her fidelity to her
that she opened up unthinkingly clues to Mrs Salazar that still made Mrs Salazar the urge to confront and
investigate the real reason for Joanna’s admission.
2. Which specific provision/s in the Patient’s Bill of Rights did the health service provider/s violate? Identify the specific
incident where such violation happened.

The right to Privacy and confidentiality is the main violation health services violate. Also the Right to Information
was unintentionally violated because the legal guardian do not had a chance to know from Physician the reason of
visit of Joanna, its because (physician) unthinkingly opens that Joanna visited her weeks ago which is a form of
negligence and just refuse to give additional details that made the mother more angry .

3. What should have been done instead in this situation? Elaborate your answer.

If only, I won’t open any matter about Joanna to prevent Mrs Salazar from thinking of that. Another thing is that if in
that scenario I will tell politely that the data and record of Joanna visit is protected by the healthcare that they may
violate the Patients Bill Of Rights. The reason I will directly state this is that the Fidelity, Integrity and Protection of
Privacy is my concern even though I came up to the point that put client’s data in risk. Also the concept of
Deleontology where it is my duty to fulfill this integrity as a physician, if ever she asks a question the safest thing I
would only say is that “she just had check ups”. Last thing is the responsibility of the billing clerk and insurance
clerk where they should have communicated or interacted that the bill will be sent through Joanna college school
address or just simply recommend Joanna to provide an account for personal use and emergency use to avoid
conflicts.