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Workers need to respect patient's confidentiality on moral and ethical grounds. But if the breach of confidentiality is unavoidable for the treatment of the patient and if it includes legal violations and crime, then the healthcare worker is in the dilemma of staying silent on the matter or disclose it to the authorities. For instance, if a person holds a criminal record and discloses his secret, it will put the healthcare worker in dilemma whether to inform the legal authorities or not as it will affect the patient's health and justice of the victim simultaneously (Petrova, Dewing, and Camilleri, 2016).
Autonomy is a basic principle of healthcare treatment and allows the patient to take decisions on his/her treatment. The dilemma arises when the decision does not align with the health progress of the patient. If the patient decides on an alternative that doesn't suits his healthcare plan well enough, the healthcare worker is in dilemma to adopt paternalism or respect the autonomy of the patient (Smebye, Kirkevold, and Engedal, 2015). For example, if a person refuses to rely on medications and wants to heal naturally but the medications will make the recovery speedier and effective then the practitioner is in dilemma to choose between autonomy and paternalism.
Risk management is a pivotal aspect of healthcare as the worker needs to ensure safety of the patient and promote independence simultaneously. There are times when the healthcare worker is I the dilemma to choose among the two available option when the case is sensitive to many factors. For Instance, if physically disabled person doesn't want to use support of any kind to walk and relies on furniture to move around the house puts the worker to promote such decision or persuade to use supporting system (Rainer, Schneider, and Lorenz, 2018).
Beneficence and Non-maleficence
Beneficence and non- maleficence include selfless and moral service with the purpose of health improvement of the patient. This requires the practitioner to be competent and willing to contribute to the healthcare of the patient. Dilemma related to beneficence occurs when the worker has to choose between autonomy of the patient and beneficence (Smebye, Kirkevold, and Engedal, 2015). For example, euthanasia puts the practitioner to dilemma to decide between the autonomy of patient to choose for her life and beneficence of her health.
In the case we can discern that Jackie is in dilemma to choose between beneficence and autonomy of Molly. Here the practitioner chose to cut Molly's nails in beneficence as she might herself while scratching or it can even lead to infection as the nails might be dirty. But Jackie's manager thinks that it is paternalism approach as it doesn't allows Molly to exercise her autonomy (Smebye, Kirkevold, and Engedal, 2015). Paternalism has certain drawbacks as it doesn't allow the patient to decide on the course of action and takes the decision on his/her behalf. The decision was undoubtly was taken in the best interest of Molly but it did not include her participation in deciding whether she wanted to get her nails cut or not. Molly might get scared and feel dejected if the decision is forced on her (Rainer, Schneider, and Lorenz, 2018). Autonomy on the other side gives freedom to the patient to choose for her treatment. The ethical principle promoted by the manager has drawbacks too as it increases the chances of ineffective decisions that might not be in the best interest of the patient. If Molly doesn't give consent on cutting her nails then she might herself and it the situation might get worse. Autonomy is suitable where the patient is able to take rational decisions and decide judiciously. Molly is suffering from learning disability and cannot take decisions without assistance of healthcare worker. Autonomy will make tasks for Jackie more difficult and impede healthcare program (Yönt et al., 2014). On the contrary, paternalism will make the patient-service provider relationship ineffective and Molly might not be able to connect with Jackie and might start feeling uncomfortable and dejected. This will also impede her learning progress as learning cannot take place with negative mindset. The patient must be willing to contribute to her health willingly. With paternalism approach, Molly might not want Jackie's service and it will lead to sluggish progress or no progress at all in the healthcare program (Holm and Severinsson, 2014). With paternalism, the practitioner does not consider other alternatives available before him/her that might work better in the case, for instance, persuading Molly to get her nails cut so that she becomes clean and feels better. Autonomy promotes wrong decisions that are not practically backed up and are based on emotions like anxiety, fear, and ambiguity. Paternalism is justified when the case needs immediate care and there is no better alternative but, in this case, Molly must be informed about the problems associated with big and dirty nails in a persuasive manner so she agrees voluntarily to let the nurse cut her nails. Paternalism will create differences between Jackie and Molly and Molly might not open up about her feelings and secrets with Jackie. Jackie must respect autonomy of Molly and ask her before cutting her nails, if she doesn't give consent, Jackie can persuade her and detail out benefits of clean nails for her (Kim, Han, and Kim, 2015).
In the case, the practitioner is in dilemma regarding confidentiality of the patient. The wife of the patient needs to be informed about the patient's bisexuality before her treatment. At the same time, it is required for the hospital to maintain confidentiality of the patient. Disclosing private information is immoral as it breaches basic healthcare principle and fundamental right of the patient (Petrova, Dewing, and Camilleri, 2016). This is a sensitive case as disclosing information can affect Jordan's relationship and health at such a vulnerable time when he needs support of his wife the most (Rainer, Schneider, and Lorenz, 2018). On the other hand, concealing such vital information from his wife will be immoral and cannot be justified on any solid ground. Breaching the principle of confidentiality can also lead the practitioner to lose his/her job (Petrova, Dewing, and Camilleri, 2016). The patient will become dissatisfied and will not continue with the treatment that will cause his health to deteriorate and will harm his relationship with his wife. Confidentiality is vital for mental health of a person who is suffering from a serious illness like tuberculosis (Kim, Han, and Kim, 2015). On contrary, concealing bisexuality of Jordan from his wife will not only lead to formal complications but will also mean that the staff is promoting an unethical and unfair means of relationship. The doctors have chosen to disclose full information to the wife as it is will make her informed about the cause of the illness and is ethically correct decision as she cannot be treated without informed consent. Informed consent includes disclosure of full information as one of the major aspects in treatment. It is obvious that his wife will demand for the information regarding diagnosis, illness, and treatment. Disclosing such severe information is likely to hurt their mental wellbeing and can make situation worse. Hiding such grave information will be violating the basic principle of honesty that is crucial for healthcare worker and his/her service (Yönt et al., 2014). By weighing the two decisions, it can be deduced that the doctors have taken a wise decision to inform the wife as she has right to be informed about her treatment and the cause. It will surely have negative impact on Jordan and his relationship with his wife but it will ensure that his wife is getting treated well and her dignity and fundamental rights are respected by the healthcare team. Such dilemmas do not have a way out and loss of either of the parties is invincible. It is therefore dependent on the healthcare staff to choose among the less risky alternative so that the benefit to each of the parties is maximized with minimum loss (Yönt et al., 2014).
Depression is a serious illness that has been overlooked by the society in the past and people have considered it as a taboo issue. In the 5th case, the dilemma faced by the nurse is to choose among patient's autonomy or beneficence. Chelsea is mentally vulnerable and any step that is likely to make her condition worse can result in lethal outcomes (Yönt et al., 2014). The nurse has to decide to omit noting down the issue of self-harming by Chelsea or to consult to authorities to provide Chelsea with needed help. If the nurse chooses not to note down the issue, it will act against the patient's beneficence as she might lose needed help and an opportunity to her way out of depression. It might be morally correct to maintain patient's confidentiality and autonomy but if the information is vital for the health of the patient, it can result in adverse outcomes. The nurse has to weigh the two options to see which one is less risky (Kim, Han, and Kim, 2015). The nurse can conceal the information and offer help informally and this can help the nurse to gain confidence of the patient. The nurse can also arrange her a psychiatrist to help her with her chronic depression. If the nurse chooses to note down the issue and pass it to senior authorities, healthcare program can be carried in a better and formal way (Holm and Severinsson, 2014). The main drawback is that it might make the patient's condition worse and she becomes more vulnerable and unsure about the treatment (Jacobs, 2019). Concealing information vital for the health of a patient is not ethical and not recommended. The patient can lose trust and become more violent with herself, the option to make the information open can damage the inner state of the patient and add to her depressive episodes. Confidentiality of the patient is fundamental principle of healthcare services and breaching this principle would break confidence and trust of the patient (Holm and Severinsson, 2014). If the case needs the information to be communicated to senior authorities of healthcare services, it should not be ignored. In this case, we can determine that Chelsea will again try to harm herself if the issue is not noted down. It can be detected that she is not getting assistance from any source and this has led her depression to take over her mental state. The nurse should inform a reliable person to address the issue and she should note down that Chelsea has tried to harm herself and needs medical assistance. This will break confidence of Chelsea initially but if she gets enough love, care, and sense of security from the healthcare program, she will realize that it's for her own benefit (Jacobs, 2019).
Holm, A.L. and Severinsson, E., 2014. Reflections on the ethical dilemmas involved in promoting self-management. Nursing Ethics, 21(4), pp.402-413.
Jacobs, G., 2019. Patient autonomy in home care: Nurses' relational practices of responsibility. Nursing ethics, 26(6), pp.1638-1653.
Kim, K., Han, Y. and Kim, J.S., 2015. Korean nurses' ethical dilemmas, professional values and professional quality of life. Nursing ethics, 22(4), pp.467-478.
Petrova, E., Dewing, J. and Camilleri, M., 2016. Confidentiality in participatory research: Challenges from one study. Nursing ethics, 23(4), pp.442-454.
Rainer, J., Schneider, J.K. and Lorenz, R.A., 2018. Ethical dilemmas in nursing: An integrative review. Journal of clinical nursing, 27(19-20), pp.3446-3461.
Smebye, K.L., Kirkevold, M. and Engedal, K., 2015. Ethical dilemmas concerning autonomy when persons with dementia wish to live at home: a qualitative, hermeneutic study. BMC health services research, 16(1), pp.1-12.
Yönt, G.H., Korhan, E.A., Dizer, B., Gümüs, F. and Koyuncu, R., 2014. Examination of ethical dilemmas experienced by adult intensive care unit nurses in physical restraint practices. Holistic nursing practice, 28(2), pp.85-90.
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