Case-Based Ethical Argument Essay Assignment
Clinical Situation: Jenkins (2006) presents a case in which a patient presents with an arm fracture due to a fall, but then privately discloses to the nurse that the injury is due to intimate partner violence. The patient asks the nurse (Jenkins) to (a) not document the true cause of the injury and (b) not inform the attending physician of the violence incident, thereby also refusing examination/treatment of any other injuries sustained during the incident. In retrospectively analyzing the care encounter, Jenkins frames her ethical dilemma as one between (i) respecting the patient’s confidentiality and (ii) maximizing benefit/preventing further harm to the patient and the patient’s children (Kirk 2015).
For this situation, the ethics question is centered around whether or not the true cause of the injury should be disclosed to the attending physician as well as documented in the chart. In addressing this ethical question, the two most important principles to consider are beneficence and autonomy. With those principles as a guide, Nurse Jenkins should not disclose the reason for the injury, whether through communicating with other members of the healthcare team or through documentation in the medical chart, but rather honor the patient’s request that the cause not be reported.
Guided by the principle of autonomy, the information should not be disclosed. The patient has free action, which is one of the main facets of personal autonomy, according to Yeo (2010). In this circumstance, that free action is the ability to choose which information is disclosed. Additionally, in choosing to not document the true cause, the patient is also taking free action in choosing what examination and treatment she receives. Yeo also mentions that “interference with autonomy…is usually justified by the claim that the client is not autonomous in some other sense…” (2010). In this situation, the patient is fully autonomous, as she has decision-making capacity, is capable of moral deliberation, and understands the consequences associated with her choices. In fact, she understands better than most considering she is a healthcare professional herself. With this in mind, knowing that the patient has decision-making capacity, her autonomy and choices for treatment and sharing of information should be upheld.
In addition to autonomy, beneficence is also an important principle to guide the decision in this circumstance. Beneficence calls for individuals to act in a way that not only benefits others, but also prevents or removes harm (Yeo 2010). If the nurse were to disclose this information, it could cause unforeseen second order effects. If the abuser found out that his wife shared this information with others, it could become a trigger or an excuse to further abuse the victim. This can also create a negative and potentially hostile work environment for the victim, as both her and her husband have worked in the same department and know many of the same people, which can lead to others “choosing sides”. If Nurse Jenkins did go behind the patient’s back, she would be violating the patient’s trust in healthcare providers to treat her the way she wishes to be treated. It could also eliminate any chances to benefit the patient and reduce harm in the future, as the patient may no longer see this location as a safe space. Keeping the information private as the patient has requested will benefit the patient by maintaining her trust in her healthcare providers, which could in turn lead to further benefit in the future, because the patient now has an ally to turn to when she is ready to escape the abuse.
Some may say that beneficence in this situation would call for a disclosure of the information in order to prevent future abuse, and take action to get the patient out of this situation. Additionally, perhaps disclosing the information would allow the patient to receive more comprehensive treatment currently, as there are most likely other injuries. However, it’s important to consider that this is the choice of the patient.. While it may seem beneficent to disclose the information, no one truly understands the reasoning behind the patient’s choice better than the patient, and it is the patient who should have the final say. Yeo also mentions that “beneficence may come into conflict with other important values, and in particular with autonomy and truthfulness” (Yeo 2010). Promoting beneficence at the expense of patient autonomy is not the right action to take. Patient autonomy in tandem with beneficence should be given priority in determining the appropriate course of action.
In order to uphold both autonomy and beneficence of the patient, the source of the injury should not be disclosed against the patient’s wishes or without her consent, nor should it be recorded in the medical chart. The patient’s appraisal of the situation has guided her choices, and using free action she has decided to not disclose the cause of the injury. Beneficence focuses on promoting good and reducing harm, and adhering to the patient’s wishes will provide the maximum benefit to the patient. While there may be other options at hand that could promote beneficence in other ways, the most important factor in this situation is the patient and the patient’s choices. As the nurse is contemplating next steps, autonomy and beneficence should guide her to respect patient choice.
References
Jenkin, A, Millward, J. (2006). A moral dilemma in the emergency room: Confidentiality and domestic violence . Accident and Emergency Nursing, 14(1), 38-42.
Kirk, TW. (2015). Confidentiality . In N Cherny, M Fallon, S Kaasa, R Portenoy, & D Currow (eds.). Oxford Textbook of Palliative Medicine. (5th ed.) New York/London: Oxford University Press, pp. 279-284.
Yeo, M et al. (2010). Autonomy [selections]. In M Yeo et al. (eds.). Concepts and Cases in Nursing Ethics. [3rd edition] Ontario: Broadview Press, pp. 91-97, 103-109.
Yeo, Michael et al. (2010). Beneficence . In M Yeo et al. (eds.). Concepts and Cases in Nursing Ethics. [3rd edition] Ontario: Broadview Press, pp. 103-116.
