NURSING AND MIDWIFERY

ETHICS

ANTOINETTE ATTARD

Confidentiality

Confidentiality

“Nurses and Midwives should: safeguard and

protect all information,.….obtained in the

course of the professional relationship with the

patient or client. A nurse or midwife cannot

disclose such information without the consent

preferable written, of the patient or client.

Exemption to this rule exists only where

required by local laws” (N&MB 1997)

Confidentiality

Patient CharterSection 3 deals with confidentiality

Privacy

Confidentiality of information including records

Right to review records

Right to complain

Confidentiality

ConfidentialityBased on principles of:

Autonomy – patients have a right to control personal information and to protect privacy

Nonmaleficence – disclosing information may cause harm to patients

Confidentiality

ConfidentialityInformation disclosed to health carers is based on the principle of trust.

Information cannot be shared except by the patients permission

Confidentiality

Boundaries to confidentiality

Confidentiality

Barriers to confidentiality

Confidentiality cannot be ethically

justified:

`harm principle’ – confidentiality cannot be

maintained if it will cause harm to others

Confidentiality

Harm PrinciplePersons should refrain from acts or omissions which could result in harm to others

Harm

Private

public

Confidentiality

Harm Principle

Harm as hurt

Physical

Emotional

Confidentiality

Harm Principle

Harm as non benefit

not educating children

not telling patients the truth

Confidentiality

`Barriers to confidentiality

`vulnerability principle’ – the duty to protect against harm tends to arise most strongly when someone is specially dependent or vulnerable

Confidentiality

Breaching Confidentiality

Patient or legal advisor gives valid consent

Information is required by law

Confidentiality

Breaching ConfidentialityTo protect patient – such as not giving patient information but telling family if patient will be harmed by the truth

Is this paternalistic?

Confidentiality

Paternalism versus Beneficence

Who decides whether patient can cope with the truth?

Are we hiding behind beneficence to refrain from the difficult duty of giving bad news?

Confidentiality

PaternalismPaternalism is only justified if the harm prevented is greater than the harm caused by taking someone’s autonomy away?

How can one tell?

Confidentiality

Breaching Confidentiality

To protect public interest

For medical research if ethically approved

Thank you for your attention.

Confidentiality

‘Which are the common ethical concerns you

encounter in your clinical area?’

Theme Occurrence

Information giving

Truth telling

Chronic conditions

Seperated parents

16

Confidentiality

Same locality

HIV

Relatives

9

Letting die 6

Accountability

Reporting

Ward management issues

Resources

Priorities

5

2

3

Table 1: Common Ethical concerns you encounter in your clinical area

Confidentiality

Questionnaire

33 Candidates

Departmental Nursing Managers

Nursing Officers

Deputy Nursing Officers