Ethics

Step 1

Is this an ethical dilemma? Describe the ethical issue in this case. Pick two ethical values in the CNO Ethics Standard which are in conflict or relate the most to the case. Also identify the two ethical principles (from Lakeridge handout) that relate to this case study. Describe how each value or principles applies to the case study. Ensure that you have selected 4 different values / principles.

Step 2

Step 2a: Gather all relevant information. Identify known and unknown facts and evidence. Consider medical indications, client capacity and preferences, quality of life and client safety, social, legal and economic factors.

Walter is a man who was diagnosed with HIV and AIDS and has hidden it from his family for 14 years. He was admitted into the hospital for pneumonia and informed the healthcare team not to let his family and friends know about his illness; his condition worsened, and he fell into a coma. We are not given any social factors aside from his family and friends, no legal or economic factors are given to us as well in this case study. We do not know his age or entire mental capacity in this case either, but we can assume that he was able to make informed decisions with the right state of mind until he fell into a coma, leaving his substitute decision maker to take over. We also don’t know Walter’s code status, allergies, or family history, but know he has a medical history of HIV and AIDS. What is also unknown about the case study is the relationship Walter has with his family, specifically his substitute decision maker who happens to be his brother. Finally, we also do not know if Walter was informed by the healthcare team about the risks of hiding his illness to his family it may pose on him.

Step 2b: Consider policies, guidelines, professional standards, code of ethics and relevant legislation which relate to this case study (support with evidence of research).

According to the CNO (2017b), the substitute decision-maker must make decisions based on the client’s desires and must consider the impact of treatment on the client’s well-being and weigh the benefits and risks. In the same document, they continue by stating, “a substitute decision-maker has the right to access the same information that a capable client would be able to access” (CNO, 2017b). Because of these statements, it should be allowed for Walter’s brother be allowed access to his health information in order to make an informed decision, but the rest of the family is not allowed in order to respect the wishes and privacy of Walter. Another CNO document called Confidentiality and Privacy – Personal Health Information (2017a), sets rules for the management of personal health information and balances the need of a clients right to privacy and the need for individuals and the health care team to access and share information. In the CNO document (2017a), it makes note that nurses meet the standard for potential of harm regarding clients that “consulting with the health care team when there are concerns about harm resulting from sharing information with a client”. With that in mind, it would be best if the health care team consulted amongst themselves concerning this ethical dilemma because Walter stated that he did not want them to inform his family and friends about his illness, yet his brother is asking about his condition and he is the substitute decision maker.

Step 3a: Identify and Evaluate Stakeholders Responsibilities & Perspectives

Complete the chart below by considering the following for each identified stakeholder:

· What are their responsibilities (roles, duties or obligations) in this situation?

· Which of their values, beliefs, goals or assumptions will affect this decision?

Step 3b: Identify where conflicts exist by reflecting on the following questions:

· Do the responsibilities of one stakeholder conflict with others’ responsibilities or perspectives?

The responsibilities of the healthcare team conflict with the responsibilities of the substitute decision maker. The healthcare team was specifically instructed not to disclose the client’s illness of HIV and AIDS to his family and must maintain the commitment. But the substitute decision maker is the client’s brother and is conflict with the clients wishes, yet he is unable to make a correct and informed decision on his brother’s behalf without access to all the health information.

· Do the values, beliefs or goals of one stakeholder conflict with other’s responsibilities or perspectives?

Walter’s beliefs of his illness not being shared with family members or friend’s conflict with his brother’s responsibility to make a correct and informed decision with the healthcare team based on Walter’s diagnosis and treatment plan. Although they both have the same goal, which is Walter recovering from pneumonia and get discharged from the hospital, but Walter does not want anyone to know about his illness and his brother needs to know about his entire condition in order to make the correct decisions regarding his care.

· Do any stakeholders’ perspectives hold greater weight/priority? Why?

The brother of Walter holds the greatest priority. Although Walter instructed that the healthcare team does not disclose his health history, specifically his illness of HIV and AIDS, his brother must know about it because he is his substitute decision maker. For a substitute decision maker to make an informed decision on behalf of the client, they have the right to access all the health information of the client.

Step 4

Examine and determine your own values on the issues presented in the case, and how that might impact your ethical perspective?

In my opinion, I believe it is important for Walter’s brother to be informed of Walter’s illness of HIV and AIDS because he has a right to know about it as a substitute decision maker in order to decide a treatment plan. Although it goes against the patient’s wishes to inform his brother about his illness, Walter gave away that right when he appointed his brother to be his substitute decision maker, due to them having the right to access the same health information as Walter was when he was capable. I do understand that the healthcare team must promote the confidentiality of the patient, but they also must consider the client’s well-being and rights of the substitute decision maker by releasing the pertinent information of Walter.

Step 5

Write out the issue/problem – clear, simple statement. Ensure that you identify the problem in terms of ethical values/principles.

The ethical dilemma in this case study is a patient was admitted into the hospital for pneumonia and they had a health history of HIV and AIDS for 14 years and hidden it from his family and friends since getting diagnosed. He instructed the healthcare team not to inform his family about his illness before his condition worsened and fell into a coma. His substitute decision maker who is his brother wants to know about his diagnosis. The healthcare team must maintain the obligation of protecting the privacy of the patient who specifically instructed them not to release the information, yet the brother has a right to know the information in order to make decisions regarding his care since he is the substitute decision maker.

Step 6

Brainstorm all possible options or courses of action. For each identify the Pros/Benefits and the Negatives/Consequences. Consider the stakeholders when considering all of the options.

Step 7

Make or recommend a decision and provide the justification/rationale. Based on the full analysis of the options, determine which option best addresses the situation.

In this situation, the best option is to go against the client’s wishes and allow the substitute decision maker, who is the client’s brother, to be informed of the client’s condition. Although this is unfavourable for the client, it is clearly outlined in CNO best practice guideline (2017b) that the substitute decision maker has the right to access the information of the client as they would if capable. Legal action may be taken if the client were to wake up from their coma and realize the commitment the healthcare team gave was breached, but according to laws regarding substitute decision makers, nurses are allowed to reveal confidential information to others if the need arises and if it within the obligations of the law and standards of practice (CNO, 2018). The healthcare team can instruct the client’s wishes to the substitute decision maker and delegate the responsibility to them, but it is not allowed to withhold the information from them because they have a right to it; the healthcare team can get into legal trouble if they withheld the right of the substitute decision maker access to information in order to make decisions regarding his care. Another benefit to informing his brother about his condition is that the brother can promote not only the best possible care for the patient but also consider personal values and beliefs when planning treatment options.

References