Health Care Ethics: Confidentiality and Privacy

This article discusses the ethical standards and regulations related to confidentiality and privacy in health care ethics. It explores the varying perspectives of the parties involved and provides a six-step process to find practical, ethical solutions. The article also includes references for further reading.

“HA 570 Health Care Ethics” 1
“HA570 Health Care Ethics”
“Unit 4 Assignment”
Name of the Student
Student ID
Name of the University

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1. Summary of the story
Twyla Roberts works as a “therapist” for “Marion Home Care Agency” and operates
from home looking after elderly patients and using the online patient care information
system. She was entrusted with the treatment of Mary Lewis for safety evaluation and for
physical therapy to restore the function of her right hand. Mary Lewis had a fall due to
push by her husband during a heated exchange with her husband who was suffering from
mental illness. This information was not disclosed to the hospital authorities but was
narrated to Twyla with a request to keep confidential. Instead of responding positively to
Mary’s request, Twyla was more interested on respite care and getting more assistance
for her husband. Twyla was in a dilemma as she should have stooped Mary disclosing
confidential information about her husband but once the confidentiality is lost, Twyla
might have to repent in future if the statement of Mary is not recorded.
2. The varying perspective of the parties involved.
The first party in this story is Twyla Roberts, who is a therapist for the “Marion
Homecare Agency” who provides treatment of patients from home. She uses an online
information system on patient care to know the history of the patient and after treatment,
updates records in the system.
The second party is Mary Lewis, the patient who came to Twyla Roberts for physical
therapy to restore the strength of her right hand. She was discharged from the hospital
and was referred by a social worker to Twyla Roberts for a therapy.
The third party is Mary Lewis’s husband who was suffering from middle stage Dementia,
.He was frequently get agitated. He pushed her wife during heated exchange resulting in a
fall and damage of the right hand of Mary Lewis.

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The fourth party is Michael White, a social worker who referred Mary to Twyla Roberts.
He was concerned to know the developments of Mary Lewis’s home therapy.
3. Ethical standards relating to the scenario.
From the story, we can establish that the ethical objective of finding a caring response
needs that Twyla should address both traditional and contemporary dimensions of
confidentiality, and the private confidentiality shared by the patient (Hewitt, 2010). She
should understand the meaning of confidentiality and its appropriate limit and use. She
also should be aware of privacy and challenges of maintenance of confidentiality in a
computerized environment (Lafky & Horan, 2011). The basic principles of healthcare
and the ethical dictum of ethical health codes are confidentiality. Confidentiality is the
practice of maintaining the information of the patient with harmful, shameful or
embarrassing contents within appropriate boundaries ("Book discusses privacy, the
confidentiality of health care information", 2009). To this ethical practice, the right to
privacy gives necessary legal standing (MARMOR, 2015).
4. The regulations and connected laws.
AMA code of ethics relating to privacy and confidentiality is:
The privacy of patients includes elements that include personal space (“physical
privacy”), private information (“informative privacy”), private decisions that include
religious and religious affiliations (“decisive privacy”), and private interactions with
members of family and other associated people (“associated privacy”). Doctors should try
as far as possible to safeguard the privacy of patients in all environments ("OPINIONS
ON PRIVACY, CONFIDENTIALITY & MEDICAL RECORDS," 2016) and should:

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(A) Privacy intrusion should be minimized when it is necessary to balance patient privacy
against other variables.
(B) The patient should be informed of a substantial breach of privacy that would
otherwise not be known to the patient.
(C) To be aware that in any or all of these fields, individual patients may have particular
worries about privacy.
5. “Six step process to explain a practical, ethical solution” (Enck, 2013)
Let us relate confidentiality with the case study using the six-step process.
Step 1: To get relevant information.
Twyla’s main concern was whether Mary was safe with her husband. She could probe
further by asking more questions about Mary’s husband’s behaviour towards her.
Whether Mary’s husband is getting proper care on dementia, whether any other
stakeholder is involved in the family, what resources are available to Mary and her
spouse, why she wants to keep the information confidential, whether Mary can treat her
husband with an injury? Family dynamics are so complex that it may affect the quality of
life for couples.
Step2 and 3: To identify ethical problems and ethical approach to solve it.
Twyla was in two minds whether to record Mary’s conversation or not, knowing very
well that this information will be accessible by others. In some instances of
confidentiality moral distress may face the moral agent. She is facing the dilemma that if
she records Mary’s statement, Mary will lose confidence in her and if she suppresses
information it is also against ethical norms.
Step 4: To find out other practical alternatives.

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One way for Twyla to manage this scenario is by exchanging data with the
interprofessional support team of Mary. Social workers are well educated in policies and
processes relating to the abuse and neglect of elderly people. Twyla can expand her
understanding and maximize resources through collaboration with the social worker.
Twyla may be in a situation, by breaking the confidentiality may be necessary to protect
the welfare of the individual as per American Medical Council codes of confidentiality.
Step 5: To complete the action.
This case does not have a simple answer. Twyla should go back to Mary and inform that
she is compelled to document the conversation of Mary as it is important for Mary’s care
and it is her moral duty to document the conversation.
Step 6: Evaluation of the process and outcome.
Any caring professional should be concerned about the consequences of overriding a
patient’s wish due to her professional obligations. Whatever Twyla does, she should take
her time to review her actions step by step.

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References
Book discusses privacy, confidentiality of health care information. (2009). Perspectives
In Healthcare Risk Management, 5(1), 2-2. doi:
10.1002/jhrm.5600050104
Enck, G. (2013). Six-step framework for ethical decision making. Journal Of Health
Services Research & Policy, 19(1), 62-64. doi:
10.1177/1355819613511599
Hewitt, B. (2010). Exploring how security features affect the use of electronic health
records. International Journal Of Healthcare Technology And
Management, 11(1/2), 31. doi: 10.1504/ijhtm.2010.033273
Lafky, D., & Horan, T. (2011). Personal health records. Health Informatics
Journal, 17(1), 63-71. doi: 10.1177/1460458211399403
MARMOR, A. (2015). What Is the Right to Privacy?. Philosophy & Public
Affairs, 43(1), 3-26. doi: 10.1111/papa.12040
OPINIONS ON PRIVACY, CONFIDENTIALITY & MEDICAL RECORDS. (2016).
Retrieved from
https://www.ama-assn.org/sites/ama-assn.org/files/corp/media-browser/
code-of-medical-ethics-chapter-3.pdf