Factors Contributing to Dilemmas in Healthcare: Confidentiality, Autonomy, Justice, and Risk Management

This article discusses the factors that contribute to dilemmas in healthcare, including confidentiality, autonomy, justice, and risk management. It also provides case studies and possible ways of resolving dilemmas in healthcare.

Task A
Confidentiality
Health and social care workers undoubtedly face various kinds of dilemmas in their working
practice. One of the serious dilemmas they encounter is associated with the confidentiality of
the patients. Occupational therapists are bound to maintain the confidentiality of the
information regarding patients’ health but in some situations they need to prioritize the
wellbeing of the patients and hence, they need to disclose private information to their families
without their consent which in turn results in dilemmas (Wong and Morgan-Lynch 2017). As
an example it can be said that if a teenager have been diagnosed as pregnant and she is
requesting the physician to keep it secret to her parents then at that stage healthcare workers
face dilemma.
Autonomy
Patients’ autonomy is another factor that can raise dilemma for the health and social care
workers while providing care. Autonomy is basically the rights and opinions of the patients
and no healthcare worker can influence any patient in making health-related decisions.
Healthcare workers might have the right to educate the patients but they cannot make any
decision for the patients (Tønnessen, Ursin and Brinchmann 2017). Suppose, if a person with
multiple chronic health problem refuses the placement of feeding tube despite being told that
normal feeding process could harm his health, the healthcare providers should respect his
autonomy but they face dilemma as it can worsen the health condition of the patient.
Justice
Justice is an important term in healthcare. It involves the use of concepts in determining how
the resources should be distributed among patients irrespective of their community (Resnik,

MacDougall and Smith 2018). It promotes fair and equitable treatment to all the individuals
of any population. It seems like straightforward and simple however, in clinical settings it
might appear as a challenge for the healthcare workers. Suppose, in a homecare, some
residents might face serious health hazards if come in contact with cigarettes but explaining
all other residents to stop smoking for the sake of those particular patients who are suffering,
then it can raise dilemma for the healthcare workers.
Risk Management
Dilemmas associated in risk management in the field of healthcare are quite common.
Independence of patients always gets highest priority in healthcare and patients should
always have the right to choose or decide while doing something. Therefore, it is important to
develop proper risk management facilities to support the independence of the patients whilst
providing care (Russell and Kumar 2015). As an example it can be said that, suppose, if a
partially physically disabled person is willing to do his personal work such as going toilet,
bathing and other works independently then healthcare workers will face dilemmas regarding
the risk associated with the independency of the patient.
Task B
Dilemma is basically a part of life and none can deny that he/she have not faced dilemma in
their life. It can be personal as well as professional, and in both cases it can affect the
wellbeing of people. In all kinds of professional fields dilemma is significantly associated and
healthcare field is not an exception from it (Sortedahl, Mottern and Campagna 2018).
Healthcare professionals always a significant role in maintaining the health of people and
dilemmas often arise while making any decision in their clinical setting and it includes ethical
components as well (Hem et al. 2018). The decisions of the healthcare professionals are
highly important as it impacts the health and wellbeing of the patients and at the same time it

also impacts the reputation of the healthcare organization (Jenkinson et al. 2015). Various
factors are there that contributes in the arising of dilemma in healthcare and they are
confidentiality, autonomy and others. However, every dilemmatic situation requires taking
proper decision in order to resolve the dilemmas associated with the healthcare (Chiumento et
al. 2016). The following section thoroughly depicts the factors creating dilemmas and also
analyses the possible ways of dealing with those dilemmas in healthcare settings to provide a
quality of care.
Confidentiality is one of the important factors in healthcare where patients’ personal
information should not be disclosed to a third party without the consent of the patient. All the
healthcare professionals must follow the HIPAA privacy rule which stands for Health
Insurance Portability and Accountability Act which is a federal privacy law and it sets the
baseline of protection for the health information of the patients (Rodríguez-Vilá, Nuti and
Krumholz 2017). Maintaining confidentiality and privacy is extremely vital in establishing a
faithful relationship between the patient and the healthcare provider. It helps in providing a
secure environment for the patients and at the same time, it also reinforces confidence in
healthcare (Liu, Miao and Zhang 2016).
In the provided case study, confidentiality and its contribution to the dilemma associated with
the lives of healthcare workers have been clearly demonstrated. Case study 4 can be
considered while discussing on the confidentiality of the patients. In the case study 4, the
patient is Charlie, a 33 year old married man, who has been admitted to the hospital with TB
but he has also been diagnosed with syphilis which is a highly contagious sexual disease. He
confessed to have a bi-sexual relationship with another man but his wife is unaware of it. His
wife got infected but he wants the hospital staffs to reveal anything about his bisexuality to
his wife. He demands that patients’ information should be kept confidential but doctors say it
must be informed to his wife. In this situation dilemma arises. If the nurses disclose the fact

to the wife without the consent of Charlie, then it will break the trust of Charlie for the
healthcare providers, and again, if they do not disclose the fact, the condition of his wife
might get worsened. Therefore, it is very much essential for the nurses and other healthcare
professionals to resolve the dilemmatic issue. In this regard, the nurses and other healthcare
professionals should educate Charlie about the importance of telling the truth to his wife. As
he states, he loves his wife and due to this, he would never have wanted her wife to suffer and
thus he should be motivated to disclose the truth to his wife. In this way, the dilemma can be
resolved successfully without harming the trust of the patient. Also, there will be no impact
on the reputation of the organization.
Autonomy is another factor that influences quality of care by introducing dilemma in
healthcare (Banerjee, Hemphill and Longstreet 2018). Autonomy has a range of different
meanings but in healthcare it is related to the independence of the patients. It is highly
essential for good quality of life as well as being able to live independently without any third
person’s intervention or assistance. It is also identified as being from any controlling
influences of others. According to healthcare guidelines, patients’ autonomy should be
considered as one of the most important factors to be maintained while providing care (Fox
and Vaidyanathan 2016). In medical ethics, respecting the autonomy of the patient is
considered as one of the fundamental principles (Blake et al. 2017). But, while providing
care, respecting the autonomy sometimes impact the quality of care and which in turn might
contribute to the poor health outcome of the patients and in this way, healthcare providers
need to face dilemma regarding autonomy and patients’ health (Martin et al. 2018).
Numerous case studies are there demonstrating how autonomy of the patient can become a
barrier against the care provided to them and the case study 1 also depicts such situation
where the autonomy of the patient has been harmed which as a result raised a dilemmatic
situation for the healthcare provider. In the case study 1, Ellen is a 55 year old woman with

learning difficulties. She is unable to communicate verbally as well. Layla, the care provider
is concerned regarding the finger nails of the patient because they are long and harmful and
as per the case study, Ellen is scratching herself. Layla decides to cut them but Ellen is
reluctant and not keen for Layla to do that first. Here the main dilemma arises because, in this
way, the rights of the patient are violated and she was not left with any choice. Even, Layla
did not consult with other team members as well. Doctors can say that Layla is not correct as
the autonomy of the patients has not been respected in this way. The autonomy mainly
reflects the independence of the patient and here, the care provider Layla did not think about
the autonomy and independence of the patient rather, she thought for the health benefit of the
patient, Ellen. It created dilemmatic situation and shows an example of bad practice in the
clinical care settings. However, it is important to resolve any dilemma or ethical conflict in
order to improve the quality of care provided to the patients. In this case, if the care provider
would have consulted with other team members regarding the matter then it would be better.
Moreover, it is necessary for the patient to understand the necessity of cutting nails at right
time and she should know that Layla wanted to assist her and nothing else. If Ellen would
have informed and if her consent was taken before taking any action, then it would not harm
her independence or autonomy. Therefore, educating patients is the most essential and
effective way out in order to resolve any kind of ethical conflict and dilemma in healthcare. It
would also reflect a good practice in the clinical care setting.
Case studies are reflecting dilemmas that can impact the quality of care provided to the
patients. In any dilemmatic situation, it is highly important to take proper decision. The
decision taken in those situations, impact the health and well being as well as the efficiency
of the care provider. Confidence and autonomy these are two factors which must be
maintained by the care professionals. This paper analyses the possible ways of resolving
dilemmas created by those factors. It is essential for the care providers to think from the

perspective of the patients while providing care and they should follow the rules and
regulations of medical science in this regard.

References
Banerjee, S., Hemphill, T. and Longstreet, P., 2018. Wearable devices and healthcare:
Data sharing and privacy. The Information Society, 34(1), pp.49-57.
Blake, L., Francis, V., Johnson, J., Khan, M. and McCray, T., 2017. Developing
robust data management strategies for unprecedented challenges to healthcare
information. Journal of Leadership, Accountability, and Ethics, 14(1), pp.22-31.
Chiumento, A., Khan, M.N., Rahman, A. and Frith, L., 2016. Managing Ethical
Challenges to Mental Health Research in Post‐Conflict Settings. Developing world
bioethics, 16(1), pp.15-28.
Fox, M. and Vaidyanathan, G., 2016. Impacts of healthcare big data: a framework
with legal and ethical insights. Issues in Information Systems, 17(3).
Hem, M.H., Gjerberg, E., Husum, T.L. and Pedersen, R., 2018. Ethical challenges
when using coercion in mental healthcare: a systematic literature review. Nursing
Ethics, 25(1), pp.92-110.
Jenkinson, M.D., Weber, D.C., Haylock, B.J., Mallucci, C.L., Zakaria, R. and
Javadpour, M., 2015. Atypical meningoma: current management dilemmas and
prospective clinical trials. Journal of neuro-oncology, 121(1), pp.1-7.
Liu, J., Miao, J. and Zhang, D., 2016. Dilemma of healthcare reform and invention of
new discipline of health fiscalogy. Global health research and policy, 1(1), p.4.
Martin, E., Lober, C., Benabio, J. and Feldman, S.R., 2018. Addressing public
criticism: a potential HIPAA violation. Dermatology online journal, 24(6).

Resnik, D.B., MacDougall, D.R. and Smith, E.M., 2018. Ethical dilemmas in
protecting susceptible subpopulations from environmental health risks: Liberty,
utility, fairness, and accountability for reasonableness. The American Journal of
Bioethics, 18(3), pp.29-41.
Rodríguez-Vilá, O., Nuti, S.V. and Krumholz, H.M., 2017. Healthcare disparities
affecting Americans in the US territories: a century-old dilemma. The American
journal of medicine, 130(2), pp.e39-e42.
Russell, A.B. and Kumar, R., 2015. Early onset neonatal sepsis: diagnostic dilemmas
and practical management. Archives of Disease in Childhood-Fetal and Neonatal
Edition, 100(4), pp.F350-F354.
Sortedahl, C., Mottern, N. and Campagna, V., 2018. Case Managers on the Front
Lines of Ethical Dilemmas. Professional case management, 23(1), pp.4-9.
Tønnessen, S., Ursin, G. and Brinchmann, B.S., 2017. Care-managers’ professional
choices: ethical dilemmas and conflicting expectations. BMC health services
research, 17(1), p.630.
Wong, D. and Morgan-Lynch, S., 2017. Patient portals and young people: addressing
the privacy dilemma of providing access to health information. Journal of primary
health care, 9(4), pp.240-243.