Ethics Argument Essay

Amber Shaikh Sonam Bhandari
Case-Based Ethical Argument Essay Assignment
Confidentiality Discussion Exercise.
Patient presents to the ER with a fracture of her arm documented as a result of a fall. However, the X-ray showed that the fracture was inconsistent with a fall and was likely caused due to a direct blow. In the privacy of the plaster room, patient disclosed that she sustained the injury as a result of being thrown down the stairs by her husband while her two children heard the argument between them. A more comprehensive history revealed localized pain in the right side of her chest during inspiration, but no loss of consciousness and is found to be alert and oriented to person, place and time. Patient requests that the cause of her injury, intimate partner violence, and the new physical findings not be documented or disclosed to the attending physician while also refusing treatment for her other injuries. This brings upon an ethical dilemma of whether or not to respect the patient’s request of nondisclosure.
The ethics question here is “Should we honor the patient’s request for nondisclosure?”
Ethical principles used in this argument are Autonomy and Nonmaleficence. The principle of nonmaleficence is to “do no harm”, which goes hand in hand with beneficence, which means to do that which provides most benefit to the patient. The ethical principle of autonomy states that patients have the right to make their own medical decisions. It consists of 4 aspects; autonomy as effective deliberation, autonomy as moral reflection, autonomy as authenticity, and autonomy as free action.
We recommend honoring the patient’s request for nondisclosure using the principles of nonmaleficence and respecting autonomy.
Nonmaleficence is defined as a moral obligation to do no harm. It goes hand in hand with the ethical principle of beneficence which means we have an obligation to maximize patient benefit and minimize harm. This is done by taking into account the patient’s goals and values and doing what we can as clinicians to result in the best, most beneficial outcome. Benefits of nondisclosure of her domestic abuse include maintaining the patient’s trust with her provider and in the medical system. She will also avoid potential harm of retaliation from her husband if he finds out that she disclosed

the violence. As per a study by JAAPA, more women are in threat of being abused or killed by their spouse when they try to expose them and leave their circumstances. Disclosing may also create a potential harm for her children, because it may put them in the midst of retaliation as well. Considering they both work in the same hospital network; it is easier for him to find out the details of her visit. Not disclosing the IPV will also respect the patient’s wishes and allow her to come to the conclusion of telling the physician of the abuse when she is ready.
As clinicians, we have an obligation to respect patient autonomy- which is giving the patient the right to make their own medical decisions while also ensuring that patient is practicing autonomy as a free action- the choice is their own, as effective deliberation – the choices they make are consistent with their end goals, as moral reflection- is aware of the effects of her choices, and as authenticity – her choices are consistent. The patient has decided to not disclose the new physical findings or the cause of her injuries, practicing autonomy as free action. She also recognizes that by not disclosing the physical findings to the physician she is not going to receive treatment for her other injuries and her physical history will also be inaccurate however she is still making the decision to not disclose, practicing autonomy as moral reflection. Her action – requesting not to disclose her IPV and new physical findings are consistent with her goals of not having others find out about the violence she faces. Here she’s practicing autonomy as effective deliberation. The course of action proposed here respects her autonomy.
While we believe our decision to not disclose the information about our patients’ domestic violence and new physical findings is the best course of action, there are numerous reasons to argue against it. One main argument against our decision to disclose is that the patient is not going to receive treatment for her current injuries. While this may be true, the patient can still not consent to receiving the treatments after disclosure. Therefore, disclosing the new physical findings or IPV may still not lead to the patient being treated. The patient disclosed this information while in a vulnerable situation; we can either violate the trust that the patient’s placing on us or decide on building this trust. This may in the long run benefit the patient either by having the psychological benefit of having someone to share the information with and by seeing the ER as a safe haven where she can get treated for her injuries.
In order to come up with the best course of action for the care of our patients, we need to evaluate the risk vs benefit ratio consistent with the principles of nonmaleficence, while respecting her autonomy. Our argument for nondisclosure is stronger than the counter argument of disclosing the information as it respects the patient’s goals and wishes while also maintaining confidentiality and the patient’s trust in

the medical system and eliminating potential harms of retaliation. Our course of action respects the patient’s autonomy and also is consistent with the principles of beneficence which the counter argument is not.
Using the argument of nonmaleficence and autonomy, we justify our decision to honor the patient’s wishes of nondisclosure. Our argument is also embedded in the ethical concept of confidentiality, which means to maintain confidence and trust in the relationship between a patient and a provider. In this case, maintaining confidentiality is justified as it respects personhood and prevents potential harm to the patient. By looking at the harms/benefits profile in our patient’s case, we find that not disclosing her abuse provides the increased benefits of improved relationship between the patient and provider, psychological benefits of maintaining her personhood, and reducing potential future harm as outlined in our argument which is greater than the benefits versus harm ratio of the disclosure. Respecting her autonomy is also consistent with our course of action of nondisclosure.
Clinicians are faced with uneasy decisions tied to difficult circumstances that the patient’s encounter. It is in these situations, such as that of our patient, that ethical principles such as Autonomy and nonmaleficence should guide our decision making.
References:
1. AAPA. (2013). Guidelines for Ethical Conduct for the Physician Assistant Profession.
https://www.aapa.org/wp-content/uploads/2017/02/16-EthicalConduct.pdf
2. Collett, D. S., & Bennett, T. (2015). Putting Intimate partner violence on your rada. JAAPA,​ ​28.​ Retrieved from https://bbhosted.cuny.edu/bbcswebdav/pid-42420532-dt-content-rid-347644331_1/course s/YRK01_HPPA_508_P_1199_1/JAAPA IPV.pdf
3. Jenkins A, Millward J. (2006). A moral dilemma in the emergency room: Confidentiality and domestic violence . Accident and Emergency Nursing, 14(1), 38-42.
4. Kirk T. Summary of HPPA 514 Confidentiality Discussion Exercise 11/6/2019
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D Currow (eds.). Oxford Textbook of Palliative Medicine. (5th ed.) New
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6. Yeo, Michael et al. (2010). ​Beneficence​ . In M Yeo et al. (eds.). ​Concepts and
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7. 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