What are the limits of patient confidentiality? Are there situations in which a duty to warn or otherwise protect third parties might exist? Provide a rationale for your position
Patients have the right to enjoy confidentiality. Safeguarding patient confidentiality is considered ethical. Safeguarding patient confidentiality builds trust between the patient and the healthcare personnel (Sheather & Brannan 2013). However, there are limits to patient confidentiality and sometimes there is a need to disclose patient confidentiality with or without his consent. For instance, if a patient's condition poses threats to the welfare of the public it is necessary to inform the people around the patient. Furthermore, when a patient arrives at the hospital with gunshot wounds his right to confidentiality is limited, as this information has to be reported to the authorities. A medical professional has to warn and protect the third party. When a patient has threatened or assaulted one of the staff or tends to be violent, it is justifiable to warn people attending to him for their protection. I think safeguarding patient information is necessary however if patient confidentiality poses threats to other people it is justifiable to disclose the information.
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Why is competence sometimes very difficult to determine? Why is the ability of the patient to make an informed refusal so impacted by competence? When patients are legally allowed to be irrational?
The patient is entitled to autonomy whether to accept or decline a medical treatment course. A patient is considered competent to make a treatment decision when their mental and cognitive capacity is not questionable. It tends to be difficult for physicians to determine the competence of a patient because the patient may have no history of mental health issues but the news of his ailment and treatment may cause confusion and denial, therefore, making an irrational decision at that particular moment. The healthcare personnel will have no legal ground to oppose the patient's decision. In the US and UK, when a patient refuses medical treatment, the law requires the patient's decision to be respected unless he is mentally unstable (Zhang et al, 2015). The patient is considered legally irrational when his mental and cognitive capabilities can be questioned with evidence that can be proven in court.
Kidders Ethical checkpoints is a decision-making model that is often used in health care. Provide an example of how this model could be used to make an ethical decision. What do you like and dislike about this model?
The model has nine checkpoints that help in decision-making. For instance, a terminally ill patient who is going through unbearable pain may request help from the healthcare personnel for termination of his life consequently resulting in an ethical dilemma. This model encourages exhaustion of all available options that will not lead to the ultimate decision of ending the patient life in this case. It is ethical to settle for a decision that serves the best interest on both parties (Ellison 2019) The patient desires to terminate his life because of the intense pain therefore the physicians may try to introduce strong pain relief medicine on the patient with the intent to ease the pain. I like this model because it encourages people to exhaust all other options and not rely on specific grounds in making a decision. I dislike this model because it may prove difficult to determine all the possible outcomes using this model in decision making thus leading to unanticipated repercussions.
References
Ellison, E. C. (2019). The ethical challenges of surgical leadership. In Surgical Ethics (pp. 53-73). Springer, Cham.
Sheather J, Brannan S. Patient confidentiality in a time of care.data. BMJ . 2013;347:f7042. Published 2013 Nov 27. doi:10.1136/bmj.f704
Zhang, S., Mellsop, G., Brink, J., & Wang, X. (2015). Involuntary admission and treatment of patients with mental disorder. Neuroscience bulletin , 31 (1), 99-112.
