Discussion: Legal and Ethical Conduct

Posted: February 15th, 2023

Discussion: Legal and Ethical Conduct

As emphasized in this week’s media presentation, all nurses need to be familiar with the laws and regulations that govern their practice: their state’s Nurse Practice Act, ANA’s Nursing: Scope and Standards of Practice, specialty group standards of practice, etc. In addition, basic ethical principles guide nurses’ decision-making process every day. ANA’s Code of Ethics and ANA’s Social Policy Statement are two important documents that outline nurses’ ethical responsibilities to their patients, themselves, and their profession. This said, there is a dilemma: The laws are not always compatible with the ethical positions nurses sometimes take. This week’s Discussion focuses on such a dilemma.

To prepare:

Review this week’s Learning Resources, focusing on the information in the media presentation about the relationship between the law and ethics.

Consider the ethical responsibility of nurses in ensuring patient autonomy, beneficence, non-malfeasance, and justice.

Read the following scenario:

Lena is a community health care nurse who works exclusively with HIV-positive and AIDS patients. As a part of her job, she evaluates new cases and reviews confidential information about these patients. In the course of one of these reviews, Lena learns that her sister’s boyfriend has tested HIV positive. Lena would like to protect her sister from harm and begins to consider how her sister can find out about her boyfriend’s health status.

Consult at least two resources to help you establish Lena’s legal and ethical position. These resources might include your state’s Nurse Practice Act, the ANA’s Code of Ethics, ANA’s Nursing: Scope and Standards of Practice, and internal or external standards of care.

Consider what action you would take if you were Lena and why.

Determine whether the law and the ANA’s standards support or conflict with that action.

Post a description of the actions you would take in this situation, and why. Justify these actions by referencing appropriate laws, ethical standards, and professional guidelines.

Required Readings

Milstead, J. A. (2019). Health policy and politics: A nurse’s guide (6th ed.). Burlington, MA: Jones and Bartlett Publishers.

Chapter 4, “Government Response: Regulation” (pp. 56-81)

This chapter explains the major concepts of the regulation of health professionals, with emphasis on advanced practice nurses (APN) and the process of licensure and credentialing.

ANA’s Foundation of Nursing Package – (Access this resource from the Walden Library databases through your NURS 6050 Course Readings List)

Guide to the Code of Ethics: Interpretation and Application

This guide details the history, purpose and theory, application, and case studies of this must-have Code of Ethics.

Nursing Social Policy Statement

The Nursing Social Policy Statement provides an understanding of the social framework and obligations of the nursing profession.

Nursing: Scope & Standards of Practice

This book contains several national standards of practice that can be used to inform the decision-making process, development, implementation, and evaluation of several functions and aspects of advanced practice nursing.

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Legal and Ethical Considerations in Disclosing a Patient’s HIV Status
Introduction
Nurses face complex situations that require balancing legal obligations with ethical responsibilities on a daily basis. One such dilemma involves maintaining patient confidentiality while protecting others from potential harm. This paper analyzes the legal and ethical issues surrounding a community health nurse considering revealing her sister’s boyfriend’s HIV-positive status without his consent. Relevant laws, codes and guidelines are examined to determine the most appropriate course of action.
Laws Governing Patient Privacy and Confidentiality
In the United States, the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule sets national standards for protecting individuals’ medical records and other personal health information (PHI) (U.S. Department of Health and Human Services, 2023). PHI encompasses any information relating to an individual’s physical or mental health, healthcare provision or payment that can reasonably identify them (U.S. Department of Health and Human Services, 2023).
HIPAA restricts disclosure of PHI without patient authorization except under specific circumstances like public health activities, health oversight, judicial proceedings or law enforcement (U.S. Department of Health and Human Services, 2023). Revealing a patient’s HIV status to a third party not involved in their care would constitute improper disclosure under HIPAA, unless an exception applied (Centers for Disease Control and Prevention, 2016).
State laws also govern confidentiality. For example, California’s Confidentiality of Medical Information Act prohibits healthcare providers from disclosing medical information without patient consent, with limited exceptions for serious threats (California Legislative Information, 2022). Similarly, New York’s Public Health Law protects confidentiality of HIV-related information and only allows disclosure to prevent transmission (New York State Department of Health, 2016).
Nursing Codes of Ethics
While laws set minimum standards, codes of ethics provide moral guidance. The American Nurses Association (ANA) Code of Ethics (2015) emphasizes respect for human dignity and worth of persons in Provision 1.2. It states nurses should advocate for patient safety, health and rights. However, Provision 1.1 prioritizes patient autonomy – the right to make decisions about one’s own care.
The International Council of Nurses (ICN) Code of Ethics (2012) also stresses confidentiality is fundamental to nursing. Information should only be shared with patient consent, unless required to protect others from serious and identifiable harm. Even then, the “duty to warn” must be carried out protecting privacy and minimizing disclosure as much as possible (ICN, 2012).
Analysis of the Dilemma
In Lena’s situation, directly informing her sister about the boyfriend’s HIV status without his permission would breach HIPAA, state confidentiality laws and nursing codes discussed above. While wanting to protect family is understandable, autonomy and consent are cornerstones of the nurse-patient relationship (ANA, 2015; ICN, 2012).
However, the boyfriend’s behavior of engaging in unprotected sex without disclosure arguably endangers Lena’s sister in a way that could trigger “duty to warn” exceptions. Some options Lena could consider are:
Discussing the situation anonymously with her facility’s ethics committee for guidance (Robertson, 2019).
Encouraging open communication between her sister and boyfriend about getting tested, while maintaining confidentiality (NCSBN, 2019).
If risk of transmission is imminent, reporting the situation to public health authorities rather than taking direct action, as per guidelines (CDC, 2016).
This allows addressing the ethical duty of beneficence within legal and professional standards. The best approach respects all parties’ rights and safety.
Conclusion
Nurses face complex situations at the intersection of law and ethics. In dilemmas involving confidentiality and duty to warn, they must balance patient autonomy, beneficence and professional accountability. With careful consideration of relevant regulations and codes, there are often approaches respecting all principles involved. For community nurses, maintaining trust is paramount, and anonymous policy consultation prevents undue disclosure.
References
American Nurses Association (ANA). (2015). Code of ethics for nurses with interpretive statements. write my essay Silver Spring, MD: Nursebooks.org.
California Legislative Information. (2022). Confidentiality of medical information act. California Civil Code §§ 56-56.37. https://leginfo.legislature.ca Civil Code §§ 56-56.37. https://leginfo.legislature.ca.gov/faces/codes_displayText.xhtml?lawCode=CIV&division=1.&title=&part=2.6.&chapter=1.&article=
Centers for Disease Control and Prevention. (2016). Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports, 65(RR-18), 1–20. https://doi.org/10.15585/mmwr.rr6518ar1
International Council of Nurses. (2012). The ICN code of ethics for nurses. Geneva: ICN. https://www.icn.ch/nursing-policy/icn-code-of-ethics-for-nurses
New York State Department of Health. (2016). New York public health law article 27-F: Confidentiality of HIV related information. https://www.health.ny.gov/diseases/aids/general/law/
National Council of State Boards of Nursing (NCSBN). (2019). A nurse’s guide to professional boundaries. https://www.ncsbn.org/NurseGuidetoProfessionalBoundaries.pdf
Robertson, J. (2019). Navigating ethical dilemmas: The role of an ethics committee. American Nurse Today, 14(1), 54-55. https://www.americannursetoday.com/navigating-ethical-dilemmas-role-ethics-committee/
U.S. Department of Health and Human Services. (2023). Summary of the HIPAA privacy rule. HHS.gov. https://www.hhs.gov/hipaa/for-professionals/privacy/laws-regulations/index.html