Clinical placements

Patient confidentiality: how a complicated case created an ethical and legal dilemma

A service user’s chlamydia diagnosis taught me lessons about disclosure and breach of trust
Confidentiality illustration

A service users chlamydia diagnosis taught me lessons about disclosure and breach of trust

I was on clinical placement with a drug and alcohol service when a male service user attended the clinic to receive the results of a screening for sexually transmitted infections.

The service user was informed that he had tested positive for chlamydia, and, in line with guidance from the National Institute for Health and Care Excellence (NICE), he was advised of the importance of ensuring any recent sexual partners were treated for potential infection.

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A service user’s chlamydia diagnosis taught me lessons about disclosure and breach of trust


Picture: iStock

I was on clinical placement with a drug and alcohol service when a male service user attended the clinic to receive the results of a screening for sexually transmitted infections.

The service user was informed that he had tested positive for chlamydia, and, in line with guidance from the National Institute for Health and Care Excellence (NICE), he was advised of the importance of ensuring any recent sexual partners were treated for potential infection.

He was also advised that any recent sexual partners could be referred for screening and treatment anonymously if he felt uncomfortable speaking to them personally.

Service user did not want to disclose chlamydia result

The service user told the caseworker that he had only slept with his wife and one other partner in the previous six months, and that he did not intend to disclose his condition to his wife for fear of damaging their relationship.

The situation was further complicated by the knowledge that the service user and his wife were trying for a child. He was given information about the potential health risks of chlamydia for women, including risk of infertility, and was encouraged to speak to his wife and second partner.

Request for extra antibiotics to treat partner

When the service user was given a prescription for the required antibiotics and advised to avoid sexual contact until seven days after the end of treatment, he asked if he could have extra medication so he could covertly treat his wife for possible infection.

The request was refused, and he was advised that such measures would not be legal or ethical, and that the only way his wife could receive treatment was if she were to seek testing and treatment herself.

Ethical and legal dilemma regarding confidentiality

This presented the healthcare professionals involved in this case with an ethical and legal dilemma. Would it be morally or legally permissible for the clinician involved to breach the service user’s confidentiality and contact his wife to offer testing and treatment?

This case has two potential outcomes:

  • The clinician respects the service user’s confidentiality, maintaining his trust and protecting his relationship but leaving his wife at risk of harm.
  • The clinician informs the service user’s wife, removing the potential harm but creating conflict in the relationship, losing the service user’s trust and damaging the client/clinician relationship.

The Nursing and Midwifery Council code of conduct states that nurses have a duty to respect individuals’ confidentiality unless it is overridden by a duty to public or patient safety. The threshold for this is not clearly stated but is generally understood to refer to serious physical harm or death.

Confidentiality can influence whether people access services

While confidentiality is important to all patients and service users within the healthcare sector, research shows it is especially important to those who access sexual health services. This is because there is a strong correlation between a patient’s likelihood to access services and the perceived confidentiality of that service.

The dilemma facing the healthcare professionals in this case is underpinned by three key pieces of legislation: the Mental Capacity Act 2005, Article 8 of the Human Rights Act 1998, and the Data Protection Act 1998. These work together to protect individuals’ rights to privacy and autonomy in their personal lives.

Mental Capacity Act 2005

Under the Mental Capacity Act 2005, individuals must be considered to have capacity until proven otherwise. This protects people’s rights to make unwise decisions that may go against professional advice, providing they demonstrate understanding of the potential consequences.

Article 8 of the Human Rights Act 1998

In combination with the Mental Capacity Act, Article 8 of the Human Rights Act 1998 affords individuals the right to autonomy over their own private lives. While a clinician may feel a decision is unwise, they do not have the right to dictate action to service users. It is therefore important that clinicians provide individuals with the information necessary to make informed decisions on their own.

Data Protection Act 1998

The Data Protection Act 1998 limits the reason for collection of personal information to ‘specified and lawful purposes’, and prohibits its sharing beyond these reasons. This prevents individuals or businesses abusing trust and using information for their own benefit.

 

Under UK law, no ethical obligation or legal support exists for a decision to breach the service user’s confidentiality in the case outlined above. While the clinician may consider him to be acting in an immoral or unwise fashion, as a member of the public he is under no obligation to act in his wife’s best interests.

Although the clinician was emphatic in their advice to the service user to disclose his status to his wife, care had to be taken not to overstep the mark in accordance with the clinician’s professional duty. An individual’s right to act in their own interest following an informed decision is enshrined in law, however unwise that action may seem to be.

A higher moral standard

This dilemma demonstrates how healthcare professionals are subject to a higher moral standard than the general public. Although we must act within the bounds of what is justifiable and legal, this can lead to conflict between personal and professional morality.

This case challenged my understanding of what it means to be a nurse. It felt counterintuitive to refrain from action despite the evident risk to the service user’s wife, and this left me feeling guilty.

Showing impartiality is paramount 

I was also frustrated that the service user refused to tell his wife about his diagnosis, and I found myself making judgements about him based on limited information. This goes against my professional duty to remain impartial and shows how important it is for healthcare professionals to be aware of their own biases.

No matter what our personal views are, we must ensure that we do not act in a way that compromises the autonomy of our patients or the quality of care they receive.


Michael Muggridge is a third-year mental health nursing student at the University of Leeds

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