Fbi

Choose Your Own Ethical Choose Your Own Ethical AdventureAdventure

You are a successful dermatologist working in Tucson, Arizona. One evening you are watching the evening news with your wife and the leading story is about a women that has obtained explosives and is suspected to live in the area. The FBI reports that she and her associates should be considered dangerous.

You suck in your breath when you see her picture. The woman in the news has not been identified, but they are calling her the She-bomber. A patient of yours named Jane Doe looks a lot like theShe-bomber and you have been taking care of her acne problems for the past five years. As a matter of fact, you saw Jane in your office last month and you are positive that the private information at your office will probably assist the FBI in tracking down the She-bomber if she is Jane.

Your wife asks if you recognize her and you tell her your not sure, but you will be looking into it at work tomorrow. The news story concludes with a phone number for an anonymous tip line number.

If you decide to immediately call the tip line and give all the information you have to the FBI go to slide #3

If you decide to gather information and research the problem go to #4

The FBI use caller id to identify your phone number. They then arrive at your office the next day with a warrant to retrieve all of your medical records, question your staff, and interview all your previous clients.

Jane Doe is not the She-bomber, she just looks a lot like her. Jane proceeds to sue you for everything your worth.

Your reputation is ruined and you lose your practice. Your wife leaves you for a plastic surgeon down the street and your dog runs away.

The End

The following day you go to work and review Jane Doe’s chart. There is no record in her chart of her verbalizing that she wanted to harm anyone, nor did she give you the impression that she was a danger to herself or others. Because of her acne, you have taken pictures to track her treatments progress. Using the internet you research the news story and decide that Jane and the She-bomber are definitely similar, if not identical. You hate to think you might be getting worked up over a case of mistaken identity.

You also review the FBI warning and note that the She-bomber has never actually blown anybody up. She appears to be in possession of explosives and has friends that like to blow things up. You feel that there may be danger involved but not immediately.

If you decide to go to Jane’s house and ask her to clarify whether she is She-bomber or not go to slide #5

If you decide to continue to researching the problem go to #6

Later that morning you go to Jane’s house and ask her if she is the She-bomber. Jane laughs and says that you are the third person to ask her that since the news story came out yesterday. She wholeheartedly denies any connection to the She-bomber and you complement her on how well her skin is looking.

That evening when you get in your car to go home it erupts into a ball of flames.

The End

Since you are not a trained FBI agent, you are unable to determine if Jane is or is not the She-bomber. You sit in your office, torn, because you do not want anyone to get hurt because of your inaction. You are also not in a position to just hand over to the FBI private, confidential information.

Therefore you realize you have stumbled across an ethical dilemma. Two choices lie before you, yet each one may have negative consequences. What do you do? How will you prioritize your principles?

If you feel the two principles in conflict are autonomy and justice go to slide #7.

If you feel the two principles in conflict are confidentiality and nonmaleficence go to #8.

While both of these principles are very important, neither happen to be in conflict. Go back to and try again.

Autonomy Justice

Autonomy refers to the patient having the right to make decisions regarding the treatment and care of there own body. This principle rests on the capacity of the individual to make decisions.

Justice in health care is usually defined as a form of fairness, or as Aristotle once said, "giving to each that which is his due.” One of the major concerns in healthcare is that some goods and services are in short supply there is not enough to go around, thus some fair means of allocating scarce resources must be determined.

Confidentiality vs. Confidentiality vs. NonmaleficenceNonmaleficenceConfidentiality

The AMA states, in it’s principles of medical ethics, a physician shall safeguard patient confidence and privacy within the constraints of the law. This principle is also stated in the Hippocratic Oath: Whatever, in connection with my professional service, or not in connection with it, I see or hear, in the life of men, which ought not to be spoken of abroad, I will not divulge, as reckoning that all such should be kept secret.

You have it ingrained within you to protect an individuals privacy because trust is so important in the physician-patient relationship, but you also recall the decision made in Tarasoff vs. Regents of Univ. of California. Basically it is justification, or a loophole, for the disclosure of confidential information when it can avert harm to a third party. The Tarasoff doctrine has paved the way for rulings regarding child abuse, HIV notification, or public health risks.

To help get a better grasp on the subject you read from the AMA, “Whenever possible, physicians should avoid disclosing information that could identify the patient. In some contexts, such as law enforcement, identifying information may be necessary to accomplish the purpose of disclosure. In other situations, identifying information should be withheld unless a statute specifically requires such information or a court orders the disclosure. If there is no statute or court order compelling disclosure, the confidentiality of patient information should be maintained. In all situations, physicians should provide no more information than is required.

You conclude that you must not provide any information unless: You have very specific evidence or knowledge that the patient will harm

others or There is a statute (law) or court order requiring you to disclose

information.

Go to the next slide.

Confidentiality vs. Confidentiality vs. NonmaleficenceNonmaleficenceNonmaleficence

“First, do no harm.” This phrase you have always held dear since the time it was taught to you the first year of medical school. You consider the principle of nonmaleficence and realize that it requires you to not intentionally create a needless harm or injury to the patient, either through acts of commission or omission. You also know that this principle expands to everyone, not just your patients. Therefore, if you did not stop the She-bomber, and you could have, you would sacrifice the principle of nonmaleficence.

You conclude that it is imperative that you do what you can to keep others from harm, even if it means giving up patient information.

By now you see the dilemma’s true colors: Do you risk breaching confidentiality in favor of nonmaleficence? Or do you put others at harm just to satisfy confidentiality?