NHS FPX 4000 Assessment 3 Applying Ethical Principles

Healthcare professionals, in any role within the field, must use ethical principles and values as the foundation for their clinical decisions. These principles include autonomy, informed consent, beneficence, non-maleficence, fairness, and justice. In this assessment, an ethical case study is analyzed, and a possible solution is proposed using an ethical decision-making model. This assessment will help us understand the moral values of healthcare and prepare a ground for further moral decision-making. 

Overview of the Case Study

The case study is about a patient, Mr Alex Turner, 35 years old, who has been suffering from depression and anxiety for about six months. He is under the care of a clinical psychologist, Dr. Laura Simmons. Alex and Dr. Simmons have had a trustworthy relationship where the healthcare professional has always encouraged open communication. Because of this encouragement, Alex openly and honestly shares his deepest thoughts with Dr. Simmons. In one fine session, Alex shared his comprehensive plans and thoughts of harming his colleague with whom he has several personal and professional divergences. 

Facts of the Case Study 

This situation has led Dr. Simmons to encounter an ethical dilemma between patient confidentiality and beneficence/non-maleficence as crucial ethical principles in healthcare ethics. Confidentiality, critical to the patient-provider relationship, requires her to keep Alex’s thoughts private without sharing them with others. At the same time, beneficence/non-maleficence compels her to prevent harm to Alex and the people surrounding him. This circumstance is not only affecting the doctor but has a significant impact on Alex and his colleague, who is unaware of Alex’s plans. Along with the dispute between confidentiality and beneficence, the lack of appropriate guidelines for revealing information makes it difficult for psychologists and other healthcare professionals to decide when and how to disclose confidential information.

An integrative review by Conlon et al. (2019) supports this analysis by presenting that disclosing patients’ confidential information is essential when a risk of harm is being assessed to protect patients and the people around them. This risk can be for self-harm or homicidal. However, an appropriate method of information disclosure is required to avoid violating the principle of confidentiality. Another literature review mentions that psychologists or mental health practitioners face several challenges related to the sharing of information when they foresee a risk of violence. In such situations, understating the risk behaviors and making appropriate adjustments in mental health practices can assist professionals in combating the challenges.

NHS FPX 4000 Assessment 3 Applying Ethical Principles

Nevertheless, the primary goal should be preventing harm and protecting the client and their surroundings (Brooks, 2021). These peer-reviewed journal articles are credible and relevant as they are published in authorized journals, and the authors of the articles are well-versed in the mental health domain. The articles briefly present the study’s claims and limitations while mentioning the requirements for future studies. It is relevant because the articles are about the disclosure of confidential information and how sharing of information by mental health professionals is vital to protect the risk of violence, which is directly related to our case study. Thus, these sources can be used to develop a solution for Alex and Dr. Simmons’ case study.  

Effective Communication Approach Used in the Case Study

The communication approaches in the case study are open and honest communication and active listening. Dr. Simmons has developed a therapeutic relationship with her patient using open and honest communication. This method of communication is effective in building rapport with the patients and gaining their trust. A study uncovered that communication in an effective way is essential for building trust and delivering patient-centered care (Asan et al., 2021). In the case study, Alex was encouraged to discuss his thoughts on homicide through open, direct, and honest communication.

Another effective communication approach is active listening. Dr. Simmons actively listens to Alex, demonstrating empathy and understanding. Ricks and Brannon (2023) emphasize that active listening is a ground skill that assists mental health practitioners in building effective relationships with patients and engaging them in conversation. This approach enables patients to share their feelings, thoughts, and experiences with the providers and gives providers a sense of understanding and paraphrasing their client’s messages.

Similarly, in the case study, Dr. Simmons’ enthusiastic listening to Alex made him feel valued and invigorated him to continue sharing his thoughts about harming his colleague. In contrast, communication approaches that should be avoided are dismissing the patient’s thoughts. This act from healthcare providers makes patients feel invalidated and disregards their feelings and autonomy. Other approaches that should be avoided are being judgmental of their feelings and expressing personal opinions. Therapists should focus on providing support through research-based evidence and guidance rather than expressing their personal views.

Ethical Decision-Making Model and Case Study

In the case study, the actions undertaken by Dr. Simmons demonstrate her approach to effective communication and ethical decision-making. The possible approach used by Dr. Simmons is based on three components of the ethical decision-making model: moral awareness (identifying the concern), moral judgment (gathering information), and ethical behavior (ethically sound solution). Initially, she recognized the ruthlessness of her patient’s homicidal thoughts and considered it an ethical dilemma because of a conflict between patient confidentiality and beneficence/non-maleficence.

In the second step, she established a therapeutic relationship with the client using an open and honest communication approach to gather maximum information about the patient’s feelings and ideation. Furthermore, her possible actions would be considering alternatives for the patient to ease his homicidal thoughts, such as involving crisis intervention services, family involvement, or directly informing Alex’s colleague. She would perform a risk-benefit analysis considering the consequences of each action and accordingly make a decision. Such a decision can prioritize the principle of non-maleficence and prevent potential harm to the patient as his colleague.

NHS FPX 4000 Assessment 3 Applying Ethical Principles

As per her decision, she will implement an ethically sound action to resolve the dilemma and maintain her relationship with the client. There are several potential consequences of using effective, ethical decision-making approaches. Such an approach can assist healthcare providers in recognizing the risk earlier, allowing them to take preventive measures (Haddad & Geiger, 2023). Additionally, this approach reduces the risk of harm and maintains patient’s trust in providers and healthcare services. Overall, ethical decision-making preserves patient safety and promotes their overall well-being. On the other hand, ineffective approaches may lead to poor decisions, unethical behaviors, legal reprimands for the providers, loss of patients’ trust, and damage to providers’ reputations.

Ethical Solution for the Case Study

This case study has a primary conflict between ethical principles of confidentiality and beneficence/non-maleficence. Dr. Simmons is bound to preserve the patient’s confidentiality, but her duty to protect the patients and their surroundings compels her to consider disclosing Alex’s thoughts to the colleague. A possible solution to this dilemma would be for Dr. Simmons to reveal Alex’s homicidal ideation to his colleague while also taking measures to protect Alex’s confidentiality and therapeutic coalition. This solution is based on the ethical principle of beneficence/non-maleficence, where healthcare providers must act in the best interest of patients and others around them, preventing the risk of harm (Varkey, 2020).

Dr. Simmons should consider obtaining informed consent before disclosing the information to protect Alex’s confidentiality and maintain the therapeutic relationship. This action is based on the patient’s autonomy, where the patient’s willingness to share information and acquire help is essential. Healthcare providers must balance patients’ autonomy and right to safety (beneficence) (Cheraghi et al., 2023). This approach enables Dr. Simmons and other healthcare providers, in general, to navigate complex situations and make decisions aligning with ethical principles. This possible solution will establish a trustworthy and respectful impression of her in front of her colleagues, fostering collaboration within her organization. 

Conclusion

In conclusion, maintaining patients’ confidentiality and abiding by the principles of beneficence and non-maleficence is a continuous battle in the healthcare industry. In our case study, the patient had expressed homicidal ideation for his colleague, because of which Dr. Simmons had encountered an ethical dilemma. For this purpose, she used an effective, ethical decision-making model to ensure that an ethically sound and effective solution is derived. It is necessary to balance patient autonomy and beneficence and disclose information where needed appropriately to avoid breaching confidentiality and upholding therapeutic relationships. 

References

Asan, O., Yu, Z., & Crotty, B. H. (2021). How clinician-patient communication affects trust in health information sources: Temporal trends from a national cross-sectional survey. PLOS ONE, 16(2), e0247583. https://doi.org/10.1371/journal.pone.0247583 

Brooks, N. (2021). When clients harm others: The challenges confronting the psychology profession. Psychology Aotearoa, 13(2), 106-111. https://www.researchgate.net/publication/356982250_When_clients_harm_others_The_challenges_confronting_the_psychology_profession 

Cheraghi, R., Valizadeh, L., Zamanzadeh, V., Hassankhani, H., & Jafarzadeh, A. (2023). Clarification of ethical principle of the beneficence in nursing care: An integrative review. BMC Nursing, 22, 89. https://doi.org/10.1186/s12912-023-01246-4 

Conlon, D., Raeburn, T., & Wand, T. (2019). Disclosure of confidential information by mental health nurses, of patients they assess to be a risk of harm to self or others: An integrative review. International Journal of Mental Health Nursing, 28(6), 1235–1247. https://doi.org/10.1111/inm.12642 

NHS FPX 4000 Assessment 3 Applying Ethical Principles

Haddad, L. M., & Geiger, R. A. (2023). Nursing ethical considerations. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK526054/ 

Ricks, D., & Brannon, G. E. (2023). “It’s real. It’s a thing:” Mental health counselors’ listening exhaustion during COVID-19. Qualitative Research in Medicine & Healthcare, 7(2), 11261. https://doi.org/10.4081/qrmh.2023.11261 

Varkey, B. (2020). Principles of clinical ethics and their application to practice. Medical Principles and Practice, 30(1), 17–28. https://doi.org/10.1159/0005