51. CASE: Confidentiality and Privacy

Joanne Baker, a nurse practitioner in a small community, prescribed a partial opiate agonist to a young man, Brian, for treatment of prescription opiate dependence. Brian is talented and plays on the same soccer team as Joanne’s son.

Three weeks later, Brian is found unresponsive after an overdose of opiates, requiring intubations and medical evacuation to a city three hours away. He recovered and didn’t want others in the community to discover that he had attempted suicide. He began to spread rumours that Joanne was incompetent and prescribed a medication that she didn’t know how to use.

Another patient brought up these rumors during his own appointment with Joanne. Joanne wishes she could set the record straight, and explain that Brian obtained opiates from a provider in a neighbouring city and had taken these in large quantities in a suicide attempt. She is unsure of how to discuss the situation without breaching Brian’s patient confidentiality.

  • How should Joanne proceed in this situation?
  • How can she clear her name/ reputation without breaching confidentiality?
  • What are the competing values in this case?
  • What role/ responsibility should Brian have in the outcome of this situation?
  • What is the specific ethics conflict or question in this case?
  • How is this ethics conflict affected by the rural context?
  • What resources are available to help Joanne address the situation?

Some Values and Ethics Issues to Consider

  • Professional boundaries
  • Community and family relationships
  • Respect for professional integrity
  • Compliance with policies and procedures
  • Respect for privacy and confidentiality
  • Overlapping roles and responsibilities
  • Patient-provider relationships
  • Professional competence
  • Transparency
  • Stigma
  • Vulnerability
  • Respect for human dignity

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