46 unit 1 | Professional Considerations
that will most likely require intensive therapies and
treatments for a lifetime, adding up to more
millions of health-care dollars? In the social and
business world, welfare payments are based on
need, and jobs and promotions are usually distrib-
uted on an individual’s contributions and achieve-
ments. Is it possible to apply these measures to
health-care allocations?
Philosopher John Rawls addressed the issues
of justice as fairness and justice as the foundation of
social structures. According to Rawls, the idea of
the original position should be used to negotiate
the principles of justice. The original position based
on Kant’s social contract theory presents a hypo-
thetical situation in which individuals act as a
trustee for the interests of all individuals. The indi-
viduals, known as negotiators, are knowledgeable
in the areas of sociology, political science, and eco-
nomics. However, they are placed under certain
limitations referred to as the veil of ignorance. These
limitations represent the moral essentials of origi-
nal position arguments.
The veil of ignorance eliminates information
about age, gender, socioeconomic status, and reli-
gious convictions from the issues. Once this infor-
mation is unavailable to the negotiators, the vested
interests of involved parties disappear. According
to Rawls, in a just society the rights protected by
justice are not issues for political bargaining or sub-
ject to the calculations of social interests. Simply
put, everyone has the same rights and liberties.
Fidelity
The principle of fidelity requires loyalty. It is a
promise that the individual will fulfill all commit-
ments made to himself or herself and to others. For
nurses, fidelity includes the professional’s loyalty to
fulfill all responsibilities and agreements expected
as part of professional practice. Fidelity is the basis
for the concept of accountability—taking responsi-
bility for one’s own actions (Shirey, 2005).
Conf identiality
The principle of confidentiality states that anything
said to nurses and other health-care providers by
their patients must be held in the strictest confi-
dence. Confidentiality presents both a legal and an
ethical issue. Exceptions exist only when patients
give permission for the release of information or
when the law requires the release of specific infor-
mation. Sometimes, just sharing information
without revealing an individual’s name can be a
breach in confidentiality if the situation and the
individual are identifiable. It is important to realize
that what seems like a harmless statement can
become harmful if other people can piece together
bits of information and identify the patient.
Nurses come into contact with people from
different walks of life. Within communities, people
know other people who know other people, and so
on. Individuals have lost families, jobs, and insur-
ance coverage because nurses shared confidential
information and others acted on that knowledge
(AIDS Update Conference, 1995).
In today’s electronic environment, the principle
of confidentiality has become a major concern.
Many health-care institutions, insurance compa-
nies, and businesses use electronic media to trans-
fer information. These institutions store sensitive
and confidential information in computer databases.
These databases need to have security safeguards to
prevent unauthorized access. Health-care institu-
tions have addressed the situation through the use
of limited access, authorization passwords, and
security tracking systems. However, even the most
secure system is vulnerable and can be accessed by
an individual who understands the complexities of
computer systems.Veracity
Veracity requires nurses to be truthful. Truth is fun-
damental to building a trusting relationship.
Intentionally deceiving or misleading a patient is a
violation of this principle. Deliberately omitting a
part of the truth is deception and violates the prin-
ciple of veracity. This principle often creates ethical
dilemmas. When is it permissible to lie? Some
ethicists believe it is never appropriate to deceive
another individual. Others think that if another
ethical principle overrides veracity, then lying is
permissible. Consider this situation:Ms. Allen has just been told that her father has
Alzheimer’s disease. The nurse practitioner wants to
come into the home to discuss treatment. Ms. Allen
refuses, saying that the nurse practitioner should
under no circumstances tell her father the diagnosis.
She explains to the practitioner that she is sure he
will kill himself if he learns that he has Alzheimer’s
disease. She bases this concern on statements he has
made regarding this disease. The nurse practitioner
replies that medication is available that might help