NR 581NP Week 6 Ethics Case Analysis Example

Ethics Case Analysis: An Adult Daughter Asks a Nurse Practitioner for a Parent's Scan Result After the Patient Has Said No, Worked Through Law, Code, Policy and Principles

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College of Nursing, Chamberlain University

NR 581NP: Foundational Concepts for Advanced Nursing Practice

Instructor Name

Month Day, Year

Ethics Case Analysis: An Adult Daughter Asks a Nurse Practitioner for a Parent's Scan Result After the Patient Has Said No, Worked Through Law, Code, Policy and Principles

The Case

A 78-year-old with decision-making capacity is seen in a primary care practice for weight loss. A CT scan shows a mass in the pancreas. At the follow-up visit, the patient hears the result and asks the nurse practitioner not to tell the patient's daughter, who shares the home and drives the patient to appointments, until the patient has decided how to break the news personally. Two days later the daughter calls the practice, says something is clearly wrong, and asks the nurse practitioner directly what the scan showed.

The Conflict

The obligation to keep the patient's information confidential, as the patient has asked, conflicts with the daughter's legitimate interest as the person who provides care and transport, and with the nurse practitioner's wish to help the daughter.

The Legal Position

Under the federal privacy rule, a covered provider may share information with a family member who helps with the patient's care, provided the patient is there and raises no objection, or when the patient is absent and the provider judges that sharing is in the patient's interest (Uses and Disclosures Requiring an Opportunity for the Individual to Agree or to Object, 2024). Here the patient has capacity and has objected. The rule therefore does not permit disclosure to the daughter on these facts. A separate provision permits disclosure to avert serious, imminent danger to someone's health or safety; a new diagnosis is not that kind of danger.

The Professional Obligation

The Code of Ethics for Nurses commits nurses to respect the dignity and autonomy of each person and to guard what patients share in confidence (American Nurses Association, 2025). The provisions on respect for persons and on the patient's interests support keeping the information private. Nothing in the code requires the nurse practitioner to withhold support or compassion from the daughter.

Institutional Policy

The practice's written policy, reviewed by its privacy officer each year and signed by every clinician at hire, follows the federal rule closely: information is shared with family only with the patient's agreement, documented in the record, except in emergencies.

The Principles

Respect for autonomy: the patient has capacity and has made a clear choice about the patient's own information. Beneficence: the daughter may be able to help more with the information, but the patient has not refused to tell the daughter; the patient has asked to do the telling. Nonmaleficence: disclosing against the patient's wishes could damage the patient's trust in the practice and the relationship with the daughter. Justice: not directly at issue here, since no one else's access to care is affected.

Each principle is used here, not only named. Autonomy weighs most heavily because the patient has capacity and the request is limited in time.

Why the Case Is a Real Conflict

Neither obligation is trivial. The daughter is not a stranger seeking gossip; the daughter is the patient's main support and will need to know soon. The patient's request is not a refusal to involve family; it is a request for time and control over how the news is shared. A scenario in which one side was plainly wrong would leave nothing to weigh; this one requires the nurse practitioner to honor one obligation while still serving the other.

Options

Tell the daughter the result: not permitted by law or policy, and contrary to the patient's wishes.

Refuse to discuss anything: lawful, but leaves the daughter without support.

Decline to share the result, acknowledge the daughter's worry, say the practice will speak with the patient, and contact the patient that day to report the call and to offer help with telling the daughter: lawful, consistent with the code and policy, and responsive to both people.

Recommendation

The third option. The nurse practitioner tells the daughter: "I can hear how worried you are. I'm not able to share your dad's results without permission, but I'll speak with your dad today and say that you called." The nurse practitioner then calls the patient, reports the daughter's call and offers a joint visit to help with telling the daughter. The call and the offer are documented, including the exact words used with the daughter, so that anyone else in the practice who takes a later call gives the same answer.

What the Analysis Did Not Do

It did not decide early and recruit sources to agree. The legal position was read first, and it did not depend on the outcome the analysis might have preferred. The code was read for what it says about privacy and about compassion, and both appear in the recommendation. The policy was checked to make sure it did not impose a stricter rule. Each source was allowed to point where it pointed, which in this case was the same direction, but for different reasons.

How the Recommendation Serves Both People

The patient keeps control of the news and gets an offer of help. The daughter is not lied to, is told the practice knows of the call and will act, and is not left alone with the worry. The nurse practitioner stays within the law and the code. No option serves everyone perfectly; the daughter still waits. But this option leaves the shortest path to the outcome both people want, which is the daughter knowing, told by the patient. If that does not happen within a reasonable time, the nurse practitioner can raise it again with the patient, gently, at the next visit.

Documentation

The note records, for any colleague who reads it later, the date and time of the daughter's call, that no clinical information was disclosed, the words used, the call to the patient, the patient's response and the offer of a joint visit. If the patient later authorizes disclosure, the authorization is recorded with its limits stated: which information, to which person and until when.

If the Situation Changes

If the patient loses capacity, decisions pass to the patient's health care agent or surrogate under state law, who should decide as the patient would have (Sulmasy & Snyder, 2010), and the analysis would change. If the patient later agrees, the daughter can be told, with the patient's permission documented.

References

American Nurses Association. (2025). Code of ethics for nurses. https://codeofethics.ana.org/

Sulmasy, D. P., & Snyder, L. (2010). Substituted interests and best judgments: An integrated model of surrogate decision making. JAMA, 304(17), 1946-1947. https://doi.org/10.1001/jama.2010.1595

Uses and Disclosures Requiring an Opportunity for the Individual to Agree or to Object, 45 C.F.R. § 164.510 (2024).