Dr. Jenkins is a Doctor torn between protecting his self-interest and doctor-patient confidentiality or disclosing the mental status of a pilot who may be a danger to himself and other people to third parties including his family and employer.
The professional ethics issues, in this case, are based on doctor-patient confidentiality and professionalism on account of the physician Doctor Jenkins. Dr. Jenkins is bound by the rules of practice of the jurisdiction that he operates from, and this include his having an up to date licenses for the practice and to always maintain doctor -patient confidentiality. As a doctor, he also has a duty to the rest of the members of the public should the status of a patient be determined to the safety and wellbeing of the entire community.
Ethical Issue Statement
Should Dr. Jenkins Disclose the pilot Jack’s mental Status to his employers?
- Dr. Jenkins should disclose the pilot’s mental status to his employers and risk him (Jack) giving out information that he has been practicing without a license which will further compound the case that he has with the medical board and risk losing his entire career.
- Dr. Jenkins should not disclose the mental status of the patient to the employers. Keep it between them and avoid any issues that may further aggravate his soon to be determined case by the medical board.
- Dr. Jenkins should issue a statement to the medical board about his lack of licenses and then report then disclose the issue to jack’s employers.
- Dr. Jenkins should disclose the issue to Jack’s employers arguing that without a license he is not bound by doctor-patient privilege and should therefore not be punished for the same by the medical board.
- DR. Jenkins should request Jack to inform his employers of his mental condition the failure of which he will inform them himself regardless of the consequences as either way, chances are both of them would be out of a job.
Analysis: Relevant Facts, Ethical Values/Principles, and Consequences
There are three important considerations hat are at play as ethical principles, in this case. The first one is deontology based on the rules and regulations of the medical profession. The second one is consequentialism based on considerations of the outcomes that may subsist with each of options that are available for selection. Finally, there is the consideration of virtue ethics based on an analysis of the motivations behind the various actions that may be chosen.
Dr. Jenkins is a general physician working at a local hospital. His practice serves mostly high-end clientele and professionals and handles general matters of health ranging from physical health to mental and wellness issues. His practice has had some significant controversial issues in the past with allegations of malpractice and other breaches of professionalism in the medical profession. He had a case in the past where he diagnosed, Jeanne one of his patients as having the HIV. He conducted the test without any authorization and permission from the patient as the patient came for her routine medical checkup. She had expressly indicated before that she wanted any reasonable test to be done on her but not any tests that would ‘stress’ her in her otherwise healthy life. Dr. Jenkins made a call to Jeanne’s boyfriend Tom and requested him if he would like to come over to his office for a number of tests including the HIV test. Both Tom and Jeanne were private patients of Dr. Jenkins. They had expressly indicated to him that their medical information was not to be shared under any circumstances. On the first time that he took tests of Tom’s blood, Tom was negative. A few months later, Tom tested positive. Jeanne blamed Tom for his infidelity that brought about the infection to her and to confirm this she went to Dr. Jenkins’s office for a test, only for Dr. Jenkins’s assistant to inform her that she had been tested positive way before Tom was. Tom got wind of this news and went to social media disparaging Dr. Jenkins’s name for not disclosing to him, his girlfriend’s HIV Status. Jeanne on the other hand also went to the medical practitioner’s board to report unethical practices of Dr. Jenkins conducting tests that were not authorized.
Currently, Dr. Jenkins is still practicing but has not paid for the practicing license of the current year. A patient, Jack, who is a pilot, confides in him that he has had suicidal tendencies, and these have been bothering him for a very long while. However he cannot bring himself to do it and probably it was not anything of concerned Jenkins, who is a staunch believer of confidentiality, considering that situation the Jeanne and Tom’s case has put him in, is torn between letting Jack’s employers know of his mental state or maintaining confidentiality. Jack notices that dr. Jenkins does not have a current practicing certificate and tells him that he should not tell anyone about it, or he will reveal that he has breached ethical guidelines on registration of practice. The only person that knows about Jack’s state is Dr. Jenkins. This would have severe consequences for Dr. Jenkins including expulsion from the profession, criminal litigation and loss of reputation. Jack is due to fly outside the country on official duty in the next three days.
There has recently been a news story on national television about a suicidal pilot who crashed an entire plane killing more than 150 passengers on board. Dr. Jenkins is already facing the medical board for conducting tests that had not been consented to by the patient. He has received significant negative publicity from the media and other platforms and if the consent issue is determined and he is found culpable. One risks losing a career and ability to practice in the future based on not obtaining consent (Freedman 1975). This may either be through a suspension or expulsion from the profession. The board has seemingly been unfriendly to him based on other past issues he has been having and all indications show that he may be found culpable.
The failure to disclose the incident has the potential of endangering many people’s lives. Travelers would not only be at risk but the airline that has hired Jack as a pilot would most likely than not suffer damages in negligence suits should anything happen to the aircraft and passengers as a result of the actions of the pilot. According to Hurley (2009), the consequentialist approach looks at the consequences of the moral actions chosen. The utilitarianism approach would want to have the least harm possible and the maximum benefit for the majority of the people or stakeholders concerned. The only people that stand to gain if he fails to disclose is himself in accord of his lack of a practicing license not being found out and the pilot for him keeping the job. However, the pilot is also a danger to himself as much as he is to other people. The consequentialist approach would, therefore, require Dr. Jenkins to step up and report the issue to Jack’s employers. If he chooses to do this, then at least the should let the medical board know of his practicing licenses status as opposed to such information coming from a third party.
The deontological approach is based on established duties and obligations as per the law and other considerations such as regulations and ethical guidelines (Alexander & Moore, 2012). In this case the duty of confidentiality vis- a vis the duty to disclose to the relevant stakeholders holders any issue that may pose a danger to other members of the public need to be balanced. Both of these issues are provided for by the ethical rules and procedures of the jurisdictions in which Dr. Jenkins practices. The duty of confidentiality between doctor and patient is one that is absolute. However, there are certain obligations that also arise based on the position of the physician within the context of the society. The Hippocratic Oath mandates doctors to try their best to save lives (Tyson, 2001). This means that doctors should take all reasonable measures that they can to save the lives of their patients. Without even looking at other parties to the case, jack’s mental status makes him a danger even to himself and it is Dr. Jenkins as a medical practitioner’s obligation to adopt an intervention hat minimizes the risk to the patient and saves his life. This includes informing Jack of his need to visit a qualified mental health practitioners and telling his family and even employer for them to take certain actions that would perhaps reduce or eliminate his desire to kill himself which may also have numerous other casualties. His failure to disclose the information about the risks that Jeanne posed to his boyfriend Tom exposed Tom to a dangerous and incurable disease and perhaps learning from that experience he should inform other relevant stakeholders of jack’s position for them to take the appropriate action. The failure to do so would not only be negligent but would be unprofessional. He surely cannot let a mentally challenged person to choose for himself what needs to be done, as a doctor he must take charge based on his responsibilities as a medical practitioner.
From a virtue ethics perspective, Dr. Jenkins’s intentions in disclosing the status of jack’s mind to any other third party’s such as his family or employer should be looked at as one of the good intentions as argued by Girod (2005). With all factors meaning constant, and the existing news item about a pilot who crashed a whole plane to suit his suicidal tendencies, Dr. Jenkins’s breach of confidentiality to bring out the issue should be seen from a progressive point of view rather than one that seeks to inflict harm to any stakeholder. It is an act of goodwill which would disparage him based on his having to disclose his practicing without a license but would probably save many lives and the life of a mentally ill pilot.
Statement of Resolution
Dr. Jenkins should request Jack to inform his employers of his mental condition the failure of which he will inform them himself regardless of the consequences as either way, chances are both of them would be out of a job. He should also write to the medical board and come out clean on the fact that he has been practicing for a short period as this would remove any leverage that Jack has against him. It would also give an opportunity to the medical board to handle Jenkins’s case at once rather than open up another inquiry as to his practice without a license. The position that he is in, shows the has nothing much to lose and this would be an important opportunity that he can use to redeem himself to members of the public and to the medical board that his intentions are never based on ill motive when he takes certain actions. It just may be what is required in the ever-changing profession where the doctor has obligations to the public that should not be ignored simply because of doctor-client privilege. The profession functions within society and not within a vacuum.
Alexander, L., & Moore, M. (2012, December 12). Deontological Ethics (Stanford Encyclopedia of Philosophy). Retrieved March 30, 2015, from http://plato.stanford.edu/entries/ethics-deontological/
Freedman, B. (1975). A Moral Theory of Informed Consent. The Hastings Center Report, 5(4), 32-39.
Girod, J. (2005). Just allocation and team loyalty: A new virtue ethic for emergency medicine. Journal of Medical Ethics, 31(10), 567-570.
Hurley, P. (2009). Beyond consequentialism. Oxford: Oxford University Press.
Tyson, P. (2001, March 27). The Hippocratic Oath Today. Retrieved March 30, 2015, from http://www.pbs.org/wgbh/nova/body/hippocratic-oath-today.html