HLTH 6405 Week 9 Confidentiality Dissent Analysis Example

Dissent Analysis: The Strongest Case for Keeping Marcus's Fainting Spells Confidential, and the Facts or Values That Would Have to Hold for That Side to Win

Student Name

Walden University

HLTH 6405: Ethics and Social Justice

Instructor Name

Month Day, Year

Dissent Analysis: The Strongest Case for Keeping Marcus's Fainting Spells Confidential, and the Facts or Values That Would Have to Hold for That Side to Win

The Earlier Resolution

In Week 5, the case of Marcus, an outreach worker who transports older clients and confided two fainting spells to his supervisor, Dana, was resolved in favor of protection: Dana should remove him from driving at once, require a medical evaluation and disclose as little as possible. This paper argues the other side, that Dana should keep the confidence, as strongly as it can be argued, and then states precisely the conditions under which that side would prevail.

The Case for Keeping the Confidence

Autonomy and the Ownership of Health Information

Marcus's health information is his. He chose to share it with one person, for a purpose: to get advice from someone he trusted. Respect for autonomy, one of the four principles of health care ethics, includes control over who knows what about one's body. Acting on his confidence against his explicit request treats his disclosure as a report rather than a conversation, and it overrides his judgment about his own situation.

The Uncertainty of the Risk

Two fainting spells, unexplained, are not a diagnosis. Fainting has many causes, some trivial and situational, such as dehydration or standing too quickly, and some serious. Neither happened while Marcus was driving. The earlier resolution treated an unknown risk as a significant one. A defender of confidentiality can argue that removing a worker from his duties on the strength of two unexplained episodes, with no medical opinion at all, imposes a certain cost to prevent an uncertain harm.

The Long-Run Consequences for Disclosure

The strongest argument is consequentialist. Workplaces depend on employees telling supervisors when something is wrong. If a confidential disclosure is followed at once by a change in duties, every employee learns that confiding health problems is costly. The result is not fewer health problems but fewer disclosures. In a program that relies on staff who drive, lift and care for frail clients, a culture in which health concerns go unspoken may produce more total risk than any single case of a driver with an unexplained symptom.

A Less Intrusive Path

Public health ethics favors the least infringing means of achieving a goal (Childress et al., 2002) and the least restrictive means of preventing harm to others (Upshur, 2002). The dissent argues that Dana had a less intrusive option than acting on the confidence: she could have persuaded Marcus to stop driving voluntarily and to see a doctor within days, keeping both the confidence and the protection. Taking the decision away from him was not necessary if he could be brought to make it himself.

Where the Dissent Is Weakest

Every strong dissent has a point where it must concede something, and naming that point is part of arguing it honestly.

The dissent's weak point is that the passengers cannot consent. Autonomy covers Marcus's choices about his own risk; it does not authorize him to place frail clients at risk without their knowledge. And the uncertainty cuts both ways: unknown risk is precisely what passengers cannot evaluate. A defender of the dissent must therefore rely on facts that reduce the risk or on a path that protects the passengers without overriding Marcus.

Conditions Under Which the Dissent Prevails

The dissent wins if any of the following holds.

1. Marcus agrees, during the same conversation, to stop driving agency clients immediately and to see a physician within a few days, and Dana can verify the first commitment, for example because she controls the driving schedule. Then protection is achieved by his choice, the confidence is kept and the five conditions for overriding a moral consideration (Childress et al., 2002) are not met, because overriding is no longer necessary.

2. A medical explanation already exists that removes the safety concern, such as a documented, treated cause, so that the risk to passengers is no longer unknown.

3. Marcus's work involves no safety-sensitive tasks, so no third party bears the risk; then confidentiality should prevail and Dana's role is to encourage care.

4. The values change: if the program held that employee confidences are absolute and accepted the resulting risk to clients openly, the dissent would win by stipulation, though few health organizations could justify that policy to the people they serve.

Why Arguing the Losing Side Is Worth Doing

The exercise is also a check on the writer. A resolution reached quickly can rest on an unexamined assumption, here that unexplained symptoms imply an unacceptable risk. Making the opposite case forces that assumption into the open, where it can be defended or revised.

A resolution that has never faced its best opponent is fragile. If Dana's decision were challenged by Marcus, by a coworker or by the agency's board, the challenge would most likely come from the arguments set out above: that his information was his, that the risk was uncertain and that acting on confidences discourages disclosure. Having already answered those arguments, and having conceded what is right in them, the agency can defend its decision on the merits rather than on authority. The exercise also guards against a common failure in ethics writing, which is to describe the opposing view in its weakest form and then defeat it easily. A dissent stated at full strength forces the original reasoning to name the facts it depends on.

What the Analysis Changes

Arguing the dissent sharpens the original resolution rather than reversing it. The first condition above shows that Dana's best first move is to seek Marcus's agreement to stop driving and see a doctor, and to act unilaterally only if he refuses. The original paper reached the right outcome but understated how much of it could be achieved with his cooperation. That revision honors more of what the dissent gets right while keeping the passengers protected, and it fits the broader public health expectation that burdens be minimized wherever a cooperative route exists (Kass, 2001).

References

Childress, J. F., Faden, R. R., Gaare, R. D., Gostin, L. O., Kahn, J., Bonnie, R. J., Kass, N. E., Mastroianni, A. C., Moreno, J. D., & Nieburg, P. (2002). Public health ethics: Mapping the terrain. Journal of Law, Medicine and Ethics, 30(2), 170-178. https://doi.org/10.1111/j.1748-720X.2002.tb00384.x

Kass, N. E. (2001). An ethics framework for public health. American Journal of Public Health, 91(11), 1776-1782. https://doi.org/10.2105/AJPH.91.11.1776

Upshur, R. E. G. (2002). Principles for the justification of public health intervention. Canadian Journal of Public Health, 93(2), 101-103. https://doi.org/10.1007/BF03404547