To: Ethics inbox 

From: Concerned RN

Subject: Bedside arraignments

I am a medical-surgical nurse and admitted a patient to my unit who was arrested and injured during the commission of an alleged crime. The hospital allowed a television news crew to come into my patient’s room and record his court arraignment, which will be aired on a local station. I feel this was a violation of patient privacy. How is this fair and what should I have done? 

From: ANA Center for Ethics and Human Rights

Thank you for sending this challenging dilemma. First, the nurse’s ethical obligation is to the patient. Be sure your patient is medically stable and that you and your colleagues are safe. Next, determine if your hospital has a policy or resources to help resolve the issue so you can focus on patient care.

Ideally, a person charged with a crime has a formal reading of charges filed in a courtroom. These arraignments can involve videotaping the process to prevent having to transport defendants to the courtroom. However, an ethical dilemma presents when those charged become patients in a hospital, with the possibility of the arraignment being televised publicly. To understand the obligations of nurses in this situation, it’s important to understand the need to maintain the duty of care by protecting the rights of vulnerable populations, including the right to privacy and confidentiality.

The Code of Ethics for Nurses with Interpretive Statements specifies that nurses must preserve the rights of vulnerable groups, including those who may be socially stigmatized. Nurses must safeguard the right to privacy for all patients. Provision 3.1 states, “The need for healthcare does not justify unwanted, unnecessary, or unwarranted intrusion into a person’s life. Privacy is the right to control access to, and disclosure or nondisclosure of, information pertaining to oneself and to control the circumstances, timing, and extent to which information may be disclosed.”

Televised arraignments at the bedside may involve publicizing private patient information, including his or her location, that the patient hasn’t authorized. Furthermore, revealing this information could be unsafe for nurses and others at the hospital. For example, furtherance of the original alleged crime or acts of retaliation may place other patients and staff at risk. Interpretive Statement 3.1 asserts that nurses must advocate for environments that “provide sufficient physical privacy, including privacy for discussions of a personal nature.” As advocates for the patient, nurses must be vigilant in pursuing policy guidance from hospital leaders to address the privacy concerns and legality of the arraignment.

Patient advocacy requires assessment of the patient’s condition. This should include how the patient clinically responds to the arraignment and whether the conditions of the arraignment lead to health complications. The nurse also must determine whether the hospital arraignment is ethically appropriate for the patient. Nurses should consider factors such as safety, patient autonomy, privacy, respect, and trust.

Trust is central to the nurse-patient relationship (Interpretive Statement 3.1), so nurses should help ensure that personal health information is protected. Nurses are encouraged to demonstrate moral courage and advocate for patients in these difficult and often time-pressured situations. If nurses are working in organizations that lack policies or standards regarding recording or videotaping patients, they are encouraged to bring these concerns to the organization’s leadership team.

— Response by Renata Iskander, intern, ANA Center for Ethics and Human Rights, and Liz Stokes, JD, MA, RN, director, ANA Center for Ethics and Human Rights

Reference

Legal Information Institute. Rule 10. Arraignment. law.cornell.edu/rules/frcrmp/rule_10