QAs a nurse practitioner, I’m the primary care provider for a patient who’s clearly not taking his medications and is showing indications—through observation, vital signs, and bloodwork—of compromised health. Consequently, his life is in danger. As his primary care provider, am I allowed, or conversely, obligated, to inform my patient’s family about his deteriorated status?

ASeeing a patient or a family member not following through with therapy and other prescribed medical treatment certainly is a troubling situation. Family members in particular may find it heartbreaking when a loved one refuses to do what’s necessary for a more meaningful, healthy life. Frequently, family members beg someone else—such as their loved one’s healthcare provider—to “tell him what to do.” Families ask the provider to talk with the loved one about being a better steward of their own health and following healthcare recommendations.

The first provision, and indeed the first statement in the Code of Ethics for Nurses with Interpretive Statements (the Code), states: “A fundamental principle that underlies all nursing practice is respect for the inherent dignity, worth, attributes, and human rights of all individuals” (nursingworld.org/coe-view-only). In the context of this respect for human dignity, Interpretive Statement 4 reminds us that patients “have the moral and legal right to determine what will be done with and to their own person; to be given accurate, complete, and understandable information in a manner that facilitates an informed decision; and to be assisted with weighing the benefits, burdens, and available options in their treatment, including the choice of no treatment.”

Maintaining your patient’s privacy also relates directly to our call as nurses to respect human dignity. Provision 3.1 of the Code declares that “Nurses safeguard the right to privacy for individuals, families, and communities.” Privacy involves the right to control access to, and disclosure of, information pertaining to oneself and to control the circumstances, timing, and extent to which information may be disclosed. This provision makes clear that patients occupy the driver’s seat when it comes to releasing information about their health. This would apply to your patient as well.

This means that you, as an advanced practice RN and your patient’s primary care pro­vider, can’t reach out to his family members and explain the seriousness of their loved one’s nonadherence to treatment or medications.

However, you certainly can and should talk with your patient to ask if he would like for you to reach out to his family members and explain his current situation. Your commitment to listen carefully to what your patient wants should prevail in this situation. As challenging as his status may be, you’ll need to be careful not to ignore patient privacy and the provider’s obligation to keep patient information confidential when interfacing with his family members. As always, listening very carefully will be a key consideration in this case.

Situations in which loved ones are nonadherent to the prescribed medical regimen can prove difficult for all involved: patient, pro­vider, and family members. However, adhering to your patient’s rights to self-determination, privacy, and confidentiality should guide your actions.

— Response by Nelda Godfrey, PhD, ACNS-BC, FAAN, ANEF, member of the ANA Ethics and Human Rights Advisory Board