A nurse in a genetics clinic is caring for a 32-year-old client who has just been diagnosed with a severe, adult-onset genetic disorder. The client's sibling is also an established client at the same clinic. The client tells the nurse, "I do not want my sibling to know about my diagnosis. We are completely estranged, and even though I know they are planning to have a baby soon, my health is none of their business." Which of the following is the most appropriate action by the nurse?
- AContact the sibling directly, as the nurse has a mandatory legal duty to warn family members about severe genetic risks.
- BFlag the sibling's electronic health record so their primary care provider can initiate appropriate preventative screening.
- Respect the client's decision to withhold the information while exploring their feelings about the diagnosis.Answer
- DAsk the client, "Why would you keep this information from your sibling when it could severely impact their future children?"
Answer
The most appropriate action is to respect the client's decision to withhold the information while exploring their feelings about the diagnosis, maintaining strict confidentiality.
The correct action demonstrates mastery of strict confidentiality rules. Under the Health Insurance Portability and Accountability Act (HIPAA), genetic information is protected health information (PHI). There is no 'duty to warn' exception for genetic diseases, unlike imminent threats of physical violence or specific infectious public health threats. The nurse cannot disclose the diagnosis to the sibling or any other provider without the client's explicit authorization, but can ethically explore the client's feelings using therapeutic communication.
Step-by-Step Solution
Key Concept
Confidentiality of Genetic Information and Exceptions to HIPAA