The nursing and healthcare profession is faced with increasing ethical and legal
challenges as a result of increased medical technology, dynamic modes of communication
and increased responsibilities for nursing professions. Most of these legal and ethical
challenges are linked directly to legislative changes with regard to confidentiality matters and
ethics pertaining to medical technologies. Confidentiality is an issue that has been practiced
by the nursing profession for many years, but legal changes have increased the need for
confidentiality to be maintained. In 1996, the introduction of Health Insurance Portability and
Accountability Act (HIPAA) increased the need for protecting distribution of confidential
patient information (Lachman, 2006). Several requirements of reducing the spread and login
systems were implemented so that access to confidential information could be tracked.
Tracking of data and usage of password systems ensured that employees could not access
files of patients they were caring for.
Moffitt Cancer Centre is at the middle of controversy after it was revealed that patient
consent for research study was falsified. The center is investigating if hundreds of signatures
on documents were fraudulent, which enrolled patients to one of the largest cancer research
study performed by the hospital (Martin, 2010). When either a physician or a healthcare
provider seeks to carry out a procedure on a patient, it is the duty of a nurse to acquire an
informed consent signature. This implies that the patient knows the procedure and available
alternatives, has clarified with the provider about the procedure, knows the risks involved and
the benefits, and is at liberty to either sign or refuse to partake in the activity. When the nurse
fails to obtain and instead falsifies the signature, both the provider and the nurse can be held
accountable for any damages incurred.
The president and CEO of Moffitt Cancer Centre, Dr. William Dalton, agreed that an
employee had falsified a patient’s signature on a consent document and the committee was
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investigating 492 questionable signatures. The study, known as Total Cancer Care, is an
observation trial which tracks cancer patients over a period of time but not the form of
treatment they are given. Since confidentiality and proper consent from patients are crucial to
the research process, the discovery led to complete audit of all employees’ work on July 29
(Martin, 2010). This issue raises an ethical concern since patients’ permission to be studied
must be obtained, and the patients must believe that the study is a serious matter. The
employee who had worked for two and a half years in the hospital as a clinical consenter was
fired on July 30 due to the seriousness of his actions. Moreover, Ernest & Young, an auditing
firm, was hired to begin investigations and a handwriting expert was asked to analyze 6,464
consent signatures.
Some nurses have little or lack formal education in law and ethics, thus making them
unqualified to deal with such issues whenever they arise in a clinical setting (Kleiman, 2007).
Ethical and legal issues such as organ donation, euthanasia, genetic engineering, physicianassisted suicide, end-of-life care, and dealing with patient confidentiality have been part of
modern nursing practice, and there are legal, ethical and regulatory mandates that require
healthcare professionals to be knowledgeable on these subjects. Lack of basic knowledge
makes nurses feel powerless and thus withdraw from such issues, making mistakes to occur
frequently. Therefore, it is of vital importance for nurses to gain this knowledge and to be
guided through this vital subject in their profession.
Being aware of the deficiency in ethical knowledge on some of its staff, Moffitt
Cancer Centre initiated an intensive training program on its supervisors and consenters.
Moreover, it plans to revise the consent process to ensure additional assurance and accuracy.
The president said that the whole process could also include a follow-up to the patient to ask
them if they signed the consent form. One ethical dilemma initiated by the falsification of
patient’s signature is the loss of trust on the research process. The CEO agreed that the breach
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could lead to a situation where patients refuse to participate in the study, leading to a failure
of a process that started over four years ago and with over 60,000 participants. In addition,
grant funding into the project may be suspended and according to Dr. James Omel, who is a
patient in this study, the inappropriate actions
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