1. Choose Your Own Ethical Adventure

2. You are a successful dermatologist working in Tucson, Arizona. One evening you are watching the evening news with your wife and the leading story is about a women that has obtained explosives and is suspected to live in the area. The FBI reports that she and her associates should be considered dangerous. You suck in your breath when you see her picture. The woman in the news has not been identified, but they are calling her the She-bomber. A patient of yours named Jane Doe looks a lot like theShe-bomber and you have been taking care of her acne problems for the past five years. As a matter of fact, you saw Jane in your office last month and you are positive that the private information at your office will probably assist the FBI in tracking down the She-bomber if she is Jane. Your wife asks if you recognize her and you tell her your not sure, but you will be looking into it at work tomorrow. The news story concludes with a phone number for an anonymous tip line number. If you decide to immediately call the tip line and give all the information you have to the FBI go to slide #3 If you decide to gather information and research the problem go to #4

4. The following day you go to work and review Jane Doe’s chart. There is no record in her chart of her verbalizing that she wanted to harm anyone, nor did she give you the impression that she was a danger to herself or others. Because of her acne, you have taken pictures to track her treatments progress. Using the internet you research the news story and decide that Jane and the She-bomber are definitely similar, if not identical. You hate to think you might be getting worked up over a case of mistaken identity. You also review the FBI warning and note that the She-bomber has never actually blown anybody up. She appears to be in possession of explosives and has friends that like to blow things up. You feel that there may be danger involved but not immediately. If you decide to go to Jane’s house and ask her to clarify whether she is She-bomber or not go to slide #5 If you decide to continue to researching the problem go to #6

6. Since you are not a trained FBI agent, you are unable to determine if Jane is or is not the She-bomber. You sit in your office, torn, because you do not want anyone to get hurt because of your inaction. You are also not in a position to just hand over to the FBI private, confidential information. Therefore you realize you have stumbled across an ethical dilemma. Two choices lie before you, yet each one may have negative consequences. What do you do? How will you prioritize your principles? If you feel the two principles in conflict are autonomy and justice go to slide #7. If you feel the two principles in conflict are confidentiality and nonmaleficence go to #8.

9. Confidentiality vs. Nonmaleficence Nonmaleficence “ First, do no harm.” This phrase you have always held dear since the time it was taught to you the first year of medical school. You consider the principle of nonmaleficence and realize that it requires you to not intentionally create a needless harm or injury to the patient, either through acts of commission or omission. You also know that this principle expands to everyone, not just your patients. Therefore, if you did not stop the She-bomber, and you could have, you would sacrifice the principle of nonmaleficence. You conclude that it is imperative that you do what you can to keep others from harm, even if it means giving up patient information . By now you see the dilemma’s true colors: Do you risk breaching confidentiality in favor of nonmaleficence? Or do you put others at harm just to satisfy confidentiality?