What Would You Do?
A resident in a care home has recently been diagnosed with a serious health condition. They have mental capacity and have clearly said,
“I don’t want everyone knowing my business — just the people who need to.”
However, over the following days, the resident becomes more unwell and occasionally confused. Staff notice changes in their behaviour, eating, and mobility. Some team members feel that sharing more information with the wider staff group would help provide better, safer care.
Others argue that the resident’s wishes about confidentiality must be respected and that information should only be shared on a strict “need to know” basis.
A senior carer says, “If we don’t share enough, we risk getting care wrong. But if we share too much, we break their trust.” WWYD?
It is very dignified and respectful to keep your client's wishes.
But in this case 'just the people who need to know basis' should include those who support with care and wellbeing. Informing the right people despite how many they are, does not break the trust. The lady might be in need of adjusting her diet or mobility equipment, which is a call for all other professionals. If the recent diagnosis does not alter/change the care intervention in place then there will be no reason to share their serious health condition, and should be respected as such
From my own 'nerdy analytical' position, the crucial sentence here is:
'However, over the following days, the resident becomes more unwell and occasionally confused.'
'Occasionally confused' suggests 'most-of-the-time mentally capable'. So I think the situation is that when the lady isn't in an 'occasionally confused' period, the issue should be discussed with the lady: she can then decide for herself whether she prefers less confidentiality and 'more risk', and she could be specific about with whom information can be shared. Confidentiality is a right which, so far as I understand it, is not affected by the 'how [physically] ill' the patient is.
If the lady becomes very-obviously 'non-capacitous' and she hadn't changed her position on what can be shared, then we have a conflict between the logical requirements of Mental Capacity Act best-interests decision making and respecting her previously-expressed desire for confidentiality: that conflict has not, so far as I've seen, ever been resolved within clinical guidance in a rigorous and well-explained way (clinicians tends to write guidance which places confidentiality above MCA best-interests decision making - whereas I tend to do the opposite).
But, in the scenario as presented, it seems the lady is in essence capacitous, so the situation can be discussed with her and she can decide. Remember that we are all allowed to make stupid decisions, while we are capacitous - we decide which 'risks' to accept.