The Company That Cared Too Much
This case discusses how a company handled a very sensitive issue about confidentiality of health information and the professional responsibilities of health professionals.
Lynda is a chemist who works for Brock Plastics, a large company in New York. Brock Plastics has a reputation for treating its employees extremely well. In addition to offering generous benefits and bonuses, the company has an on-site occupational health and fitness center that is staffed by a team of company doctors, nurses, nutritionists and fitness experts. This team is responsible for providing free health care, health promotion programs and fitness programs for Brock's employees.
Last year Lynda scheduled an appointment for an annual physical exam with Mary Wolf, the company's occupational health nurse The exam includes a thorough assessment of the employee's health in the prior year. During the exam Lynda informed Wolf that she has been going through a difficult time with her mother, who has been diagnosed with severe depression but has benefited little from her current treatment. Lynda, who is an extremely private person, rarely discusses her personal problems with her co-workers. However, she was relieved to be able to share with Wolf her feelings about the stress of handling her mother's condition. Wolf lent an empathetic ear and provided sound advice for possible psychotherapy and pharmacological treatments for Lynda's mother.
A few weeks after Lynda had her health exam she began receiving pamphlets, through intra-office mail, about a workshop that the company was offering on the current treatments of depression. Lynda shares a large cubicle with two other workers who love to gossip. She was concerned that her co-workers would see the pamphlets and ask questions. As a result, Lynda made an appointment with Wolf to discuss the intra-office mailings.
When Lynda met with Wolf, she expressed her discomfort about receiving personal health information through the company's intra-office mail. Wolf explained that the occupational health department conducts targeted mailings according to health problems that that employees mention about themselves or family members during health exams. When the company decided to offer a class on the latest treatments for depression, Lynda was tagged as an employee to receive the information.
Wolf decided to take this issue back to the team of health care specialists in her department. Some team members reported that other employees had expressed similar concerns. However, they knew how effective the mailings were for recruiting employees into beneficial programs. Furthermore, employees more typically thanked them for remembering that they had a particular health problem that needed attention.
After thoughtful consideration, the team decided to ask employees during their health exams if they would be interested in receiving health information through company mail. If the employees said no, they were tagged in the computer tracking system as ineligible to receive mailings. After one year of the new process, approximately 35 percent of all employees asked during an exam declined having personal health information sent to them through intra-office mail.
- Did the company nurse violate confidentiality by sending unsolicited health promotion information to Lynda through intra-office mail?
- What steps did Mary and the rest of the occupational health team take to ensure that they were ethical in their health care delivery and research practices?
- Did the occupational health department deceive employees by not informing them that they would be sent unsolicited health promotion information through intra-office mail?
- Should employees be informed when their personal health information is being used to determine which health promotion classes should offered by the company?
- Should employees be informed of the occupational health department's confidentiality policies and procedures?
Used with permission of Association for Practical and Professional Ethics. Case drawn from Research Ethics: Cases and Commentaries, Vol. 6, 2002.