What are students thinking when we present ethics cases?: an example focusing on confidentiality and substance abuse.

As part of an ethics course, health professions students were asked to identify ethical issues and to propose resolutions before and after a class discussion of a case involving confidentiality and substance abuse. Students listed an average of 2.4 issues before and 3.6 issues after the discussion. After discussion 50 per cent of students made explicit changes in their proposed resolution. Opinions varied widely on breaching confidentiality and the responsibility for protecting the patient's health. After the discussion almost 20 per cent of the class felt it was acceptable to breach confidentiality as long as the patient was unaware. Many students identified more with the health care provider than with the patient. The presence of substance abuse altered many students' views on confidentiality. In this experience students were less rigorous in their application of principles, creating an excellent opportunity for teaching through exploration of the complexity of ethical decision-making in a specific case.