Ethical Dilemmas in Patient Confidentiality: A Case Study of Unintentional Disclosure in an Iranian Emergency Department

Background: Confidentiality is a cornerstone of nursing ethics and a critical determinant of patient trust and safety. In culturally conservative societies, breaches of confidentiality can result in disproportionate social, psychological, and familial consequences, especially for sensitive medical issues. Case Presentation: This case study examines an ethical dilemma in an emergency department in western Iran involving a 26-year-old unmarried woman whose early pregnancy was unintentionally disclosed by a staff member. Despite initial adherence to confidentiality protocols, a colleague congratulated the patient in front of others, triggering a cascade of personal and social fallout. The patient’s partner denied paternity and informed her family, leading to her abrupt removal from care and loss to follow-up. Discussion : The incident underscores critical ethical gaps in team communication, cultural competence, and institutional safeguards. In high-pressure clinical settings, confidentiality must be proactively managed through structured ethical training, contextual risk assessment, and design of patient-centered communication environments. This case highlights how a lapse in discretion can escalate into a cultural crisis, demanding system-level reforms and a redefinition of ethical responsibility from individual to institutional. Conclusion : Maintaining confidentiality in culturally sensitive contexts is not a passive obligation but an active, dynamic responsibility. This case calls for a paradigm shift in ethical nursing practice—one that integrates cultural awareness, proactive communication, and systemic accountability to prevent harm and uphold patient dignity.