Nurses and physicians are faced with the ethical dilemma of disclosing information about a given diagnosis to patients. While patients have a right to information, they are often not ready to handle the truth when a diagnosis is completed. This is common among patients suffering from terminal illnesses such as cancer. According to Farhat, Othman, El Baba & Kattan (2015) disclosure of cancer diagnosis is one of the major challenges physicians face in different healthcare settings. In some cases, the patient may be well prepared to handle such information. However, when it happens as a surprise, the physician has to consider the effects of the information to the patient as well as family attitudes towards such a diagnosis. The attitude of the patient towards such information can also prompt the physician to withhold information and wait for family members to break the news to the patients. The physician would face the risk of being sued if the patient claims that information regarding their diagnosis was withheld. Sarafis et al. (2014) notes that for a long time, doctors were held as the final decision makers when determining whether to disclose information to a patient. However, with changing laws, the situation is changing. Information disclosure is a major ethical dilemma considering the beliefs and attitudes the patient and the family may have towards terminal illnesses.
There are several underlying reasons and factors that hinder physicians from disclosing medical information such as diagnosis to their patients. Physicians often rely on the doctrine of therapeutic privilege to determine how much information they can disclose to the patient. However, there is an ongoing debate to establish whether therapeutic privilege is justified in the law. Therapeutic privilege means that in some cases, the physician or nurse may tell the truth but avoid disclosing any information that may cause panic on the side of the patient. The patient’s recovery may be adversely affected if the information is disclosed. Edwin (2008) argues that the doctrine of therapeutic privilege is not accepted in all jurisdictions. This means that the physician or nurse should engage the healthcare community to establish how much information should be disclosed to the family and the patient. The patient’s right to self-determination (autonomy) states that the physician should always provide correct information about the tests conducted on the patient and their results. This includes the results of diagnosis to inform management decisions. Healthcare ethics is anchored on several principles including autonomy, beneficence, non-maleficence and justice. If one of the considerations is ignored, the quality of care provided can be challenged or disputed. Therefore, when making such a decision, physicians should consider legal underpinnings such as therapeutic privilege, sensitivity of the information and the attitudes of the family and patient towards such information.
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To determine the ethical dilemma, a nurse of physician handling the case should ensure that the four pillars of healthcare ethics are considered. The pillars include justice, non-maleficence, beneficence and autonomy. The issue of disclosure touches on patient autonomy. The patient has right to confidentiality. Therefore, unless they are in a vegetative state, it is always right to ask their opinion when disclosing the information to their family or friends. The physician should consider the effects of the information and the state of the patient. The patient may need to be counseled before the information is relayed. Many healthcare facilities have special units handling such patients and preparing them for the long journey ahead. They are helped to form a new perception especially in cases where they view diseases like cancer as the end of their lives. The therapist should also avoid disclosing so much information since it may occur that the physician had already disclosed the information about the diagnosis to a third party. However, in cases where the patient is so ill, the physician can consider sharing the information with family members after subjecting them to a counseling session to handle the information. Since ethical dilemmas are inevitable in a healthcare setting, it is upon healthcare workers to employ critical and creative thinking skills to balance between the rights and privileges of a patient and the effects of every action to the patient.
References
Edwin A. (2008). Don't lie but don't tell the whole truth: The therapeutic privilege - Is it ever justified?. Ghana Medical Journal , 42 (4), 156–161.
Farhat, F., Othman, A., El Baba, G., & Kattan, J. (2015). Revealing a cancer diagnosis to patients: attitudes of patients, families, friends, nurses, and physicians in Lebanon-results of a cross-sectional study. Current oncology (Toronto, Ont.) , 22 (4), e264–e272. https://doi.org/10.3747/co.22.2351
Sarafis, P., Tsounis, A., Malliarou, M., & Lahana, E. (2013). Disclosing the truth: a dilemma between instilling hope and respecting patient autonomy in everyday clinical practice. Global Journal of Health Science , 6 (2), 128–137. https://doi.org/10.5539/gjhs.v6n2p128
