Medical ethical practices require the disclosure of truthful information to patients even if it means relaying bad news to them. Such news may include confirming a serious condition or diseases like serious cancer, disease relapse or failed treatment. Nurses encounter difficulties in making a decision to disclose such news to patients and their family members. Truth-telling and full disclosure is at the core of medical ethics but also presents a major dilemma situation for nurses and other healthcare providers (Erickson & Millar, 2005). The patients’ right to full information about their medical circumstance, is largely based on their right and freedom to make decisions on their behalf, without undue influence by others.
In my nursing practice, I encountered a situation that presented a truth disclosure ethical dilemma. A female patient was diagnosed with the last stage of breast cancer that had already metastasized. There was no hope for recovery. The patient’s family requested the patient not be informed of her condition to save them her what they referred to as unnecessary agony. They did not want her to spend her last moments with sorrow. As a healthcare provider, I had to be guided by the principle of autonomy in which the patient has the right to full control over their body. The patient reserves the right and freedom to make their own decisions independently ( Butts & Rich, 2019). The right to self-determination is the basis of patient-healthcare provider interaction. Nurses should assume the role of brother or sister’s keeper and morality should guide them ( Butts & Rich, 2010). We took time to evaluate the family’s perspective and position. They had enough reason to worry and be anxious. The family’s plea was also very emotional making it harder for us to come up with a decision.
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However, ethical codes are very clear on this issue. The patient takes priority before the family. We had to tell the patient the true nature of her diagnosis. We reached this decision after careful consideration of the situation (not ethical demands only). First, there were additional decisions to be made and they required the patient’s approval or otherwise. Secondly, if we did not disclose the truth to the patient at this juncture, we could have been forced to lie to her in future. Thirdly, most patients suspect their diagnosis and may find out later. It is crucial to have a trusting relationship with a patient. We explained to the family our position and assured them we will handle their loved one as sensitively as possible. We then inquired from the patient if she wanted to know her diagnosis or would we rather tell her family. The patient wanted to know the full diagnosis but she requested us to have her family present when we conveyed the news. This is what we did. Unfortunately, she did not live for long. She passed away a few weeks after breaking the news to her.
Nurses are confronted with such decisions throughout their careers. It is imperative to let ethics guide the practice of healthcare while at the same time weighing the situation rationally to ensure the most appropriate outcome is achieved for all parties involved.
References
Butts, J. B., & Rich, K. L. (2019). Nursing ethics: Across the curriculum and into practice 5 th Edition.
Butts, J. B., & Rich, K. L. (2010). Philosophies and Theories for Advanced Nursing Practice. Jones & Bartlett Learning.
Erickson, J., Millar, S. (2005). Caring for patients while respecting their privacy: Renewing our commitment. American Nurses Association. http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume102005/No2May05/tpc27_116017.html
