|Type of paper:||Research paper|
|Categories:||Ethical dilemma Nursing care|
Nurses face various issues in their daily work that require them to reconcile their values with the nursing code of ethics. The term ethics broadly defines the branch of philosophy that seeks to address the concepts of right or wrong (Shapira-Lishchinsky, 2009). The foundation of ethical behavior is individual values since they influence both attitudes and behavior (CCAB, 2014). One essential but complex value in nursing care is truthfulness. In healthcare, truth telling refers to the practice of having complete openness about a patient's diagnosis (Kazdaglis et al., 2010). In nursing care, the ethical dilemma of telling or concealing the truth emerges in the situation of having to share bad news and may require a professional approach.
The term ethical dilemma refers to a problem with alternative competing choices (Shapira-Lishchinsky, 2009). A major ethical dilemma that nurses face has to do with disclosure of a life-threatening medical condition to patients. A specific example occurs when a patient medical diagnosis reveals that he or she has an advanced cancerous tumor and the prognosis suggests that the patient will only live for six months. In such circumstances, the family may issue an instruction that the patient should not be informed about the situation or be taken through a gruesome experience of chemotherapy. Nurses may find themselves caught in a dilemma on whether or not to disclose this information to the patient under their care. This dilemma involves two ethical principles of veracity meaning devotion to truth and non-maleficence referring to avoidance to cause harm.
Importance of Disclosure in Nursing
The idea of telling the truth relates to the principle of veracity that has broad applications. Truthfulness describes patient care and the concept of informed consent (Friedrichsen, Lindholm, & Milberg, 2011). It is established that patients depend on the information they are accorded by a nurse to make informed decisions relating to their care. Patients expect that caregivers will tell them the truth about their conditions and this includes errors made in the healthcare and eventualities of medical processes. A request by the family not to share the truth complicates the nurse duty to obtain the patient consent based on the right information. The principle also applies to the general expectation that honesty guides professional interactions. As such, veracity is required in maintaining professional relationships, peer reviews, documentation, risk management and authorized reports and compliance.
The view of not sharing the truth relates to the standard of non-maleficence. Usually, nursing care interventions involve both benefits and risks understood as good and harm (Bhanji, 2013). There are specific interventions in nursing that guide the application of the non-maleficence principle. One, nurses should in practice avoid deliberate harmful procedures and risk of harms associated with nursing care harm (Bhanji, 2013). Two, caregivers should consider the proper degree of risk. Lastly, nurse ought to determine whether the use of technology in healthcare presents benefits that outweigh the harm. In most cases, nurses are asked to review their first intent in a medical intervention to ensure it is good.
Opposing Ethical Viewpoints
In theory of ethics, veracity refers to the principle of sharing the truth that is founded on the belief that a person has the capacity to make individuals decisions about their life. The rule argues that for individuals to make logical decisions, they must have all the information that is relevant to the condition that they are deciding on (Chagani, 2014). The information shared must be concise and easy to comprehend. Violation of veracity rule occurs in two situations. First, when a caregiver tells a lie to the patient or their families or deliberately gives any information they know is incorrect or misleading. This offense includes all acts of omission that happen when a nurse intentionally holds back part or entire portions of facts. Secondly, the principle is contravened in instances where information is concealed using medical jargons or another language that misleads or prevents information from being interpreted by the recipients.
The principle of non-maleficence simply states that a health practitioner should not inflict harm on the patient (Chagani, 2014). Hence, non-maleficence requirement ensures that nurse's actions benefit the patient. An ethical dilemma arises when there it emerges that a medical intervention or failure of it has potential harm to individual patients and the family is against disclosure to the patient. In the ethical dilemma provided, on one part the nurse is aware that patients have a right to decide on a matter as important as their life and death. On the other side, the caregiver recognizes that chemotherapy may not save the patient even after costly and painful treatment procedures. In extension, the nurse needs to respect the family's wish that their patient relative deserves a peaceful death.
There are various viewpoints related to the idea of nurses telling the truth to the patient in regarding the two ethical principles. The patient having realized the truth and armed with information will be more empowered to make crucial life decision rather than leave it to relatives. In this case, the patient may decide to undergo a tortuous treatment for the tumor and face a painful death ultimately, or they may opt for no treatment and dies in dignity. Should the patient decide not to undergo treatment, they may use the time they have with their relatives or fulfilling a religious or recreational desire (Wood, McCabe, & Goldberg, 2009). It would still be unethical for the nurse to treat the patients without informing them about their condition. In this case, the nurse will have supported the patient to achieve self-autonomy by sharing the truth and respecting their independent choices.
On the contrary, the patient may react in a self-destructive manner. There is an equal likelihood that if the nurse discloses the information of the advanced threat to life to the patient they may have psychological disturbances (Sarafis, Tsounis, Malliarou, & Lahana, 2014). Depression may result in more mental health conditions and reduce even the prognosis period for the patient. More so, the patient may experience resentment and attempt to commit suicide (Bhanji, 2013). In addition, lack of appropriate time, place, and cultural difference may lead to non-disclosure (Sarafis et al., 2014). These scenarios reflect the adverse effects that disclosing the truth may have on the principle of veracity and non-maleficence. The nurse would compromise patient's ability to make balanced decisions and even cause them more suffering and indignity by declaring the truth to them. Faced with such a scenario, then a positive view would be that hiding or distorting the truth does no harm to the patient. Though the patient meets eventual death, he or she is still entitled to die with dignity. As such respecting the patients access to information would interfere with the benefits that the same patient would accrues if the facts of the diseases were undisclosed.
More so, the nurse may be unable to judge the reasons behind the relatives request not to disclose the disease prognosis to the patient. The reasons may be supportive or selfish (Chagani, 2014). Should the nurse decide to stay silent and support the relative's position, she or he is promoting a paternalistic approach. Paternalism refers to the act of a nurse having a protective attitude on patient (Punjani, 2013). If the patient later discovers the truth from the relatives, the deception would compromise the trust in the nurse (Bhanji, 2013). The nurse would shoulder the guilt of knowing the patient died believing that the caregiver lied. The self-blame may trigger personal frustration and work related displeasure to the nurse (Chagani, 2014). As such, the different arguments demonstrate that disclosure and concealment of truth are both potentially harmful to the patient thereby resulting into an ethical dilemma for nurses.
The professional position is that nurses must show fidelity to their code of conduct and disclose the information to the patients however unfavorable. The ethics dictate that nurse's primary obligation is to be an advocate and protector of patient's universal right to quality healthcare (Punjani, 2013). As, such the nursing code of ethics and not the families wish should dictate the actions of a caregiver.
Argument for the Professional Position
In making a decision on the ethical dilemma, nurses ordinarily weighs the ethical principles, in this case veracity and non-maleficence. However, value conflict may remain after analyzing the principles. As, such the nurses should pursue a professional approach that is guided by their code of conduct and the hospital policy (Punjani, 2013). The code provides ethical guidance in decision-making processes to meet the need of a diverse society (CCAB, 2014). This means that the system standardizes behavior for all nurses to ensure their reaction to moral dilemmas can be more predictable and regulated.
The ethical code and standard policies permit patients to get access to any medical information that threaten their prognosis, knowledge on available treatment options and their outcomes. For example, the nursing standards prescribed by the American Nurses Association, states that respect for human dignity should be the guide to nurses' service to patients (ANA, 2001). Furthermore, it says that nurses should not be restricted by the social or economic status of patients, neither their attributes nor the nature of their health condition (ANA, 2001). Hence, the medical diagnosis of advanced cancer should not prohibit the nurses from exercising their duty. Correct information ought to be provided to patients to respect their dignity and to protect their rights.
Telling the truth is considered a moral obligation for all nurses. The quality of nursing care depends on the nature of the relationship between nurses and patients (Bhanji, 2013). A fruitful relationship depends on the nurse ability to establish and maintain trust with the patient, and that requires accurate communication (Wood et al., 2009). Additionally, patients expect that nurses will respectfully provide them with truth the same way they disclose their truth to the care providers. Nurses continuously communicate with their patients and are duty bound to ensure patient's wishes are recognized and honored. Therefore, information disclosure optimizes the connection between the nurse and the patient.
Sharing information increases awareness and enhances the ability to make informed actions. Studies show most patients are more concerned about their life continuity as a person than their non-existence (Friedrichsen et al., 2011). Hence, patients prefer to be informed to make decisions on their healthcare and plan their life accordingly. Studies have shown that when patients have full knowledge of their conditions, they can better be engaged in their care resulting in increased adherence to palliative care (Kazdaglis et al., 2010). Research also reveals that many patients prefer to know their diagnosis. In countries like USA, Finland, Canada, and United Kingdom, the disclosure policies mandate the nurses to provide full information to their patients (Kazdaglis et al., 2010). The countries legislations also empower the patients to participate in deciding on their own healthcare decisions (Wood, McCabe, & Goldberg, 2009). The evidence from studies and international best practices advocates for a culture of full disclosure by nurses.
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