Case Scenario

An older citizen woman of Asian origin is admitted to hospital, with characteristically weight loss,pulmonary mass and general weakness. In addition on further examination revealed the woman has pulmonary tuberculosis. The older family then approaches the doctor  and requests that the patient be hidden from the truth her health status. Again they argues that according to their belief in the mainland China, tuberculosis disease was one of the most dangerous , and therefore revelation of this fact amounts to “death sentence”. The scenario brings dilemma to the physician whether to heed to the family requests.  Several cultures have different beliefs on honesty versus withholding information in medical situations. Some Asian families strongly belief that its recommended to withhold medical information from a senior citizen for purposes of respect and protecting them from possible harm. Further in situation whereby a patient and family members belief on withholding information, then a such a belief must be respected and alternative decision making with family sought for. However, there should be no assumption that any patient from Asian origin holds the belief system as described in the case scenario. Furthermore, the doctor should try to conduct detailed investigation to ascertain the belief system. IF the physician confirms that the patient truly holds the belief system about the deleterious nature tuberculosis then, he(physician) should consider withholding the diagnosis information about the patient.

The case scenario elicits ethical and legal dilemma on whether a physician should be honesty to patients to relieve them anxieties and fear(Dauwerse, et al 2011).  Withholding information may take several dimensions, and for different reasons, and which bears diverse consequences. The issue of honesty and withholding information cuts across human communication. People are raised in different settings such as workplaces,clubs,families,churches, and physician/ patient relationship, therefore this concept may bear dfferent configuration.

Withholding information from patient in the modern world may require special attention because it may result to serious harm to some patients when they detected the same.Furthermore, withholding information from a patient amount to undermining of his/her autonomy and mistrust which is significant in the treatment and healing process of patient. Patients also require honesty because they are under pressure and vulnerable and this condition requires honesty for them to understand their own health status.Honesty is key value in medical and nursing fraternity  and loss of the value spells doom to the profession.

Honesty vs withholding information in the medical fraternity causes a new ethical dilemma. The dilemma necessitates a diverse decision making process and challenges too. Advanced practice nurses of all fields face significant amount of ethical dilemma cases daily and many involves withholding information from patient. Sometimes some family members argue that patients should  not be informed on their medical condition as one way of avoiding them unnecessary emotional distress. While the nursing proffesion ethics stipulates that patients provided with truthful information. Again the questins that still linger is whether the patient should be provided with all the information, because some information may bring harm. When nurses encounter such a scenario they get confused between honesty with patient or withholding some information from patient to prevent possible harm.

Therefore,a nurse leaders face diffiucult situation that requires wide consultation   and decision making process as it result to ethical  and even legal consequences. Nevertheless,nursesshould apply the guidelines provided in collaboration with family members to make decision concerning dilemma case.

Code of Conduct and Ethical Principles

Therefore the code of conduct associated with honesty vs. withholding information is that patients’s  wishes takes preferences and in situation a nurse faces dilemma situations he/she should liase with family members to deal with  particular case.Generally, a number of ethical principles are applied in the specific dilemma case. The nurses code of ethics clearly stipulates that nurses’ primary responsibility and commitment should be to a patient(Westrick, 2013). Ideally nurses should communicate with patients on the diagnosis and possible treatment alternative unless the patient is not in capacity to communicate that’s when family members are consulted.

The Asian woman case scenario is very complicated because the issue of cultural belief system is involved. Ideally, the patient should determine what should be done as far as medical diagnosis is concerned or in case of incapacity family members should determine the cause of medical action for a patient including treatment process. To avoid violation of ethical principle of honesty and trust the physician in charge should explore to ascertain the claims of the family members about Asian culture that socializes members to associate tuberculosis with “death sentence”(Oestberg, 2013). The physician should then request the family members bring written evidence that could support their claims. The written piece of evidence may be from any authority within their community.  The elaborate decision making is to safeguard physician from blatant violation of integrity and ethical principle. Since violation of such ethical principle amounts to prosecution in the court of law, the nurse should ensure adequate evidence is presented by the family and this helps to protect integrity of the nurse.According to ethical principles healthcare providers are mandated to prioritize the interests of the patient. Therefore the patient priority should come before the family members.

The patient has a right to be informed of the diagnosis for two major ethical reasons namely a) the information belongs to the patient thus its prudent she/she informed b) there always exists alternative decision making concerning the diagnosis therefore a patient should be informed  of the diagnosis  ad prognosis as he/she maybe involved in further decision making for example consent is required in palliative care. Again many other reason support disclosure of diagnosis information to the patient such as it prevents healthcare providers from deceiving the patient.Rssearch shows that majority of patients want healthcare provders to inform them of the results of diagnosis. Finally, many patients already suspect  the results of diagnosis therefore discussing of diagnosis with patients helps cement trust in the therapeutic relationship and process.

Questions on whether healthcare providers should ignore the family members and their requests about the diagnosis of their keen. The patient family should be fully involved in the diagnosis and treatment process because the members understands the health background of the patient better than the healthcare nurses, therefore they may understand the likely effects of information to the patient. Second, the family should be involved because  there may exist cultural issues that may have bearing on patient health. For example some culture do not agree to the concept of individualistic autonomy of patient health like in most western healthcare culture, but do have a standard practice that every member subscribe to when sick.Thirdly,the family should get involved in patient diagnosis because some patients do not want to know their diagnosis.

Recommendation for the Ethical Dilemma

Some recommendations for advanced practice nurse to avoid moral distress in dilemma situation include finding compromise with family members and deploy a level ground strategy that wontvilate ethical and legal principles

1. Ascertain the validity of the family concerns but explain to them why the patient should know the diagnosis.The family should be reassured that the diagnosis conversation will be informed to the patient in compassionate and sensitive manner.Again let them know no diagnosis will be imposed on patient.
2. Clarify the patient’s stand concerning the diagnosis and ask whether she/he like you to discuss with family. And incase the patient wants informed know to what detail, and if when informing the patient ensure the family is around to provide moral emotional support.
3. Explain the diagnosis to the patient carefully and slowly and give time for questions.
4. If possible explain to the patient the likely next course of action and options available for tuberculosis patients. A nurse should not leave a patient in hopeless situation.

In conclusion, the dilemma situation about honesty vs withholding information can be avoided if preferences and decisions are discussed earlier in visitation days.Its advisable to talk with patient at first to avoid dillemma situation.

References

Dauwerse L, Abma T, Melowijk J, &Widdershoven G, (2011): Needs for ethics support in healthcare. Views of Dutch board members and Ethics support staff. Journal of Medical Ethics 37(8)

Nickitas, D. M., Middaugh, D. J. Aries (2014): Policy and politics for nurses and other health professionals. Jones & Bartlett Book.2nd Edition. 9781284053296

OestbergF(2013): Policy and politics: why nurses should get involved. Nursing. 42(12): 46-49.

WestrickS.J(2013): Essentials Of Nursing Law And Ethics. Jones & Bartlett, 2nd Edition, 978-1-284-03020-4

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