Today, being a nurse is associated with a number of complexities due to the need to comply with diverse obligations in social, political, and healthcare segments (Hamric, Hanson, Tracy, & O’Grady, 2013). It remains apparent that concepts such as fidelity are the core definers of nurses’ actions and behavior, as a nurse plays a role of a mediator between the management of the hospital, healthcare system, patients, and their relatives (Hamric et al., 2013).
Nonetheless, apart from living in a democratic society, ethical dilemmas tend to take place due to differences in the interpretation of ethical standards and guidelines. Today, nursing education is highly focused on this sphere, as only advanced nursing practitioners can contribute to fair decision-making by employing the principles of diverse ethical theories. Along with theoretical frameworks, role models such as Florence Nightingale assist nurses in becoming ethical leaders, who view ethics and justice as their priorities (Dossey, 2010).
Consequently, the primary goal of the paper is to describe ethical dilemmas that incurred in the healthcare setting while referring to its specific characteristics, violated ethical principles, and existent barriers to ethical practice. Based on the analysis of the situation, the most appropriate ethical decision-making theories and initiatives will be suggested to resolve similar cases in the future. In the end, conclusions are drawn to summarize the main findings of the paper and express my emotions about the occurred situation and my potential future attitude towards similar incidents.
Ethical Dilemma and Described Situation
As it was mentioned earlier, ethical dilemmas in nursing are rather common. Thus, one of the cases incurred at my workplace in the recent past. The situation took place at the hospital, where one of the patients was transferred due to some health problems. Thus, after organizing a series of tests, it was revealed that a patient had a type of cancer with a low chance of being cured. The thirty-year-old woman (the patient) was informed about her condition by her family doctor after being released home from the hospital. Thus, it could be said that she lost hope, as her condition continued to worsen, as she stopped taking prescribed medication and accepting the required treatment. The procedures such as insertion of urinary catheters were essential for the maintenance of her organs and survival, but she continued to refuse them.
Apart from the patient’s confrontation, her relatives were able to convince her to stay at the hospital since there was a chance of being cured. Meanwhile, the doctors discovered her as terminally ill and informed her family about this condition. Relatives in collaboration with the medical personnel of the hospital agreed not to inform the patient about her state, as they believed that it would help her regain hope. To support this scenario, family members started planning vacations after her release from the hospital. Unfortunately, the outcome of this situation was rather negative, as the patient died without knowing about her actual medical condition.
Overall, the described situation involved relatives, medical professionals, and the patient as the main actors. It could be said that catering to the needs of the family created ethical dilemmas for nurses, as they had to lie and be dishonest to the patient. This type of problem often takes place, but it is still unclear whether physicians should disclose the diagnosis to terminally ill patients or not since it has both advantages and disadvantages.
Specific Ethical Characteristics of Dilemma
It remains apparent that the situation described above can be viewed as one of the examples of communication problems. It could be discovered as the most common issues, as for example, in oncology, along with other matters, nurses have to pay substantial attention to the clarity of communication (Luz et al., 2015). Not being able to consider this aspect of paramount importance will trigger the development of insecurity and destroy the well-developed bond between patients and medical professionals (Luz et al., 2015). Apart from that, ineffective communication and inappropriate people skills also may have an adverse effect on the psychological wellbeing of a patient.
For example, some studies claim that depression is one of the potential consequences of the inability to choose the most appropriate methods to inform terminally ill patients about their medical condition (Marcus & Mott, 2014). Consequently, inappropriate communication with the patient in the first place might have triggered patients’ negative attitudes and lack of desire to continue medical treatment.
Nonetheless, miscommunication is not always the case. For example, sometimes nurses and physicians chose to conceal the truth from terminally ill patients (Safaris, Tsounis, Malliarou, & Lahana, 2014). In the context of the presented case study, the medical personnel did it since they wanted not only to help the patient to regain hope for being cured but also to cater to the needs and desires of her family. Consequently, on the one hand, it is believed to have a positive impact on the psychological wellbeing of a patient while convincing him/her to continue having the required medical assistance (Safaris et al., 2014). However, on the other side, these actions tend to violate the concepts of patient’s autonomy, as every individual has a right to know his/her actual diagnosis and determine the subsequent plan of action (Safaris et al., 2014).
At the same time, it is possible to identify that the situation has some characteristics of multiple commitments dilemma. The assessment of the case shows that communication issue highly interferes with the need to satisfy the needs of several parties including other nurses, physicians, relatives, and patients (Hamric et al., 2013). The main complexity of the chosen case is the fact that different parties had controversial viewpoints. For example, relatives did not want to inform the patient about her terminal illness while other stakeholders had the opposite opinion. In this case, medical professionals had to choose the most suitable plan of action based on their interpretation of ethical guidelines and characteristics of the scenario. To summarize, it could be said that the identified situation has key features of communication problems while highly interfering with other general nursing principles and multiple commitments dilemmas.
Violated Ethical Principles
Due to the common occurrence of ethical dilemmas, it is easy to depict the core matters that were violated. In the first place, one of them is ignoring the patient’s autonomy, as any nurse is obliged to respect everyone’s freedoms and liberties (Hamric et al., 2013). In this case, the patient had a right to decide whether to continue receiving treatment or not, as only in this instance, her rights and freedoms would be respected. Nevertheless, due to the patient’s attitude towards diagnosis and its potential negative effect on her wellbeing and health, it could be claimed that disregarding the right to autonomy was logical, as it could improve the patient’s medical condition. However, there is not enough evidence to prove that choosing this option was the only right decision.
At the same time, it is evident that apart from a distinct violation of the patient’s autonomy, the rule of veracity was also disrespected. This concept implies that a nurse should tell the truth to a patient and provide only relevant information about his/her medical condition (Hamric et al., 2013). It could be said that deceiving patients can be discovered as one of the most common issues today since some professionals consider it a necessity in some cases. For example, Butkus (2014) views being dishonest to patients as appropriate if they have a mental impairment and cannot make logical decisions due to their psychological problems.
Nevertheless, in the context of the presented situation, the patient did not have any mental issues, but she reacted to the initial diagnosis negatively by expressing the lack of desire to continue treatment. This matter could be discovered as a potential trigger for making a particular decision. However, it is still questionable whether selecting a particular option was appropriate or not.
In turn, the presented situation is more complicated than it seems, as the actions of the medical personnel also did not comply with the rules of confidentiality and privacy. These aspects are the defining principles of the nursing profession, as nurses have to keep all confidential information in order, avoid its leakage, and do not transfer information to third parties (Hamric et al., 2013). In the presented case, the doctors decided that it would be rational to inform patients’ relatives and make a collective decision about subsequent actions. Pursuing this path did not comply with the ethical principles of the medical specialist. Nonetheless, in the context of the case, the violation of these principles is questionable due to the fact that the patient will not possibly want to continue the treatment after being diagnosed as terminally ill.
Present Barriers to Ethical Practice
Nonetheless, it is evident that there are several matters that can be viewed as drivers of the development of ethical issues. For example, Hamric et al. (2013) state that there are a plethora of external and internal factors that may have a substantial impact on the selection and implementation of ethical theories and the decision-making process. In the first place, it is crucial to consider patient-provider barriers, as these stakeholders may have entirely different perceptions concerning appropriate medical treatment and other beliefs (Hamric et al., 2013). It remains evident that these problems take place rather often due to the paramount importance of diversity and multiculturalism in the modern world. These global phenomena imply that dissimilar religious beliefs and cultural dogmas and traditions have to be treated equally and respectfully disregarding differences.
One of the clearest examples of patient-provider barriers is the need to cater to patient’s and relatives’ wishes and desires (Hamric et al., 2013). It is evident that they may be different from the commonly accepted ethical principles for nurses. The selected case study reflected its main concepts of this barrier since the family did not want to inform the patient about her condition. Nonetheless, it incurred due to the controversial attitude of the patient, and this fact provided a rationale for consulting family and concealing the truth. Nevertheless, apart from the positive intentions of these actions, this barrier required medical professionals to violate some of their ethical standards and hide the right diagnosis.
It could be stated that another barrier that is highly linked to the obstacles of the patient-provider relationship is non-adherence (Hamric et al., 2013). This concept implies that a patient may not have the desire to improve his/her wellbeing and psychological and physical condition. In this instance, following and satisfying a patient’s needs want, and desires may result in hurting one’s health. This idea does not comply with the well-defined priority of patient’s safety, as proving the appropriate, high-quality treatment is the core of the patient-centered care model (Rahman, Jarrar, & Don, 2015). The characteristics of this barrier were clearly reflected in the selected case study, as the patient did not want to continue treatment, and it was the main reason for concealing the right diagnosis from the patient. It could be said that this obstacle triggered the selection of this option, as making truly “ethical” decisions (informing about the real diagnosis) might be associated with adverse consequences.
Lastly, many theorists highlight various interprofessional barriers that tend to have a strong effect on ethical decision-making. It could be said that that the main idea of this concept pertains to the fact that different professionals such as nurses and physicians have dissimilar understandings of the same situation and interpret acceptable ethical behavior differently (Hamric et al., 2013). In the context of this case, the physician, who had a conversation with the family, considered that it would be reasonable not to tell the patient about the actual diagnosis. At the same time, it was evident that nurses, who were in direct contact with the patient, experienced discomfort, as they had to conceal the truth.
In this instance, this barrier could not be discovered of paramount importance since the factors such as non-adherence were more influential in the presented context. Nonetheless, the existence of high power distance between physicians and nurses affected the whole process and created obstacles for the decision-making mechanism since the opinions of individuals with higher positions were viewed as dominant.
Ethical Decision-Making Practices to Resolve Similar Situations in Future
The analysis of barriers and characteristics of the situation helps gain a profound understanding of ethical decision-making, and a combination of these factors assists in choosing the most appropriate and relevant theory and framework to address similar problems in the future. The case clearly shows that telling the truth to the patient may not always be good due to its potential ability to cause harm, and disregarding related controversies, deceiving a terminally ill patient may be viewed as an ethical action. To support the rationale behind this decision-making, it is reasonable to refer to casuistry, as its followers have different perceptions towards lying (Butts, 2015). This theory implies that deceiving patients may be discovered as professional duty and obligation while being viewed as a potential benefit for both sides of the patient-provider relationship (Butts, 2015).
Nonetheless, to determine whether lying is appropriate, it is vital to use a well-established decision-making framework. In the first place, all information about the case has to be collected. For example, testing a patient’s ability to make rational decisions and evaluating his/her psychological wellbeing may be essential, as any deviations will ensure that the patient cannot make appropriate autonomous decisions. After that, it is essential to analyze a situation individually, as different matters such as beliefs non-adherence may influence the expected plan of actions (Hamric et al., 2013). Being able to take into account all matters highlighted above will ease the decision-making process and provide a rationale for making a particular decision.
At the same time, referring to similar cases in the past and practical experience can also be viewed as important since these aspects are the main features of casuistry (Hamric et al., 2013). Conducting this analysis will help determine the differences between the situations when deceiving patients is discovered as appropriate and when it is not. This evaluation will have an advantageous influence on the decision-making process, as it will help provide support for choosing a particular option with real-life examples. After that, the decision has to be thoroughly discussed with the representatives of different professions since it will help explain the reasons for this solution, identify gaps in it, and minimize stress levels. Based on the steps provided above, the casuistry theory is the most appropriate method, as it will help avoid bias by considering the practical side of ethics and the existence of potential exceptions.
Overall, it could be said that the selected case is only one of the examples of ethical dilemmas faced by nurses in the modern world. Medical professionals have to constantly be under pressure and decide whether they should disclose the truth to the patients or conceal the important details of their diagnoses and medical conditions. In this scenario, nurses chose to take the side of the family and did not inform the patient about her terminally ill condition while the patient died in ignorance. The main reasons for this decision can be related to the absence of a patient’s desire to continue medical treatment in the first place.
Thus, other barriers pertain to different attitudes of medical specialists, patients, and relatives towards the problem and other interdisciplinary and interprofessional obstacles and challenges. Based on these factors, it could be said that the problem is mostly communicational but with the elements of multiple commitments dilemma due to the need to satisfy the controversial interests of different parties. Nonetheless, it seems that the selected action violated a patient’s freedoms and rights and the nurse’s code of ethics.
As for my emotions, I can freely state that it would be hard for me to make a similar decision and conceal the right diagnosis from a patient. At first glance, I viewed the actions of medical personnel and family as wrongful. This situation evoked emotions like doubt, frustration, skepticism, and frustration. Nonetheless, after sufficient evaluation, I discovered that the actions were ethical and logical. For example, I think that deceiving patients was necessary, as otherwise, her condition might have worsened due to the absence of desire to continue medical treatment and the potential development of depression.
Consequently, I can freely claim that this case assisted me in understanding that strictly following ethical guidelines might not always be appropriate. When facing a similar situation in the future, I will employ the concepts of casuistry theory, as it states that every decision is highly dependent on the characteristics of the situation. Meanwhile, every case has to be discovered individually while referring to practical examples from the past. Collecting and evaluating the most important details of the case will help unveil whether deceiving patients is appropriate. Apart from the complexity of the decision-making process and the necessity to consider a plethora of factors, I will rely on this theory, as it will help design a logical solution while taking into account the preferences of different participants.
Butkus, M. (2014). Compassionate deception: Lying to dementia patients. Philosophical Practice: Journal of the American Philosophical Practitioners Association, 9(2), 1388-1396. Web.
Butts, J. (2015). Nursing ethics: Across the curriculum and into practice. Burlington, MA: Jones & Bartlett Learning. Web.
Dossey, B. (2010). What would Florence Nightingale say about ethical dilemmas facing nurses? . Web.
Hamric, A., Hanson, C., Tracy, M., & O’Grady, E. (2013). Advanced nursing practice: An integrative approach. St. Louis, MI: Elsevier Saunders. Web.
Luz, K., Vargas, M., Schmidtt, P., Barlem, E., Tomaschewski-Barlem, J., & Rosa, L. (2015). Ethical problems experienced by oncology nurses. Revista Latino-Americana de Enfermagem, 23(6), 1187-1194. Web.
Marcus, J., & Mott, F. (2014). Difficult conversations from diagnosis to death. The Ochsner Journal, 14(4), 712-717. Web.
Rahman, H., Jarrar, M., & Don, M. (2015). Nurse level of education, quality of care and patient safety in the medical and surgical wards in Malaysian private hospitals: A cross-sectional study. Global Journal of Health Science, 7(6), 331-337. Web.
Safaris, P., Tsounis, A., Malliarou, M., & Lahana, E. (2014). Disclosing the truth: A dilemma between instilling hope and respecting patients’ autonomy in everyday clinical practice. Global Journal of Health Science, 6(2), 128-137. Web.