Nurses and doctors in emergency and trauma situations often walk a fine line of how to most effectively uphold their duty of causing no harm to the patient. While it is their duty to be honest with patients, they reach a crossroads when that honesty could do more harm than good.
The dilemma in “Case 3: Emergency and Trauma Nurses: When to Give Bad News” is when it is necessary to tell the truth to a patient in situations where delivering this news might jeopardize a patient’s health, or possibly even life. In this case, Amira’s partner Casey dies in the car crash, but the doctors are faced with a dilemma when she asks how Casey is doing. Amira is in very poor health and may not survive herself, so by telling her that her partner has died could put her body in such distress that it could possibly lead to her death as well.
On one hand, some nurses might argue that their first and foremost duty is honesty to the patient. According to an article in the Ghana Medical Journal, “a doctor who withholds information from a competent patient… violates the ethical principles of autonomy, beneficence and nonmaleficence.” By intentionally withholding information, the nurse is acting with intentional deception—a form of paternalism. And in turn, this reduces the patient’s autonomy.
On the other hand, other nurses could argue that in trauma cases like Amira’s, beneficence trumps autonomy. The nurse’s goal is to protect the health of the patient and to keep her alive, and by telling her this information, they are not displaying nonmaleficence or beneficence because it would do no good to the patient in dire need. It is also important to recognize that Amira might not be in a competent state; she is likely in a state of shock both physically, psychologically, and emotionally, and is also likely receiving drugs to alleviate the pain and prepare her for surgery.
Therefore, in trauma cases like these, I believe each situation must be contextualized in order to make the correct decision. If the patient is stable (and thus, the nurses have already upheld their duty to the health of the patient) and competent, then the nurse does need to uphold his or her obligation to tell the truth and deliver the bad news. However, if a patient is in a dire emergent situation (for example, near death and about to enter surgery, like Amira), lacking full competency, and the information would cause harm to the patient’s chances of survival, the duty remains to the health of the patient, and the information can be withheld until the patient is more stable.
Works Cited:
Yeo, Michael. “Case 3: Emergency and Trauma Nurses: When to Give Bad News.” Concepts and Cases in Nursing Ethics. 232-242.
Edwin, AK. “Don’t Lie but Don’t Tell the Whole Truth: The Therapeutic Privilege – Is It Ever Justified?” Ghana Medical Journal 42.4 (2008): 156–161.
I agree with you Brooke that each situation differs in the way it should be handled. As you mentioned in the case with Amira, she is most likely in an incompetent state, considering she just suffered a traumatic car accident and will soon undergo an emergency surgery in an attempt to save her life. Therefore, revealing the information about her partner’s current state should not be the focus at the moment. I believe that doing whatever possible to save Amira’s life is of utmost importance, especially since informing of her partner’s death could possibly affect Amira’s state as well.
This is a really interesting example of how it could be justified not to tell a patient the entire story. While I agree with you that every case is different and should be handled uniquely, this puts a lot of pressure on medical staff. With every situation, they have to waste time and possibly face emotional regret from their decision. It also can be troublesome for hospital employees because they may not know what to do, and may fear that their decisions could jeopardize their jobs. While each case is different, I also think it is helpful for a hospital to have procedures in place to handle the majority of cases. This can help doctors and nurses to act quickly based on how they have been briefed in advance if they are put on the spot and cannot first consult with the hospital’s bioethics team before dealing with a patient.
Brooke, I do not agree that the nurse should not tell Amira of the death of her partner. Telling the patient this type of information may do more harm (both emotional and possibly physical) to the patient than good. I disagree because the patient directly asks how Casey is doing. Even though this information may not be the best for the patient to hear and could possibly have horrible consequences, I think that autonomy outweighs non maleficence in this case. The patient has a right to know the truth, and I do not believe that lying to the patient is the right thing to do simply because she may have worse health outcomes. The same health outcomes could be produced from her not knowing the truth.