Background
Should the doctor or a nurse lie in favor of the patient’s interest or should they tell the truth to fulfill the biomedical moral ethics? Before answering this question, we should remember that the doctor’s primary vow must always be to ensure the patient’s health and interests. The Biomedical ethics compels the doctor to act in favor of the patient’s health and welfare (beneficence) and cause no harm to patients (non- maleficence) while respecting patient’s autonomy and choices. Despite the aforementioned, truth-telling is also a medical ethics principle that requires the doctor not to lie and instead tell the whole truth, even if this truth will harm the patient’s psychological welfare (“Ethics in Clinical Practice”). The question is, “What should the doctor do if the truth will harm the patient and violates the privacy code between the patient and the doctor? Isn’t it better for the doctor to lie than to break the ethical principles of non-maleficence and privacy?”(Mathies). The following case will elaborate on when and why the doctor is forced to lie. Justification for this lie is debatable. There is no medical ethics principle that justifies lying, even for therapeutic privilege; it only allows the doctor to withhold or tailor information that might cause harm to the patients, but not actively lying ((Mathies). However, in the following case the doctor needed to give a “Yes” or “No” answer. Any other answer would provoke doubt and curiosity to know the truth. If I were in this doctor’s place I will do exactly what he did…I would lie.
Case:
A doctor planned to do a “radical nephrectomy on a patient.” The patient’s son informed the doctor that he and his father were Jehovah’s Witnesses and they do not want to receive blood transfusion, regardless of the situation. The doctor asked the patient if this was his wish too and the father reluctantly agreed. After explaining the procedure and the consequences of their choice, the doctor made the patient sign documents (informed consent) that would release the doctor from any negligence if the patient would need a life-saving blood transfusion. However, one day before the surgery, the patient confessed to the doctor that he wasn’t that religious and he doesn’t mind to receive blood transfusion if he needs to. However, he asked the doctor not to tell him or tell his son if he was to receive any blood. The doctor documented the conversation on the patient’s chart and informed the blood bank to hold some units of the patient’s matched blood. During the surgery, the patient lost a substantial amount of blood and the subsequently became anemic and hypotensive. The doctor ordered the blood transfusion to be delivered to the patient in the recovery room. The doctor informed the nurse not to tell the family about the blood transfusion and not to let any of them into the recovery room during the transfusion. Also, to cover any tracks of having received blood, the doctor requested from the nurse to remove all respective IV tubing prior to having the family visit. When the doctor met the patient’s son after the surgery, he explained that the surgery was more difficult than expected but his father is stable. Then the son asked if his father received a blood transfusion since the family was contacted by the blood bank to ask if anyone wanted to donate matched blood. Here the doctor didn’t know what to say. The dilemma faced in this situation was, should he lie and say “no there was no blood transfusion” or shall he reveal the truth and harm the patient’s relationship with his family, not to mention disobeying the patient’s privacy? The challenge was to either tell the truth and break the relationship between the father and son as well as between the doctor and patient or tell a lie and protect the patient’s wishes and his relationship with his son. The doctor lied and assured the son that his father didn’t receive any blood transfusion. The son was relieved (“Transfusing a Jehovah’s Witness during Surgery”)
Discussion
Beauchamp and Childress suggest that there are three elements of informed consent: understanding, voluntariness, and authorization of intervention (Beauchamp and Childress, 131). In this case, the patient’s voluntariness is questioned only because of external constraints and not because of lack of adequate knowledge or “absence of psychological compulsion”. Beauchamp and Childress state that a person is considered to act voluntarily in the absence of another person’s control (138); unlike persuasion, manipulation and coercion control the patient and are thought to diminish voluntariness and autonomy (138). In this case, the patient, who is not an extremely devout Jehovah Witness, feared that his relationship with his son would deteriorate if he authorized blood transfusion. That is why the patient authorized blood transfusion in the absence of his son’s presence and influence. The patient also asked the doctor not to tell him if he receives blood transfusion so that he wouldn’t feel guilty for disobeying the rules of his religion.
This is also a patient case touching on the controversial and complicated dilemma of a physician deciding between moral beliefs, patient privacy, and non-maleficence. I totally agree with what the doctor did. The doctor’s dishonesty in this situation is justifiable as it avoids violating the patient’s privacy, non-maleficence, as well as, preserving both the son-father and the doctor-patient relationship. According to the “Declaration of Geneva” the doctor-patient relationship is the cornerstone of medical practice and medical ethics. The physician has to place the patient’s heath as his number one priority (Palaez). I personally believe that when physicians take the oath of Hippocrates and abide by HIPAA laws, they are destined to act on behalf of the patient they are treating and to do all that they could to preserve patient privacy and rights. I certainly agree with the case where the physician should at all-time keep the patient’s privacy as a number one priority during the care of a patient and their family. In this specific situation, I agree that the physician has been given the authority, per the patient, to not disclose any information about blood transfusion to the patient himself and his family. For that reason, the fact that the meeting with the patient and what he requested was clearly documented, that removes any liability from the physician and thus he is permitted to act in such a manner to avoid disclosing any information that may harm the patient or his relationship with his family. Furthermore, the legal consequences related to blood transfusion in Jehovah’s Witness patients permit the doctor to meet with the Jehovah’s patient alone and even outside the presence of close family members to confirm the patient’s actual wish and faith in relation to this issue (“Transfusing a Jehovah’s Witness during Surgery”). This was exactly what the doctor did. Education alone cannot teach a physician to the best at what he does. It is the doctor’s courage, compassion and moral goodness that impacts medical practice.
Why is the doctor’s dishonesty morally justified in this case compared to that of Amira’s?
In the “Emergency and Trauma Nurses” case, it is debatable whether Amira should be deceived about her partner’s death, Casey. In this case, the nurses have a moral dilemma between Amira’s beneficence, non-maleficence, and autonomy. The blatant truth may destabilize Amira’s fragile medical condition. As the trauma nurse, I would avoid answering Amira’s question by saying, “we will inform you as soon as we know” or “our primary concern right now is your health”. Although this is considered a form of deception, as mentioned above, therapeutic privilege allows the doctor, or the nurse, to withhold or tailor information that might cause harm to the patients (Mathies).
Works Cited
Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. New York, NY: Oxford UP, 2001. Print.
“Ethics in Clinical Practice.” NursingLink. N.p., 2015. Web. 14 Feb. 2015.
Mathies, M., and N. Hogg. “Absence of Monocyte Procoagulant Activity during the Immune Response to Influenza Virus.” Journal of Clinical Microbiology. U.S. National Library of Medicine, n.d. Web. 14 Feb. 2015.
Paleaz, Jose. CHAPTER TWO – PHYSICIANS AND PATIENTS (n.d.): n. pag. Web.
“Transfusing a Jehovah’s Witness during Surgery.” KevinMD.com. N.p., 13 May 2011. Web. 14 Feb. 2015.