Background
According to the National Trauma Institute, 30% of all life years lost in the United States is lost
to trauma accidents. This is in contrast to the relatively smaller number, 16%, who are lost to cancer. In this case, Amira, her partner Casey, and their daughter Samantha, are victims of a crash that kills Casey and injures Samantha. Meanwhile, Amira is in very critical condition and needs to quickly enter the operation room in order to save her life. However, as she goes in and out of consciousness before surgery, she asks how her family is. After quickly telling Amira that her daughter will be fine, the nurses pause to consider if they should tell her about the death of her partner.
Dilemma
The case highlighted that one of the main moral dilemmas was in deciding whether the roles of the nurses as beneficent and non-maleficent outweighed the patient’s autonomy. Also, I think, a case can be made that treating the patient justly is also important. It is possible that telling Amira the news that her partner is dead could hasten the deterioration of her present condition. This reality would support withholding the information in the interests of non-maleficent. However, in order to treat the patient justly and to respect her still intact autonomy, Amira must be told the truth
Conclusion
In this case, the nurses ought to tell Amira about the death of her partner as well as that her daughter is still alive. In this case, the patient is autonomous. Though her consciousness ebbs and flows as her physical condition changes, her personality and character are intact. By asking about her daughter and partner, even as her own body struggles to stay alive, she displays appropriate behavior. Thus, no case about incompetence can be made to validate disregarding Amira’s autonomy. Also, a nurse’s duty to be non-maleficent and only beneficent supports telling Amira the truth. Though telling Amira will cause her much sadness and distress, it also gives her peace of mind in knowing the truth. Also, telling her would keep her trust in the healthcare team intact and help prevent her from jeopardizing her own delicate condition after the surgery by refusing to comply with the healthcare team’s directions during her recovery.
A case can also be made for telling patients the truth in these tragic cases by looking at statistics. If 30% of deaths are from traumas, then it can be assumed that many situations like this occur. If in every situation like this, the patient was spared distressing news at critical times, then the patient’s right to autonomy would be continuously disrespected even when he or she is competent. Telling patients the truth is the best choice because it respects the autonomy of the patient and helps maintain the patient-health care relationship, which is 
grounded in trust. Trust is the root of justice, a principle which a competent patient has access to. The patient must already depend on the team to save her physical body. In order to remain just, the nurses must accept that Amira is entitled to have any and all information pertaining to the status of her family. Upon disclosing the information, the nurses need to be prepared to provide moral support and to help Amira focus on her role as her daughter’s caretaker.
Sources
National Trauma Institute page: http://www.nationaltraumainstitute.org/home/trauma_statistics.html
RD Moorhouse, A. and P. Khan “Case 3: Emergency and Trauma
Nurses: When to Give Bad News.” Concepts and Cases in Nursing Ethics
Images from http://www.preparliament.com/wp-content/uploads/2013/12/scales-of-justice1.jpg and https://9to20.files.wordpress.com/2012/01/trauma_center_memorial_hospital_cost_of_violence.jpg
In determining my own decision for which choice to make, I TRIED to weigh out the pros and cons for each side. The pro for telling her are that she would be informed, and according to the reading, most patients want to know the truth about their situation. In addition, no matter when Amira is told of her situation, she will be harmed regardless. However, the con to telling her is that telling her could compromise her already fragile situation.
The pro to not telling her is that the nurses avoid potential harm to the patient that could compromise her already fragile condition. However, as mentioned earlier, the patient will be inevitably harmed. As mentioned in the reading, another pro to not telling Amira is that the nurses have extensive experience with trauma patients and are aware of how psychological trauma can affect their patient’s recovery. However, a con is the point you made that by not telling Amira of her situation, Amira could lose trust in the nurses, which could compromise they’re ability to treat her in the future if necessary.
The pros and cons were both 50/50 for each situation in my opinion. But I think I’d have to agree with you and the reading that beneficence trumps autonomy in this situation.
Suranjana,
I agree with your rationale that telling her could cause trauma, but I do not agree with how you would tell her. If you told her while she was still fading through conscious and unconscious stages, the result of trauma and shock could have fatal consequences. I believe that the correct plan of action would be to not lie to the patient, but hold out on telling her the entire truth while she is fading in and out of consciousness. The doctors and nurses ought to disclose as little information on the whereabouts of her family members as possible until the patient is strong enough to hear the truth. There may not be a good way to tell when the patient is strong enough to hear the news, but someone must decide and let her know with much sympathy.
The only caveat I have with your claim regarding trust put into a team of medical professionals by the patient’s consent is where do we draw the line between knowledge and trust. One thing is to tell your physician that you trust what they do will be for your health and another is allowing complete access to a patient’s body and performing all kinds of procedures without checking on the patient for further affirmation. These kinds of situations become slippery slopes very quickly, especially considering the fact that in many medical cases, an initial procedure does not suffice in the treatment of a single ailment.
Suranjana, I think that you ave provided very good reasoning for the conclusions you have drawn however I disagree with the decision to tell her the truth. The point I most disagree with is that because she has asked after her family she is perfectly intact in her personality and character. Although she has asked after her family we cannot take that as an automatic sign that she is perfectly conscious and conscientious of herself; I personally am uncomfortable with making such an assumption. Amira asking after her family is a sign of nothing except for the fact that her brain has not been damaged to the point that she is unaware that she has a family or that something bad has happened to all of them. As you said Trauma nurses are trained in this sort of thing and have more than likely had a lot of experience with decisions of this sort. Therefore, the fact of them pausing to consider if she should hear the truth or not is a sign that she may not be in the best state to receive the news. The patients autonomy, in this particular situation, should be compromised in order for the nurses to fulfill their beneficence and non-malefacence. Telling a a patient in critical condition something that could stress them and send them over the edge would not be the morally right thing to do if it can be avoided.
Also, as far as losing trust in the medical team, I hope they would be strategic in how they told Amira about her partners death so she would not feel betrayed.