Dilemma:
In the case of Amira’s and Casey’s car accident, the moral dilemma is whether to inform Amira of her partner’s death before she loses consciousness. It is the conflict between the patient’s autonomy, including her understanding of the situation, and nonmalefiecense, avoiding harm to the patient.
Analysis:
Amira ‘s right to know about the condition of her family is important. They should tell the truth and respect the patient’s autonomy, not limit the understanding of the patient. Trust between a physician and patient is essential. It is similar to the case, “Integrity and Nurses’ Relationship with Colleagues and Employers”. Nurses are expected to develop therapeutic, honest relationships. By telling the truth, according to Edwin in his medical journal, the doctor will help the patient “understand and deal with the difficult situations they may be facing thereby benefiting them and upholding the ethical principle of beneficence”.
In this case, it is important to specify the moral norm of “tell the truth”. Timing in disclosures must always be considered. Poor timing of difficult conversations may have a deleterious effect. Specifically, one should tell truth, at the right time. Another way to specify this moral norm is to “tell the truth unless the physician has compelling evidence that the consequences may cause severe harm to the patient”. With this specification, it is important for the nurses to balance the idea of whether the news will “cause severe harm to the patient”.
In this specific case, Amira is in a critical state and fighting for her life. Any more stress could “impair her capacity to survive the surgery and post- operative care in a coma” (Moorhouse and Khan 233). It is important to specify that the medical staff should avoid causing harm that is long- term and on a more serious degree. The nurses may be going against her right to understand the situation and causing some harm by performing the surgery, but they are doing so to increase the likelihood of her survival during and after the surgery.
Anxiety is common before surgery and causes mild symptoms, like irregular heartbeat and shortness of breath. According to Evans, anxiety before surgery is common, yet “excessive preoperative anxiety is associated with unfavorable physiologic responses, such as tachycardia, hypertension, cardiac arrhythmias, hyperventilation, and postoperative pain”. It is important for the surgeon and his or her team to be fully active and engaged with the patient during the surgery to ensure a safe procedure. An anxious patient may distract the staff or unintentionally answer questions incorrectly, thus misdirecting or misleading the staff during pre-and post-operative care. This could worsen the outcome. (Dr. Joseph M Rosenwald)
Another ethical concern to consider is the nurses’ role in informing Amira. The nurse may feel it is out of his or her focus of practice to release the information to the patient. It is up to the primary doctor of Casey to inform Amira. As Amira’s healthcare provider, the nurse may call upon the doctor to inform Amira herself or himself. In this case, the time is limited, so it may be more likely that the news would be handled after the surgery.
Finally, a therapist, has an overriding duty to give their patients the best chance of surviving a medical crisis. Informing the patient of the death of a loved one, while seeming urgent to the patient, may threaten their chances of survival in a difficult procedure. Disclosing information of that sort is best done by one professionally trained and in the most optimum fashion. It is important to mitigate the harm this news can cause. Moments before a critical surgery is probably not the right time for that conversation.
Citations
Davis-Evans, Chassidy. “Alleviating Anxiety and Preventing Panic Attacks in the Surgical Patient.” AORN Journal 97.3 (2013): 354-64. Association of PeriOperative Registered Nurses.AORN Inc., Mar. 2013. Web. 30 Jan. 2017.
Edwin, AK. “Don’t Lie but Don’t Tell the Whole Truth: The Therapeutic Privilege – Is It Ever Justified?” Ghana Medical Journal. Ghana Medical Association, Dec. 2008. Web. 30 Jan. 2017.
Moorhouse, Anne, Pamela Khan, and Patricia Rodney. “Case 3: Emergency and Trauma Nurses: When to Give Bad News.” Concepts and Cases in Nursing Ethics. By Michael Yeo. 3rd ed. Peterborough, Ont., Canada: Lewiston, NY, USA, 1991. 232-42. Print.
Rosenwald, Dr. Joseph M., DDS. “Anxious Patients in Surgery.” Telephone interview. 29 Jan. 2017.
Sylvie, you did a wonderful job of providing clarity in the breaking down of the moral norm of “telling the truth” as well as explore other reasons for withholding information from the patient. I appreciated your example of anxiety as a symptom, which could “potentially harm a depressed, emotionally drained, or unstable patient” ie. Amira in this case. Your analysis of how anxiety may affect Amira’s health outcome got me thinking about other topics of mind and body health. I definitely think that what we feel and think can greatly affect our physical health conditions. If Amira had found out Casey passed away before going into to surgery, do you think her “will to live” would change? If so, how do you think that would affect her chances in surgery and her physical condition?
Sylvie, I would also like to say that I liked how you explained the moral of ” tell the truth” because it absolutely important. The timing of telling Amira the news is crucial because it could affect Amira’s health outcomes.
You mentioned nurses developing therapeutic relationships. How do you think Amira will react when she finds out that the nurses kept the news from her? I ask because is keeping the news from showing that the nurses care about her and her health? Is choosing to omit information from a person for the sake of their health the wrong thing to do?