Beauchamp and Childress talk about how we make decisions based on facts and values, but sometimes decision making becomes complicated when we consider abstract principles such as autonomy and non maleficence (Beauchamp and Childress, 13). The complication becomes whether we make the decision with autonomy as the ruling factor or non maleficence. In “Emergency and Trauma Nurses: When to Give Bad News,” the ethical concern presented in this case is “when to tell the truth in situations when, given, the physical and psychological conditions, delivering devastating news might jeopardize the patient’s life, and possibly life” ( Yeo, Moorhouse, and Khan 232). Presented is Amira and Casey and their daughter who were involved in a car accident. The daughter and Amira survive, but Casey did not. Amira is in critical condition and needs to go into surgery. Doctors and nurses are afraid that any upsetting news will worsen her conditions. While in this state, Amira asks the nurses about her daughter and her partner. Do they tell Amira that her partner died and risk losing her too? Or do they wait to tell her after her surgery? How do the nurses decide? Do they make the decision based on protecting Amira’s health? or do they make a decision based on their obligation to answer Amira’s question?
One side of the argument is that Amira should be told the truth because honesty is the best policy. Lying to Amira is not only unethical but it creates a dishonest relationship between her and the nurses. There is a possibility that Amira will be upset with the nurses for lying to her. As a result, Amira may no longer trust the nurses. She may shut down and never cooperate with the nurses and doctors during her recovery. In addition, if the nurses do not tell Amira, then they are denying her information she requested. Withholding information from Amira is acting upon paternalism–not respecting her autonomy. Amira has every right to know about what happened to her family. Failing to tell the truth, is taking those rights away from her. Although the truth will indeed hurt Amira, the nurses who told her will be there to support her through the process.
The other side of the argument is to not tell Amira because the news may cost her her life. Amira’s conditions are already worsening ,so telling her the news will cause even more distress. Nurses are taught the principle of non maleficence, to chose the option that will cause little to no harm. Choosing to not tell Amira the truth is for the sake of protecting her health status and possibly saving her life . If Amira is told the truth about her partner’s death, there is a chance that the news will also kill her. Furthermore, Amira’s conditions deem her incompetent ; she is not in the right frame of mind to understand the news about the death of her partner. Another aspect that needs to be take into consideration is the child. If Amira dies, then the daughter will be left with no parents.
I think the question of when to give bad news depends on the state of the patient. The news will hurt regardless, but the mental and physical state does play an important role. If I were to decide, I would chose to not tell Amira the truth because her life is at stake. Waiting to tell Amira when she is more stable is the best option because she can make sense of the situation a little better. In saving her life, Amira gets to live not only for her, but for her daughter too.
Works Cited
Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. 7th ed. New York: Oxford UP, 2009. Print.
Yeo, M., A. Moorhouse and P. Khan “Case 3: Emergency and Trauma Nurses: When to Give Bad News” Concepts and Cases in Nursing Ethics.
Hi Sandra!
I understand your argument about honesty being the “best policy” and definitely agree that trustworthiness in a patient-physician relationship is very important, but in this case I think that telling Amira about the death of her partner can only cause her more harm and stress. Amira is already in critical condition and if the nurses choose to tell her, it could put her at an even worse risk and possibly even leave their daughter parentless. The issue of paternalism is definitely present here, but the nurses also have to decide whether to flat out lie to Amira about Casey’s death or rather just tip toe around her questions, that is if she is even in a condition to be asking questions. Other studies have also shown that “deception is used to promote what is perceived as better care for the patient, sometimes through reassurance (for example, maintenance of hope for the future) and sometimes because of organizational needs (for example, time considerations or concern that a patient would become difficult to manage)” (Teasdale and Kent, 1995). Given the circumstances, the nurses have the right to “deceive” Amira because not telling her the truth might give her the hope and strength to recover and make it through surgery. Also, if they tell Amira about Casey’s death, they do not know how she will react, which might have serious consequences for her survival. In this situation, I think that the nurses should withhold the information about Casey’s death until after the surgery.
Works Cited:
Teasdale, K., and G. Kent. “The use of deception in nursing.” Journal of Medical Ethics 21.2 (1995): 77-81. Web.
Hi Sandra,
You make some very fantastic points on both sides of the argument. You talk about non-maleficence and patient autonomy in your discussion. A lot of questions arise from such a complicated case like this and there are many questions to be asked. Is telling Amira the truth about her loss “autonomy”. In what sense is lying bad? White lies are told very often as the aspect of paternalism factors into this. Our society gives lying such a negative connotation. We often value the truth and “facts” more than anything. Does non-maleficence and “for the better cause” outweigh a lie? I do agree with you in the sense that if a lie had to be told to save a life then it should be done.
Another factor that can also be considered is Amira’s state of cognitive ability. Will she be able to recall what the doctors told her before the surgery? If she is unable to recall it, will it be considered a lie still? I think Rylee brings up a great point with physician-patient relationships. This lie for “the better good” could be the intentions of the physician and therefore there is justification in that realm. Could this lie also play into the placebo affect? Are patients who are given a placebo and not told also lied to? A good question would be that are these two even comparable in a sense?