Understanding in the medical setting is a very important, and goes beyond what the PBE book was discussing, in terms of understanding and its relationship to informed consent. There is a need for a level of understanding between the patient and the health professional at hand, in order for the most optimal care to be administered and received and thus adhered to. Some questions might arise when one looks at what level of understanding should a patient have in a medical setting, and are their factors, circumstances, or situations to which a limited understanding on the patient side is ok?
This can be seen from our discussions that we had in class about the anesthesia case and the cancer trial case, in which we discussed whether or not a full disclosure should have been given to the patients about the components and risks of their treatment. We looked at potential benefits and risks of a patients full understanding, and some of the benefits/concerns that we looked at were more along the lines of what the effect of that full disclosure could mean for the research, whether or not the patient was harmed without the full disclosure, and the necessity of the full disclosure in the first place. Some potential areas of concern when looking at the effects of not communicating risks, the effect that the patient’s beliefs, education, and status might have on their understanding, and how the patient might not be able to understand due to emotional state, education level, health status, and circumstance.
In the medical field, there should be a level of transparency, with the doctors and health professionals ensuring that the patient knows enough about their diagnosis, condition, ect. to where there is an adequate level of understanding between the patient and the health professional. In Case 3, we see a situation in which the level of patients’ understanding is hindered by an ethical concern. This case questions whether or not the same duty of transparency applies in a situation where a full level of understanding might bring harm to the patient. Amira’s nurses have an obligation to stand by their patient and to ensure a level of understanding. But given Amira’s current medical state, considering how she is in a life or death situation, that obligation might be affected by their obligation to ensure no harm on their patient. The question for this case is whether the harm of not telling Amira is greater than the harm of telling Amira of her partner’s death.
The situation can play out in many different ways. If they tell her, she can die from stress induced trauma or a complication from the news or have an increased will to live for their 3-year-old daughter. If they decide not to tell her, she can survive her injuries and feel deceived by her nurses and lose trust and thus hinder her recover and treatment, die without knowing, or survive and not realize that the information she asked for was not disclosed to her. I think taking the patients health into consideration, the information should be disclosed to her, because the nurses can then encourage her to fight hard for their daughter.
References:
Beauchamp, Tom L., and James F. Childress. “Understanding.” Principles of Biomedical Ethics. 7th ed. New York: Oxford UP, 1994. 131-137 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 Ifechi,
I understand where you are coming from regarding the place of honesty and a level of transparency in the patient-physician relationship, but do you think that absolute transparency is necessary? There are certain circumstances, such as the case with the trauma nurses, where withholding the truth could in fact benefit the patient and cause increased chances of survival. You discussed that the main, likely outcomes of this situation were a) the stress of the situation could either take its toll on her and cause her to die in the surgery, b) the stress of the situation could cause her to fight harder for her daughter or c) finding out that she was lied to could hinder her trust of the nurses and delay her recovery. I am curious how given those options, you came to the conclusion that complete disclosure was the best option. I do agree that there is the chance she fights harder for her daughter and that complete transparency may cause her to trust in her nurses more, but complete disclosure also means that she suffers the shock and grief from the news of losing her partner while her health condition is already unstable.
Dying of a broken heart or the “widowhood effect” is an observed phenomenon in which there is an increased probability of death following the death of a partner/spouse. A study by Dr. Subramanian found that on average, there was a 66% increased chance of dying in individuals in the first three months following their partner’s death (“‘Widowhood Effect’ Strongest over First Three Months: Study.”) This study also found some evidence that this effect may even be stronger in younger partners, such as Amira and Casey, than in older people. I recognize that as a parent we hope that Amira would want to fight harder for her child, but given the immediate grief and shock of losing her partner, I think it may be a little too much to expect from her. Amira deserves to know the truth about her partner, but the timing of disclosing this information can have a direct effect on the probabilities of Amira surviving and recovering from the surgery. I think it is in the best interest of both Amira and their daughter to delay telling the truth about Casey. I don’t think it is ethical to tell a blatant lie such as “Casey and your daughter are both great” but I think it would be wise to tell her that Casey was unstable and they are unsure of the current conditions, but that they needed to focus on Amira right now. I also believe that since withholding the truth is done with good intentions, Amira would hopefully understand why the nurses did not disclose the full truth of Casey’s conditions before Amira’s life-saving surgery.
As you said I agree that a level of transparency must exist in the medical field in order to uphold the principles of nonmaleficence, beneficence and autonomy; however I do not believe that complete transparency and disclosure is always the best option when considering the patient’s health.
Citation
“‘Widowhood Effect’ Strongest over First Three Months: Study.” NY Daily News. Reuters Health, 14 Nov. 2013. Web. 06 Feb. 2017.
I understand your point, but I always think about what would have happened, or what could happen if the doctor wasn’t transparent. But, after our class discussion I do understand what you’re saying, and I’m closer to changing my mind about the Amira case, but I still do feel that generally doctors should be transparent. It’s hard cause I understand both sides, but I still feel as though she should be told, because once she asked the question, she has an obligation to know and her nurse, as her health profession has the obligation to tell her, but I do think that she can tell her at a later time, but not lie to her. Like I think my issue with the transparency was that in class it was as if the only other option was to lie to her, but I agree with not disclosing any information, but not lying, until after the surgery. I hope this makes sense.
Hi Ifechi,
I recognize where you are coming from when you say that the nurses could tell Amira the news and then try to encourage her to keep fighting for her life. But I do not believe that it will be as easy a telling to her to keep fighting and her following through. There is a large chance that after telling Amira, things can go negatively. The nurses could say everything and anything to try and get her to keep hope but that is not always guaranteed. I believe that its a bad idea to hold that risk of her skeptically looking at the situation up to chance. As much as one might think that they can predict a person’s actions, no one really has that power.
Furthermore, if one actually takes Amira’s health into consideration, one would not tell her because her being in critical condition and then getting told that her partner, her family, the other parent to her child is dead, could inevitably cause her to go into shock and would be detrimental to her health. In Dr. Alex Lickerman’s article, “How to Deliver Bad News to Patients: 9 Tips to do it Better,” he explains that, “if you destroy a person’s hope for a good outcome, they’ll suffer far more on the way to whatever bad outcome may be in store for them than if they’d had the opportunity to approach it full of hope.” In this case, the good outcome would be that Amira will know of Casey’s death but the bad outcome would be Amira not faring well after getting the news and having a detrimental mindset. Telling Amira would ruin her opportunity to approach the urgently needed surgery full of hope.
Lickerman, Alex, MD. “How to Deliver Bad News to Patients: Tips to Do It Better.” KevinMD.com. MedPageToday, 20 Apr. 2013. Web. 8 Feb. 2017.
Yeo, M., A. Moorhouse and P. Khan “Case 3: Emergency and Trauma Nurses: When to Give Bad News” Concepts and Cases in Nursing Ethics.