In medicine there’s often a debate about whether to tell a patient about a current situation, or to lie if it might be in their best interest. In the case about Amira, nurses were dealing with the moral conflict on whether to tell her that her partner, Casey, had died in the accident, or to wait until after the surgery. The moral dilemma that the nurses face is deciding between nonmaleficience and telling the patients the truth. On one hand, the nurses don’t want to do the patient any harm. By telling Amira that her spouse died, the nurses can weaken her health even more, potentially causing her death. When people learn of a sudden death of a loved one “they can experience symptoms of shock” which can affect mental state, blood pressure, or breathing (“Sudden Bereavement: Responses in the Early Weeks”). Because of her extremely fragile state, it may be detrimental to Amira’s health if the nurses were to tell her about her partner. As she has already lost a lot of blood, a drop in blood pressure because of the news of her partner could lead to her death. But, how do we know that Amira would react to the news in this manner, entering into a state of shock? Amira may take the news better than other patients—is it then obligatory for the nurses to tell Amira the news if they think she would handle it better?
On the other hand, many medical professionals find it obligatory to tell patients the whole truth, regardless of the outcome. One of the main jobs of a nurse is to build a good relationship with his or her patient in order to act as the patient advocate, advising them on procedures and making sure the patient’s best interest is in mind. A major key to establishing this relationship is building trust with the patients. If the nurse isn’t upfront with Amira from the beginning, how is Amira to trust the nurse in further discussions? Another concern the nurses had was that Amira “might die…without knowing the truth about Casey” (Yeo, 233). Though this isn’t really a concern for Amira’s well-being (if Amira dies, it won’t matter to her that she didn’t know), it’s a concern about the nurses and their own conscious, which should be considered when deciding on what to do.
Weighing both of these factors, the best decision for Amira would be to not tell her about Casey until after the surgery. One must also keep in mind the impact this decision has on their daughter: if there is any chance that not telling Amira at the present moment about Casey might increase her chances of surviving, then we shouldn’t tell Amira in hopes of giving Samantha a better chance of not being an orphan. Additionally, it’s not uncommon to withhold information. According to Thomas Smith, only “37% of terminally ill patients have explicit conversations with their doctor about the fact that they are going to die from their disease” (Schwartz). If it’s acceptable to not tell most terminally ill patients the inevitable, then it should be acceptable to not tell Amira about Casey, especially if it gives her a better chance of survival. Additionally, there are no benefits for telling Amira about her partner sooner rather than later. For example, there are benefits for telling terminally ill patients that their death is soon: they can write their wills, decide power of medical attorney, etc. But, if the nurses tell Amira about Casey, there is nothing she can do, because she’s currently fighting for her own life. Therefore, the best course of action is to tell Amira about Casey after she wakes up from surgery, and to remind her that Samantha is perfectly healthy and needs a mom.
Works Cited
Schwartz, Shelly K. “Is It Ever OK to Lie to Patients?” Physicians Practice, UBM
Medica, www.physicianspractice.com/difficult-patients/
it-ever-ok-lie-patients.
“Sudden Bereavement: Responses in the Early Weeks.” Sudden: Supporting People
after Sudden Death, Brake: The Road Safety Charity, www.suddendeath.org/
help-for-professionals/online-guidance/2-uncategorised/76-earlyweeks.
Accessed 31 Jan. 2017.
Yeo, Michael, et al. “Case 3: Emergency and Trauma Nurses: When to Give Bad
News.” Concepts and Cases in Nursing Ethics, 3rd ed., PDF ed., Broadview
Press, 2010.
Adding onto the idea of trust, the relationship in the hospital is important, and the nurse has a special obligation to be the mediator and the best health care provider. Telling Amira the truth could build the strength of the relationship between the medical staff and Amira.
One idea centers around the topic of the nurses’ uncertainty about the patient’s stress. They do not know for sure if the news would cause her harm to the extent that she would be uncooperative in the surgery. According to Edwin in his Medical Journal, “Uncertainty, however, cannot justify non disclosure… Effective disclosure will protect patient trust in the long run”. The “long run” could pertain to post-operative care, and after other visits to the hospital (with the idea that she survives).
In response to the idea that “there is nothing she[Amira] can do”, I believe Amira can alter her actions in post-operative care. She might be more willing to cooperate with her treatments and the staff rather than if she would in the situation where she figured out if the nurses lied to her about her partner’s death. This is something she can control, per her autonomy.
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.
Hi Silvie!
You bring up a very valid point. I certainly agree that, personally, if I had found out that medical professionals had lied to me, or even failed to tell me something, I would be very upset. However, I still believe that it is in Amira’s best interest for nurses to not tell her about the death of her spouse right before Amira goes into surgery. While I was looking for supplemental sources to support my claim in my original post, I, too, was looking for some authoritative backing on whether doctors should be permitted to withhold truths from patients. Sadly, I struggled finding real-life examples of doctors withholding truths about a patient from another patient: usually they were cases about whether or not to tell someone about risks of surgery or terminal diseases. I read the article you referenced “Don’t Lie but Don’t Tell the Whole Truth: The Therapeutic Privilege – Is It Ever Justified?” and it seems that this paper is largely referring to withholding truths from patients about surgery and its potential outcomes. It brings up a plethora of cases where doctors failed to mention risks of surgery, and ended up losing legal cases, and also discusses cases where doctors didn’t tell patients of the “1%” risks of a surgery.
Therefore, I think the case for Amira still has a great potential to lean in favor of waiting to tell her about Casey. Since the status of her partner has little to do with her surgery and the risks it involves, I think doctors would have a strong argument for not telling Amira for her best interest. I strongly believe that doctors would be able to regain Amira’s trust back by giving her the news of her partner gently, and by explaining that with her precarious state, they didn’t want her to enter into a state of shock, possibly leading to her death and orphaning her daughter.
Reference
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. 10 Feb. 2017.
One thing I noticed in this case was that the importance of perspective. As you have mentioned in the post, it is essential for the nurse to practice their duty as a mediator for patient’s overall well-being. Not mentioning about the truth during a health declining situation for Amira seems to be the right thing to do.
However, from a patient’s perspective, it might be most important to give her the right to access all important information as she acquired. After all, it is Amira’s life and no one should push her to make any decision even in a state when she loses somewhat consciousness. As a person, I would not want anyone to determine my life, my action. We all wear different shoes in life, and the self-interest from nurse should not be the self-interest of a patient.
Reference:
Schwartz, Shelly K. “Is It Ever OK to Lie to Patients?” Physicians Practice, UBM Medica, http://www.physicianspractice.com/difficult-patients/it-ever-ok-lie-patients.
As someone who’s had the same primary care physician all my life, I have experienced first-hand how important the trust between provider and patient is. However, in this case, I do understand why keeping information from the patient is the best course of action, assuming the only information the nurse keeps from her is about her partner. Knowing that the other patient, Casey, is her partner we can take it that Amira is of close enough relation to receive confidential information about another patient but patient privacy could also be a premise for not informing Amira. And although the nurse is withholding information not only is it in the best medical interest of her patient, but the medical information will not change her own physical health status. I agree, it is best to tell Amira about Casey’s death post-surgery when she’s not only more physically stable but possibly more psychologically stable after realizing she and her daughter are still well.
The idea of mental state affecting the physiological state of patients. I too believe that telling Amira about her partner’s death would hurt her chances for coming out of surgery. The nurses have a responsibility of taking care of Amira at the moment and if that means keeping info about her partner until after she’s out of operation.
Although it may hurt the patient-hospital relationship, much research supports the reasons to withhold the bad news. Many studies show that having positive attitude before going into something traumatic, such as as surgery, will allow the person to have a faster recovery time as well as an overall better result. According to research it allows for a reduction in stress, heart problems, and blood pressure. All of those things would allow Amira, and others in her position, a better chance of survival. And since her partner had already passed, the main focus should be Amira and her well being. In that it is in her best interest to give her the best possibility of recovery.
A good question that comes out of this case is: what is the importance of setting the mood for the patients? Although emergencies can be hectic and have to be dealt with fast, I feel like the doctors and nurses have a responsibility to control for the situation. And to do this they may have to keep some truths and or lie to patients to make sure that they remain as calm as possible during a potentially very stressful time.
Gregdowney. “‘How Your Mood Affects Your Health’.” Neuroanthropology. N.p., 07 Mar. 2008. Web.
Young, Yuchi, and Barbara Resnick. “Don’t Worry, Be Positive: Improving Functional Recovery 1 Year After Hip Fracture.” Rehabilitation Nursing 34.3 (2009): 110-17.