Tell or not tell? Amira’s emergency situation

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Background:

Amira’s family got into a car accident where her partner got a severe injury and were soon announced death. Her daughter was in light injury upon this incident. Amira was placed in the hospital’s trauma room, as she woke up and acquired immediate information about her family. Her health condition was critical and she had a big surgery to go through. The nurses were informed about Amira’s partner’s death and were hesitated to tell. They made the decision for Amira that, if Amira survived the surgery, she could learn the truth about her family tragedy in her recovering period.

Dilemma:

The Dilemma of this scenario was whether to announce the news or not. Most of the nurses insisted that under such condition, learning her partner’s death might severely threaten her own health well-being. As a nurse, one obligation is to make good health decision for the patient. It is important to implement actions which would help the patient survive. Many may claim that the patient might not show full comprehension to their own health status in emergency situation. So it might be the best idea to ask the medical professional to make the decision under those situations. In Amira’s cases, her vital signs are losing and one lung already collapsed. She is concerned about her family, and her health well-being might be the main goal from the nurse’s perspective.

A few other nurses stated that Amira deserved to get information as she acquired even in her endangered state.  Many may have claimed that she deserves to get information as she acquired. There have been researches done in the past that most patent would like to know the truth rather than white lie during the situation. In Amira’s situation, she acquired to learn about her family situation upon her wake up. This could further state the importance of her family’s well-being to her. She is concerned about her family situation like any other human beings, and she deserved to be informed of the real situation.

My decision:

Balancing both ends, I would choose to tell the patient about the truth for the sake of her well-being. There could be professional people handling the wording of the truth telling process to make it more acceptable. The truth could be hard for her to accept during the moment, but there could be professional health communicator facilitating the process who help the nurse know, when, whom, and how to tell the tragedy. The nurse could state by: “Your daughter is still waiting for you outside the emergency room, and there is a hardcore surgery you need to fight over.” By setting up faith and encouraging the patient, the truth could be told.

Another important reason is patient deserve to know the information they acquire. Even the best medical care team could make decisions for individuals. From professional’s perspective, their main objective is to cure and to save, but individual’s thoughts should play a stronger factor in their own decisions. Whatever happens, individual should get the information they acquire to know and make their own decision. Although people claimed that sometimes patient’s pain could not balance with their decision, the decision is still upon patient’s. “We don’t know what we don’t know.” As there are many circumstances going on in patient’s life, physicians should not make decisions thinking “it would be the best for patients.” We all wear different shoes in life, and only our own decisions could determine the road we are heading to.

Citation

RD Yeo, M., A. Moorhouse and P. Khan “Case 3: Emergency and Trauma Nurses: When to Give Bad News” Concepts and Cases in Nursing Ethics.

 

 

6 thoughts on “Tell or not tell? Amira’s emergency situation”

  1. Hi Tianqi! I think you did a great job balancing both of these tough issues to decide whether or not to tell the patients. While I respect and understand your opinion, I disagree. I believe that the medical team should not inform the patient of the status of her family members for a few reasons.

    First, because she has experienced recent trauma and about to undergo a risky surgery, I think the doctors should not inform her about her husband’s death as it would increase her anxiety and potentially negatively affect the surgery. Especially at this pre-operative stage following a car accident, the patient is already under considerable stress and shock. To inform her would add grief on top of these emotions which could lessen her own chance of survival, going against the principles of nonmaleficence and beneficence. In fact, a study published in the Immunology and Allergy Clinics of North America states “greater fear or distress prior to surgery has been associated with poorer outcomes including longer hospital stays, more postoperative complications, and higher rates of re-hospitalization” (Gouin, 2011). Because of the potential risks, the medical team should withhold from telling her the bad news initially and instead focus on getting her through the surgery first.

    You argue that withholding this information disrespects patient autonomy; however, if the intention is to inform her after the surgery, I do not think delaying the answer is a problem. In addition, the medical staff cannot be sure that she is fully competent at this point after her recent trauma. As a result, she may not appropriately process the bad news — another reason why it is better to wait until she has a clear mind. This is not to say we should blatantly lie to the patient upfront. Phrases such as “everything is fine” or “your husband is well” should not be considered as the repercussions of such a lie will harm the patient-physician trust in the future. In this case, the doctors need to focus on getting her through this surgery successfully first and can wait, perhaps when she is calm and surrounded by other family members or a counselor, to break the bad news.

    Gouin, J. (2011). The Impact of Psychological Stress on Wound Healing: Methods and Mechanisms. Immunol Allergy Clin North Am, 31(1), pp. 81-93. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3052954/

  2. Hello Tianqi and Julia! I found your posts and the conclusions you arrived at quite interesting. While my personal opinion is that the doctors should not give the news of the partner’s death, I have a different rationale than you had. Personally, I think the doctors should withhold the information to protect the daughter’s right to a parent. As we know, one of the daughter’s parents is already dead. The fact is that if the news is broken to the other parent, as Julia pointed out, there is a significant chance that the parent in critical condition will not survive the life-saving operation due to added stress. If the doctors respect Amira’s autonomy and tell her the news, and she goes on to die, then the daughter will be left an orphan. According to official statistics about orphans, more than half of orphans remain in foster care for two years or more, and more than 20,000 children per year become too old for foster care and are forced to face life without a family. Given that Amira’s child is so young, the potential two or more years in foster care without the presence of a true parent figure could prove irreversibly detrimental in the child’s development. In addition, in the worst case scenario that the child is unable to find a family, then this child (who may or may not have experienced developmental problems during a critical stage in her youth) would have to navigate the world alone, which could lead her to even more problems. With all of this in mind, I think it is important that the information is withheld prior to the surgery. I am not saying that the information should be withheld permanently. I just believe that the doctors have an obligation to both Amira and her daughter, and the best way to serve both of their interests is to withhold the information until the surgery is successfully completed.

    Source: https://showhope.org/2015/06/19/9-stats-about-the-orphan-crisis/

  3. Tianqi,

    While I think you did a great job addressing both sides of the argument as to whether or not the doctors on Amira’s case should tell her about the death of her partner, I disagree with your conclusion. I think that Amira should be told the horrible news after her surgery for several reasons.

    First, Amira is in a very fragile state and any upsetting news could cause her severe harm. The surgery that Amira needs is critical for her survival, as a result, the news of her partner’s death would not change her decision to get the surgery if she was being rational. The only reason Amira would choose to not get the surgery would be if the horrible news caused her to become irrational. Therefore, hearing about her partner’s death before her surgery would only cause her to make irrational decisions and could possibly lead to harm. In addition, it is important to “ensure [the doctor and the patient] have protected time” to digest the news and fully explain the consequences (Payne). In Amira’s life-threatening situation, neither the doctors nor Amira have the time to devote the necessary time to understanding what has taken place.

    Second, it is the doctor’s responsibility to do what is in the best interest of the patient. Currently, the best thing to do for the patient is to save her life. While respecting a patient’s autonomy is important, I think that the doctor’s duty to help the patient outweighs their autonomy in this aspect. If you were in a life or death position, would you rather have the doctor save your life or respect your autonomy and in the process possibly cause you more harm? I would chose to have the doctor save my life.

    Third, there is nothing Amira can do to help her partner or the situation. As a result, it does not matter whether she hears about her partner’s death before surgery or afterwards. While I think it would be courteous of the doctor to tell the patient as soon as possible, I do not think that the importance of relaying this information outweighs the need to save the patient’s life. Amira can wait to hear about her partner’s death until after she saves her own life. Regardless of when she is told the bad news, there is nothing she can do to better the situation.

    Morgan Brandewie

    Works Cited:

    Payne, Dr Jacqueline. “Breaking Bad News.” Breaking Bad News. Help for Breaking Bad News. Patient | Patient. Patient.info, n.d. Web. 08 Feb. 2017.

  4. Hi Tianqi,

    I enjoyed reading your post, it was thoroughly detailed and well-thought out. I see your point, and I understand your reasoning. It does make sense for the patient to be made aware of all information as soon as possible. This supports patient autonomy and the relationship between the physician and the patient. In fact, “most American patients want to have straightforward, honest discussions with their physicians” (Back and Curtis). However, I feel this specific case requires another approach. The case concerns a traumatic emergency in which the lives of multiple people are threatened. Although Amira’s autonomy and right to the truth are of utmost importance, I disagree with the thought that she should be informed of her partner’s death right before the surgery. This will surely agitate her, making the already traumatic situation even worse.
    “Breaking bad news is quite often not done in an effective manner in clinical settings due to the medical staff lacking the skills necessary for speaking to patients and their families” (Abbaszadeh et al.). The news will most likely cause undue stress and negatively impact her recovery. In my opinion, the physicians’ primary duty should be to save Amira’s life. As Morgan stated in the previous comment, whether or not she knows before the surgery does not change the fact that her partner has died. Not telling her in that specific instance does not have any guaranteed harmful effect. However, if the news influences her emotional state and adversely impacts her ability to survive the procedure, the medical professionals will have failed in their duty to help her.

    References
    Abbaszadeh, Abbas, Seyyedeh Roghayeh Ehsani, Jamal Begjani, Mohammad Akbari Kaji, Fatemeh Nemati Dopolani, Amir Nejati, and Esmaeil Mohammadnejad. “Nurses’ Perspectives on Breaking Bad News to Patients and Their Families: A Qualitative Content Analysis.” Journal of Medical Ethics and History of Medicine. Tehran University of Medical Sciences, 2014. Web. 10 Feb. 2017. 
    Back, Anthony L., and J. Randall Curtis. “Communicating Bad News.” Western Journal of Medicine. Copyright 2002 BMJ Publishing Group, May 2002. Web. 10 Feb. 2017.

  5. Hi Tianqi,

    I enjoyed your response a lot! Good work! I thought your response was very well thought out and brought in the many parts of this dilemma. I too considered similar situations when reading this essay. While there are many moral conundrums in this situation, I agree with your decision to tell the patient about the death of her spouse when she asks. I think that in order to respect her autonomy, the medical professionals need to be honest with her. If the individual is a fully competent adult who is aware of the world around them, then they deserve to be told the truth about the health of their other family members. Although it may cause the patient distress or a wide range of emotions, it is the nurses job to respect the patient’s wishes and tell them the reality of the situation. The difficult in the situation lies in the notion of beneficence. A nurse or physician’s job is to do no harm. The question is whether that lies in telling the patient or not. Does it harm the patient more in telling them before a big surgery in which their life is at stake? Does it put the patient more at risk by telling her or is it respecting their autonomy? It is up to the medical professionals to make the call in terms of doing no harm to their patient. While there are binary issues at play here, I stand by your decision to inform the patient of her spouses death.

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