Truth-Telling/Confidentiality in Medical Practice

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Table of Contents

Introduction
The main moral issue
Ethical arguments for non-disclosure of information
Moral arguments for the disclosure
The moral perspective of those concerned
Need for proper guidelines
Conclusion
References

Introduction

This case scenario involves the radiological discovery of a large surgical scalpel in the abdominal cavity of a patient. This case will be used as a launchpad for discussing and reflecting on practical, ethical issues and moral dilemmas that normally face healthcare professionals, especially in the doctor-patient relationship. In this case, the moral dilemma faced by the radiologists is truth-telling or an ethical issue relating to confidentiality in medical practice (Vaiani 2009, p.408). Further, two scenarios exist; when to disclose the information to the patient and when to keep the information confidential. The main issue is whether it is necessary to disclose the information to the patient.

In this manuscript, the just impasse is acknowledged and wiles in support of or against revelation are highlighted. Moreover, the speculative obscurities in harmonizing the inconsistent grounds and setting up what represents notifying the patient will be observed. Furthermore, the paper will examine the two scenarios concerning all the stakeholders, the patient, the radiologist and the institution. Before a conclusion is made, the paper will explore whether there exist any guidelines to help solve the problem. The findings are that preserving information from the patients at times would be morally acceptable (Sekerka & Bagozzi 2007, p.134).

The main moral issue

Professionals in healthcare are over and over again faced with moral and legal dilemmas in their workplaces. While some have the courage to directly deal with the circumstances others will shy away from the problem. In such a situation medical practitioners are called upon to display courage especially when it is not easy to do the right thing (Aultman 2008, p.67). According to Einarsen et al. (2007, p.210), healthcare practitioners are not invulnerable to immoral behaviours. In fact, principled impasses are encountered by these certified experts on a normal basis.

A moral dilemma often comes about when health professionals are expected to carry out more than two parallel actions concurrently (Einarsen et al. 2007, p.210). Even though this case scenario represents many dilemmas, the major dilemma concerns Ronald Rachel, a radiologic technologist who is duty-bound to disclose or not to disclose information regarding the condition of Pamela Faden who is an x-ray patient. The X-rays print outs indicate that surgical scalpel is within the patient’s stomach. This surgery was done by one of the doctors in the hospital. The question is whether Ron has the moral obligation to disclose the information to the patient or not. That is, should the radiologist disclose to the patient unexpected discovery or withhold the information?

Ron is in a genuine dilemma. The circumstances under which information are confidential. In conditions where two contending obligations equally pull in the opposite direction, a genuine dilemma exists (Clancy 2003, p.129). Before examining the two scenarios in the perspectives of those concerned, the advantages and disadvantages of discloser and non-disclosure of information are clearly brought out. In fact, each stakeholder will have a difference in regard to the discloser and non-disclosure of information. The stakeholders, in this case, are the radiologist, the patient and the institution.

Ethical arguments for non-disclosure of information

There is a moral assumption that disclosing information to the patient would do more harm than good (Lachman, 2009, p.35). All the arguments for non-disclosure of information to the patient are based on this assumption. The argument is that disclosure of information to the patient has the likelihood of harming the patients than benefitting them (Lachman, 2009, p.36). The harm may be in the form of psychological distress, emotional disturbance as well as developing a poor relationship with the medical practitioners. This poor relationship may result from mistrust that the patient may have with the health professionals and the institution (Lachman, 2009, p.36). In this case, the patient may take legal action against the surgical doctor’s negligence which in any way will add to more physical, financial and psychological constraints.

Contrary to the expectations of many people, medical practitioners are not bound by any legal means to disclose all the information concerning the patient’s medical condition (Sekerka & Bagozzi 2007, p.137). Bjarnason et al. (2009, p.497) argue that medical professionals have no obligation to discuss with the patient all the physical and medical processes surrounding their condition. The medical practitioners are ethically obligated to disclose only medically relevant information which is reasonably expected by the patient. The information must be backed up by good reasons that can be evaluated from the peripheral viewpoint (Day 2007, p.613).

The patient and any other person would expect to know about their condition especially the disease they are suffering from. However, the patients are only obligated to get information that the doctors feel is reasonable (Lachman, 2009, p.36). Derived from this dispute, it could be believed that the supposed prospect of the tolerant was perverse to be told the fact. In addition, imaging was not done to disclose the information to the patient. Rather, it was done to determine the problem after surgery. From these grounds, the case is that the outcome ought to not be unveiled to the long-suffering.

Moral arguments for the disclosure

All the moral arguments for the disclosure of information are based on the patients’ experience. The patient’s knowledge of his condition, though stressful in the short-run, is more beneficial in the long-run. Being straight to the patient may also prevent difficulties being experienced while breaking bad news. Agonizing news cannot be avoided in medical practice (Lachman, 2009, p.37). Moreover, information about the condition of the patient should not be held simply to reduce stress. Unveiling info might besides avert consequent brawl and mislay of reliance in case the long-suffering discern the reality anon. Besides, the patient will be relieved to know her condition and have assurances that she will be better after receiving appropriate treatment.

Finally, it is intrinsically good to pay respect to other people’s autonomy (Baylis, 2007, p.62). That is their aptitude to make their own deliberate choices. Notifying the long-suffering and making them powerful is in itself an honourable commitment regardless of the costs (Baylis, 2007, p.63). Regarding the case scenario, providing information and making the patient make own decision concerning the condition is morally acceptable and does not require any consent of the patient or institution.

The moral perspective of those concerned

In most cases, the patients feel that they have the right to be informed about their condition. This right cannot be compromised since it is the major reason why the patients seek medical attention (Chatham-Carpenter, 2006, p.1). Whereas knowing the truth will cause stress and anxiety, the patient needs to be informed so as to make a personal decision on the best action to take (Chatham-Carpenter, 2006, p.1). Besides, the patient would be very happy when told about the treatment and the progress being made. In this case, imaging was done to determine the problem after surgery. Therefore, the patient had the right to know the result even if the results were to cause tension between the patient and the institution.

The radiologist, on the other hand, feels that it is unethical to keep important information from the patient. In this case, the radiologist feels that he failed on his moral obligation to inform the patient of the condition. He knew that the patient has the right to know but kept the information for the sake of the institution and fellow doctors. In as much as the patients have rights to know their medical conditions, other factors must also be taken into consideration (Day 2007, p.614). These include the relationship the patient has with the doctors and the institution.

From the perspective of the institution, it is necessary to keep some information in order to uphold the institution’s reputation. Maintaining good relations with the patients and making the patient believe that the institution and the health professional offer the best is the ultimate goal of the institution. However, keeping information confidential would be detrimental to the institution particularly when the patient learns later that essential information was withheld (Vaiani 2009, p.408). Moreover, it would be immoral to keep important information from the patient.

Need for proper guidelines

The case scenarios highlight the need for proper guidelines or policy governing such situations. A guideline may be in form of code of ethical conduct that spells out the expected behaviour of the employees in an institution and determines the extent at which information could be treated confidential or disclosed to the patient (Day 2007, p.614). In conditions where the proper guideline is absent, the medical professionals could apply the general professional guidelines and their professional knowledge to determine the confidentiality of information.

Conclusion

It can be concluded that dilemma exists in the medical profession and those in medical practice must know how to deal with such dilemmas. However, in this case, providing information to the patient is not always the case. While the patient has the right to know his medical condition; several other factors must also be put into consideration. Therefore, medical practitioners must always apply the ethical and professional conduct in all their dealings.

References

Aultman, J 2008, “Moral courage through a collective voice”, The American Journal of Bioethics, vol.8 no.4, pp.67 – 69.

Baylis, F 2007, Of courage, honor and integrity, Baltimore, MD, The Johns Hopkins University Press.

Bjarnason, D, Mick, J, Thompson, J & Cloyd, E 2009, “Perspectives on trans-cultural care”, Nursing Clinics of North America, vol.44 no.5, pp.495 – 503.

Chatham-Carpenter, A 2006, Moral courage for a university ethics capstone class? Web.

Clancy, T 2003, “Courage and today’s nurse leader”, Nursing Administration Quarterly, vol. 27 no.2, pp.128 – 132.

Day, L 2007, “Courage as a virtue necessary to good nursing practice”, American Journal of Critical Care, vol.16 no.6, pp.613 – 616.

Einarsen, S, Aasland, M, & Skogstad, A 2007, “Destructive leadership behavior: a definition and conceptual model”, The Leadership Quarterly, vol. 18 no.11, pp.207 – 216.

Lachman, V 2009, Ethical challenges in healthcare – developing your moral compass. New York, NY, Springer Publishing Company.

Sekerka, LE, & Bagozzi, RP 2007, “Moral courage in the workplace: Moving to and from the desire and decision to act”, Business Ethics, vol.16 no.2, pp.132 –148.

Vaiani, C 2009, “Personal conscience and the problem of moral certitude”, Nursing Clinics of North America, vol.44 no.6, pp.407 – 414.

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