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An ethical dilemma in nursing
Ethical dilemmas arise in medical practice on an everyday basis, putting more responsibility on nurses. Deciding between hiding information regarding the medical condition of a patient and telling the patient the truth about the diagnosis is a common problem that medical personnel encounters while working with terminal cases. Often families do not want to reveal the truth about the severity of the situation to the patient. When a terminally ill person asks about the diagnosis, a nurse is faced with a choice. He or she can disclose the truth, knowing that it might have a dramatic effect on a person’s psychology, or decide to protect the patient by lying or not answering directly. As it has been shown by a recent study, there is no consensus on this sensitive issue in the medical community (Velan et al., 2019). It leads to the situation where nurses in the hospital need to approach each case individually to make sure that their behaviors are ethically justified for dealing with a particular patient.
An ethical theory to resolve the dilemma
The school of virtue ethics was first created in ancient Greece by Aristotle, and it has been further developed by many other philosophers. The philosophy of virtue ethics puts special emphasis on the role of moral character and positive intention and lists personal traits and characteristics that people need to promote in themselves in order to achieve moral excellence (Sellman, 2017). This theory provides a framework for evaluating situations regarding ethics and making a decision in accordance with it. Using this approach in the context of the dilemma in question gives a possibility to analyze the ability of the nurse to reason morally and to exercise the virtue of telling the truth. The theory is suitable for the dilemma because following logical reasoning with accordance to the virtue ethics ensures taking ethical decisions in unclear circumstances.
The situation in question involves an event when a terminally ill patient asks a nurse about the diagnosis. The nurse knows that the prognosis for the future development of the disease is pessimistic and understands that telling the patient about the impending death might cause severe distress and create a sense of hopelessness. Research has shown that gender and other personality traits affect the patients’ attitude towards knowing the truth about their case (Chen, Wang, & Tang, 2018). This fact, along with the evaluation of the emotional state of the ill person needs to be taken into account before deciding on how to answer the question.
A decision-making model to resolve the dilemma
The rational decision-making model helps to address the ethical dilemma in question. This approach consists of five sequential steps: defining the problem, choosing the criteria for the evaluation, considering all possible alternatives, selecting the most suitable solution, and implementing and evaluating the chosen solution. The problem in question can be defined as to take an ethical decision. In the framework of virtue ethics theory, the choice of a nurse is considered ethical if it is reflective of high moral principles and is motivated by the desire to exercise virtue (Sellman, 2017). It is also important to emphasize that a decision needs to be in line with ethical conduct and take into account possible consequences.
Generally, there are two possible ways to behave: to disclose the truth to the patient and to hide it either by lying or by avoiding the topic. Lying to the patient contradicts with the value of telling the truth. It also deprives the person of the right to be informed and influences the ability to make choices, thereby limiting the right for self-determination. Telling the truth, on the other hand, is in line with these virtues, but it may have negative consequences, causing. Thus, acting out of compassion, the nurse might choose to withhold some aspects of information. The problem of this reasoning lies in the fact that in many cases, it is hard to foresee the results. It is unclear wither covering the truth will indeed have better consequences for the patient than telling it. Thus, from the ethical perspective, it is justified to disclose the information, if the patient is willing to know it.
The relevance of resolving the ethical dilemma for the profession of nursing
Resolving the ethical dilemma of truth-telling with the help of ethical theories allows nurses to increases awareness and improve the understanding of their responsibilities. Research suggests that nurse’s deliberation in moral values and conscious approach to ethics have a positive effect on outcomes of their work (Dwarswaard & van de Bovenkamp, 2015). Knowing how to handle such problems facilitates the decision-making process and makes it less stressful for medical personnel.
Rational approaches to ethical dilemmas are a good tool that helps develop general methods to handle problems that arise in medical practice but is very important to take each case individually and to consider all its aspects before making a final decision. For instance, it is critical to understand the patient’s motivation and mental state to present the information appropriately and minimize possible distress. Thus, it is essential that nurses evaluate each situation and choose suitable methods of truth-telling.
References
Chen, S. Y., Wang, H. M., & Tang, W. R. (2018). The differences in preference for truth-telling of patients with cancer of different genders. Cancer Nursing, 41(4), 320-326.
Dwarswaard, J., & van de Bovenkamp, H. (2015). Self-management support: A qualitative study of ethical dilemmas experienced by nurses. Patient Education and Counseling, 98(9), 1131-1136.
Sellman, D. (2017). Virtue ethics and nursing practice. In P. A. Scott (Ed.), Key concepts and issues in nursing ethics (pp. 43-54). Cham, Switzerland: Springer.
Velan, B., Ziv, A., Kaplan, G., Rubin, C., Connelly, Y., Karni, T., & Tal, O. (2019). Truth-telling and doctor-assisted death as perceived by Israeli physicians. BMC Medical Ethics, 20(1). Web.
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