Nursing ethical issues in clinical practice

Ethical Analysis #2

Nursing Issue/Dilemma

Nurses face dilemmas of an ethical nature on a regular basis. This effectively means that from time to time, nurses are called upon make ethical decisions -- decisions that could have a huge impact on the well-being of patients. One of the current ethical issues being faced by nurses is whether or not to lie to patients. Recently, it was revealed that psychiatrists and nurses caring for dementia patients were actively practicing what Williams (2013) refers to as "therapeutic lying" in an attempt to keep the said patients happy. As a matter of fact 98% of nurses, as William further points out, admitted to lying to dementia patients. The question that ought to be answered in this case is; should nurses withhold some potentially upsetting information about diseases that happen to be life-threatening?

B. Ethical Principles and Theories at Issue

The ethical principles at work in this case are nonmaleficence, fidelity, and paternalism. The ethical theories at work, on the other hand, are feminist theory and deontology.

C. How the Ethical Principles and Theories Conflict

It is important to note that while the principle of nonmaleficence and paternalism seem to be in support of "telling lies" to patients, the principle of fidelity flatly opposes such a move. Nonmaleficence, according to the American Medical Association -- ANA (2014), has got to do with avoidance of hurt or harm. It advocates for behaviors that do not cause others distress. On this front, telling patients the truth about the nature of their illness or other distressing news could bring about significant distress and mental anguish. For instance, an accident patient in the ICU could seek to know the whereabouts of the other individuals they were travelling with. Telling an inquisitive patient that someone close to them (i.e. their child) perished in the accident would appear unwise in this scenario. As per the principle of nonmaleficence, telling the patient the naked truth at this point would cause them great hurt, and could even compromise the recovery process. When it comes to the principle of paternalism, ANA (2014) points out that some of the typical decisions healthcare professionals make have got to do with the patient's diagnosis, therapy, as well as prognosis. In the author's own words, "based upon the health care professional's belief about what is in the best interests of the patient, he/she chooses to reveal or withhold patient information in these three important areas" (ANA, 2014). Thus as per this principle, telling the patient the truth in some instances, such as the one recounted above, may not be in the best interests of the patient. A nurse could therefore be forced to withhold the information about the death of a loved one until such a time when the patient will have recovered enough, and in a proper state of mind to receive such news.

Fidelity, according to ANA (2014), "requires loyalty, fairness, truthfulness, advocacy, and dedication" to those patients one is assigned to in the course of duty. Obviously, by lying to the patient, regardless of the reason behind telling the lie, one would be going against the spirit of this very principle.

When it comes to the ethical theories at work, we have the feminist theory and deontology. While deontology judges a given action's morality on the basis of its adherence to rules, the feminist theory fronts ethical relativism (ANA, 2014). In that regard, therefore, the "feminist theory requires examination of the context of the situation in order to come to a moral conclusion" (ANA, 2014). Thus as per the feminist theory, the context of the situation, i.e. The critical or fragile state of the patient's health would warrant that any information that could further worsen their health be withheld from them. The deontological moral system would demand that the patient be told the truth at all times, as being truthful is a moral duty of a nurse.

D. Current Law and/or Regulations that are or May be at Issue

It is important to note that most states mandate healthcare practitioners to disclose to patients all the relevant health information. Essentially, "doctors and nurses have a fiduciary duty "….to protect the interests of and to cater for people who have entrusted themselves into their care" (Corner and Bailey, 2009, p. 275).

E. Ethical Theory Identification and Resolution Proposal

The dilemma highlighted above could, in my view, be resolved by making use of deontological ethics. As per this ethical theory, actions cannot be justified by calling out the good consequences they produced. Some nurses could argue that lying to patients could in some cases avert distress and, hence, keep patients happy. This is, however, not the right thing to do. Nurses should only be concerned with doing that which is right. Telling patients the truth is, in principle, the right thing to do. It has been noted in the past, as Laabs (as cited in XXXX) observes, that "(1) honesty is a prerequisite for good care, (2) dishonesty is always exposed in the end."