Four Principles Of Healthcare Ethics Nursing Essay
Cancer is a very fearing word in today’s society because death is attached to it. Its impact on the recipients can cause stress and anxiety. Historically, doctors were the one who used to break the news first; and family decided not to inform patient. It is difficult for the nurse to balance between autonomy, beneficence and non-maleficence at the same time. When such differences occur, an ethical dilemma emerges due to two unfavorable situations. As a health care professional we always experience such difficulty in our health settings When we talk about patient’s rights that he has an autonomy which means freedom to make choice; on the other hand, it is closely linked with the notion of respect for a person as he has the right to know about his diagnosis, but do we really mean it? As a nurse, we are not sure how this impact of the news affects on patient mental status. In western countries, patient’s autonomy is considered as a corner stone in involving patient in their end of life decision. Whereas in Pakistan, decision making is different from western societies; people in Pakistan mostly live in an extended family system, where family dominates and direct decision making which stresses the principle of beneficence and maleficence rather than autonomy. As a nurse my personal feeling is I m supporting the family rather patient who’s having a trusting relationship with the nurse.
Compare and Contrast
According to Jonathan Breslin (n.d), the only way to accept family’s suggestion is not by telling the patient about the disease, until, the entire health care team agrees to take the same step. In our health care system telling the truth is strongly deep rooted as a nurse, when we are told not to disclose the diagnosis, we immediately feel that we are asked to do something that is directly violating the ethical principles. However, the first reaction that comes in the mind is ‘Patient has the right to know’ .However, it is also important to maintain relationship with the family in providing quality care and avoiding stressful environment, Various models on ethical decision making are available in which one is MORAL model developed by Thiroux (1977), applicable in nursing situation; later on utilized by Crisham (1990). It has got five steps (a) issues are identified and taking into consideration all value system and major ethical principles (b) options are examined (c) plan of action to resolve the dilemma (d) implementation (e) evaluation. These steps guides the entire health teams to reach to conclusion and at the same time follow ethical principles of patient’s autonomy, non-maleficence, beneficence and justice.
Model, also in its initial steps suggests assessing the patient knowledge level and influence of the value system in decision making process. It is favorable to acknowledge the family that they know patient better. But we need to find out that why they are not willing to tell patient about the disease, has the patient mentioned in the past that if god forbids I get cancer I would prefer dying then suffering, or patient has seen other cancer patients having a difficult death. Are there things that need to be settled, but it is difficult to settle without patient participation for example wills and mortgages. Moreover, it will also direct us about patient risk and benefit in hiding information. Furthermore, in the Pakistani culture families plays the role of paternalism, where they take decision on behalf of patient with intention to protect their loved ones from psychological distress. Additionally, to my view, by not telling truth we are violating individual’s rights. In the Aga Khan Hospital, we do follow patients’ Bill of Rights but there is no policy developed whether patient should be told about their diagnosis or not, or discussion about advance directives prior to admission. The bottom line is that the patient has the right to know about their disease on basis of two ethical principles; firstly, it is patient’s personal information, secondly, there is always additional information and consent need from the patient regarding palliative care or procedure. Simultaneously it will also help health care members to prevent themselves from deceiving the patient.
Does that mean we, as a health care professionals, should ignore family’s decision as they know better than the health care professionals, their major concern is whether this information will harm the patient or not .
On many occasions, family, cultural and religious values dominate the decision making for the disclosure of the patient diagnosis. Health care teams have to face these barriers which bound them not to reveal the news. If I take these things into consideration, and not informing the patient so how can a patient be an autonomous being despite of medical advancement . Patient gradually would come to know through other sources. Are we doing justice to patient by giving fair, equitable and appropriate treatment in the light of the rights of an individual’s?
This intertwined relationship is based on the ethical principle of beneficence and maleficence, these principle are like ends of the continuum relating to harm and obligations to help, when family is taking the decision on the behalf of the patient which is a very common trend in different cultures where collective decision is acceptable. Suppose if patient is educated, has access to medical information, needs emotional support where health members require patient’s participation in decision making, it is very helpful and therapeutic, and even gains co-operation from patients in diagnostic procedure and eventually improves outcome. In today’s hi-tech society, media is giving latest researches on cancer signs and symptoms and its related treatment. If a patient is asking a nurse about his disease, what answer she will give, if she is not giving the right answer then nurse is violating the ethical rights of the patient. If we consider autonomy then another concept which enters the scene is, are we doing good to the patient by not involving him in his treatment by listening to family’s view. Without patient participation we cannot achieve the goal, as patients trust the nurses, and giving patient the autonomy, we give patients the right to die peacefully.
According to Singapore Journal (2002), Lin conducted a study that those patients who were informed about cancer diagnosis, experienced less worse pain which was not bothering them and were more satisfied with pain management which was provided by the health care team. For example patient who received chemotherapy had to face side effects or patient having breast cancer needs mastectomy. In these cases, medical professionals want make their quality of life better. On the other hand we are forced by the family not to discuss the patient about his diagnosis how the medical team will perform a surgery without patient consent but that means that sooner or later they will come to know about their disease. Similarly, if he knows about the diagnosis earlier he could participate in his treatment with a positive attitude, which would help him to cope with the disease process. On the other hand, they would make major decisions about their family, children and own personal business if they know about their prognosis. In my opinion, disclosure of diagnosis is followed by the process of (Kubler Ross) (denial, anxiety, anger, withdrawal and acceptance) here also family can support patient to bring normal life. I think this is just temporary harm, because the family loves the patient and do not want to torture him or lose hope. Some patients do get depressed in the initial phase of disclosure of diagnosis that they get suicidal thoughts as going through chemotherapy is a torturous process. Family can take help from counselor which would enhance his will power and help the patient cope with the adverse effects of the treatment process. If he knows about the diagnosis he can even plan for unfinished life goals.
In contrast, if we are not disclosing the diagnosis to the patient, I think the nurse is breaking the principles of ethics in not doing justice which means we are not following the ethical principles. Moreover, in many cultures doctors disclose this news to family first, some culture like in Japan, it is often believed that it is family’s duty to protect patient from burdensome information and take end of life decision on behalf of the patient. Family decision is greatly respected in this regard because the word cancer has got stigma attached to it. So directly informing patients is considered very rude, insensitive, and disrespectful and by nondisclosure, they are avoiding open discussion. It is very difficult to deal with the family who keep insisting not to disclose about his disease - thus nurses feel helpless.
Hence, it is one of the most challenging situations for the nurse to balance truth telling and protecting the patient from harm within this professional relationship. Nurses often want to help patients while not giving false hopes and by protecting the autonomy of the patient as a care provider and having a trusting relationship with the patient. Still nurses always have ambiguity feelings whether to inform or not. On one hand we are giving rights to the patient that he can refuse the treatment means we are giving autonomy and on the other hand, we are violating their rights, by not telling them about their diagnosis. This is a major dilemma in our profession and it is really difficult to deal with it. Patient’s right to autonomy should be respected. In my opinion, as a nurse I give respect to the family decision and do not disclose the diagnosis to patient.