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Ethical dilemmas for physicians
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Healthcare professions have codes of conduct and ethics that address the issue of honesty and trust in relation to patient encounters yet truth-telling (or being honest) versus deception (or being dishonest) has been identified as an ethical issue in hospitals, particularly about diagnosis and prognosis disclosures. Dossa (2010) defines being honest or telling the truth as relating the facts as one knows them. Furthermore, Dossa (2010) states that deception can be an act of dishonesty but also can be without lies. In other words, forms of deception include not giving any information, not giving information of the truth, withholding information, selecting what information to give and not give, and giving vague information.
The most common areas of clinical practice where truth-telling and deception become an ethical dilemma are critical care, cancer and palliative care, mental health and general nursing practice (Tuckett, 2004). Other areas where it can raise potential ethical concerns are in placebo therapy, disclosure of human immunodeficiency virus and informed consent (Tuckett, 2004). Truth-telling is also an act of exchanging moral agents (patients, relatives, nurses) with their sets of values and norms, which in turn are derived from culture, personal and religious beliefs, and traditions (Dossa, 2010). For this reason, the issue of truth-telling is not only approached differently in the various clinical settings but also in different countries, cultures and religions (Kazdaglis et al., 2010). For example, in the United States of America (USA), England, Canada and Finland, the majority of patients are told of their diagnosis (Kazdaglis et al., 2010). Conversely, in Japan, family members play a major role in the decision of ...
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...t, G., & Horsfall, J. (2009). Delivering difficult news in psychiatric settings.
Harvard Review of Psychiatry, 17(5), 315-321.
Dossa, N. (2010). To tell the truth or not?. Journal of Community Nursing, 24(4), 14-16.
Kazdaglis, G. A., Arnaoutoglou, C., Karypidis, D., Memekidou, G., Spanos, G., &
Papadopoulos, O. (2010). Disclosing the truth to terminal cancer patients: a discussion of ethical and cultural issues. Eastern Mediterranean Health Journal, 16(4), 442-447.
O'Sullivan, E. (2009). Withholding truth from patients. Nursing Standard (Royal College of
Nursing (Great Britain):1987), 23(48), 35-40.
Potter, P., & Perry, A. (2009). Fundamentals of Nursing. Ethics and Values (7th ed.) St.
Louis, MO: Mosby Elsevier.
Tuckett, A. (2004). Truth-telling in clinical practice and the arguments for and against: A review of the literature. Nursing Ethics, 11(5), 500-513.
When it comes to a bad diagnosis it is often difficult for doctors to tell their patients this devastating news. The doctor will likely hold back from telling the patient the whole truth about their health because they believe the patient will become depressed. However, Schwartz argues that telling the patient the whole truth about their illness will cause depression and anxiety, but rather telling the patient the whole truth will empower and motivate the patient to make the most of their days. Many doctors will often also prescribe or offer treatment that will likely not help their health, but the doctors do so to make patients feel as though their may be a solution to the problem as they are unaware to the limited number of days they may have left. In comparison, people who are aware there is no cure to their diagnosis and many choose to live their last days not in the hospital or pain free from medications without a treatment holding them back. They can choose to live their last days with their family and will have more time and awareness to handle a will. Schwartz argues the importance of telling patients the truth about their diagnosis and communicating the person’s likely amount of time left as it will affect how the patient chooses to live their limited
Cullen and Klein understand that deception is wrong and disrespectful to the patient but criticize that some cases are more complicated and not so black and white. They argue that physicians should be able to withhold information that can significantly benefit the patient. The key part is that the benefit is greater than what the deception causes.
One day while doing his job, a physician used a used swab that was possibly infected with HIV on another patient. When looked at by certain people, the doctor did the correct thing by telling his patient that he roused a swab on him/her. However, the chances of this patient getting HIV was substantially low, and he should have waited for the patient to develop symptoms, which would have been rare, before telling the truth. As stated by Michael Greenberg, “he might have done better by keeping his mouth shut.” If the doctor did lie, he could have lied to protect himself, the quality of life of the patient, and his ability to help others with their lives. If he had not told the patient that he used the swab on him/her, he/she would not have had to live in fear of getting HIV. Because of this decision of truth telling, the doctor lost his job, money, confidence, and also affected someone’s quality of life.
One of the most complex, ever-changing careers is the medical field. Physicians are not only faced with medical challenges, but also with ethical ones. In “Respect for Patients, Physicians, and the Truth”, by Susan Cullen and Margaret Klein, they discuss to great extent the complicated dilemmas physicians encounter during their practice. In their publication, Cullen and Klein discuss the pros and cons of disclosing the medical diagnosis (identifying the nature or cause of the disease), and the prognosis (the end result after treating the condition). But this subject is not easily regulated nor are there guidelines to follow. One example that clearly illustrates the ambiguity of the subject is when a patient is diagnosed with a serious, life-threatening
The nurse should not inform the patient of her leukemia. The nurse has not been observing the patient long enough to use her assumption that the patient is mentally sound as a means to justify telling the patient stressful information. The nurse ought to follow the physicians instruction to refrain from giving the patient news about their chronic lymphocytic leukemia. This resolution follows with my own moral intuitions. If someone is not in a healthy mental state, it would not be morally permissible to provide information to that person which could cause their mental state to worsen. Although in most cases it is obligatory for a moral agent to always tell the whole truth in accordance with the prima facie principle of honesty, the principle of beneficence in moral situations similar to this one overrides the principle of honesty. One’s own health and well-being is more important than answering their questions to the fullest knowledge
Jackson, D. and Raftos, M. (1997) In uncharted waters: confronting the culture of silence in a residential care institution. International Journal of Nursing Practice. 3 (1), pp. 34-39.
TELEOLOGICAL: If there is no hope for a patient then doctors should in no way keep it from them. All options that are available to help them should be present. If the patient/client chooses an option that the doctor knows isn’t the best one then, a little white lie to persuade them to choose the option that is the...
Burkhardt, M. A., & Nathaniel, A. K. (2014). Ethics & issues in contemporary nursing (4th ed.). Stephan Helbra.
When one initially chooses a career path, one rarely looks at all the negatives that may be associated with that choice. Most career paths have some negatives associated with the field, but few face the moral dilemmas associated with modern healthcare. Those who choose to be in the healthcare profession today are faced with moral and ethical dilemmas that would make King Solomon tear his hair out. In many cases, doctors, and sometimes nurses, are faced with life and death decisions without the benefit of knowing the patient’s, or the patient’s family’s, wishes. However, aside from those tragic times when a patient’s wishes are unknown, healthcare professionals must always put their own morals aside, and act
American Nurses Association. (2015, January 2015). Code of Ethics for Nurses With Interpretive Statements, 1-76. Retrieved from
Benner , P., Tanner, C., & Chesla, C. (1996). Expertise in Nursing Practice, Caring, Clinical Judgement and Ethics. New York, New York: Springer.
Pergert, P., & Lützén, K. (2012). Balancing truth-telling in the preservation of hope: A relational ethics approach. Nursing ethics, 19(1), 21-29.
Ethics is defined as moral principles that govern a persons or a group’s behavior, ethical principles apply to both personal and professional relationships (Webster, 2015). The field of nursing is a profession that has been highly regarded and respected in society. Most nurses enter the profession in order to utilize their clinical skills to help others in their time of need. Those in failing health rely on nurses to care for them in their most vulnerable states, and expect a level of compassion and humanity while receiving care. Nurses have an ethical responsibility to their patients, clients, and their community. Compassion, empathy, and integrity are staple characteristics that nurses possess that allow them to successfully perform their
In conclusion, there are numerous legal and ethical issues apparent in the nursing practice. Nurses should study and be as informed as they can with ethics and legality within their field in order to ensure no mistakes occur. Ethical issues vary based on patient’s views, religion, and environment. Nurses are influenced by these same views, but most of the time they are not the same as the patients. As a nurse we must learn to put the care of our patients and their beliefs, rights, and wishes before our own personal
I do not know of anyone who wants to be known as Pinocchio, the wooden boy who lies and in a result, makes his nose grow bigger. As an old proverb says, honesty is the best policy. I agree with being honest at all times. First, telling the truth to me, is always the right thing. When I catch someone in a lie, I just think to myself, what has come up of this world? A person’s truths and lies prove who that person is, and what that person is capable of. Second, people can earn a great deal of respect and trust from telling the truth. Now, people trust their “gut feeling”, but someone’s “gut feeling” should always be truthful. Respect is something that is earned, and at sometimes, given to people who do the things that they are supposed to do for themselves and for others. Last, most people were taught to tell the truth at a very young age. A truth is