Truth Telling and the Respect for Patients’ Autonomy in Saudi Arabia
Introduction
In the Western society, truth telling is an essential part of the patient’s autonomy. However, this moral stance is not shared in the Middle East more particularly in Saudi Arabia (SA) and other Islamic societies. Withholding information from the patient regarding diagnosis, treatment, prognosis is considered an acceptable practice in these cultures. The decision-making is shared among family members except with the patients themselves. The truth concealment is more prominent toward elderly and women patients. The Saudi society believes that disclosing bad news about the serious diagnosis or prognosis will extinguish patient’s hope and faith in being cured.
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They defined the respect for autonomy as “ acknowledging people right to hold views, to make choices, and to take actions based on their values and beliefs” (Beauchamp & Childress, 2009, p. 106). They identify the autonomous person as a person who has the capacities of self-governance such as understanding, reasoning, deliberating and independent choosing (Beauchamp & Childress, 2009). Also, they mentioned that in case of delegating the right to make decision to someone else that decision must be made autonomously by the patient (Beauchamp & Childress, 2009). Assuming that most of these Saudi patients are autonomous people, they deserve respectful actions and behaviors in the health sitting by all healthcare providers and family members based on the common morality …show more content…
The Kantian theory is often called a deontological or non-consequentialist theory . In Kantianism, a moral act is not only according with but also for the sake of obligation and duty (Beauchamp & Childress, 2009). This act must be taken without any traditional or personal motivations (Beauchamp & Childress, 2009). So, a Kantian perspective would in favor telling the truth while concealment and deceiving are actions that lack moral worth. So, lying or withholding the truth is an act that cannot consistently be universalized as a norm of conduct (Beauchamp & Childress, 2009). Similarly, common morality theory emphasizes on a common acceptable moralities that are applicable to all human being despite any cultural, traditional, group or individual variables (Beauchamp & Childress, 2009). Common morality theory stands for actions and traits such as truthfulness, keeping promises, honesty, trustworthiness and other moral standers. Beauchamp and Childress (2009) mentioned that moral responsibility and ethical obligation (e.g. respect for autonomy) must be fulfilled unless it competes with another stronger moral obligation. However, proving supportive justifications to on principle must be met before overriding the other ethical principle. In presented case above, the identified ethical conflict was
Patients have the right to self-determination and individuals should have control over their own lives. With respect for human autonomy comes respect for patient rights. Apart of the nurses job is to promote, advocate and protect the rights, health, and safety of our patients. Patients have the right to determine their health needs, make informed decisions, and the right to information regarding their treatment and also the refusal of treatment. Nurses are obligated to know the rights of a patient and to make sure the patient understands their treatment plan. Supporting patient autonomy includes making decisions in the best interest of the patient, considering their values and recognizing differences between cultures. In the treatment
In his article “Whose Body Is It, Anyway?”—appearing in the New Yorker in October 1994—Dr. Atul Gawande highlights the complexities of the doctor-patient relationship vis-à-vis patient autonomy and decision-making. Dr. Gawande explains that a respect for patient autonomy (i.e., allowing patients to choose between courses of treatment, therefore directly influencing their health outcome) is the “new normal” for medical practitioners. However, Gawande also contends that there are times when patients are better served by a voluntary relinquishment of that autonomy.
The concept of autonomy in the medical practice brings many different views. Autonomy is the ability individuals have to be self-governing. In these different views there exist two schools of thought, one is the belief that people are born with the ability to do what they want their body and no organization can tell them what to do with their body, like the government. On the other hand, some people believe that it is more complicated and conditional on mental competency so that person can make rational decisions. However, the majority of people seem to advocate for autonomy. A particular largely uncontroversial discussion arises with the case of Dax Cowart, who had his right to autonomy taken from him in a tragic accident and is
Autonomy includes three primary conditions: (1) liberty (independence from controlling influences), (2) agency (capacity for intentional action), and (3) understanding (through informed consent) (Beauchamp & Childress, 2009, p. 100). According to Beauchamp & Childress (2009) to respect autonomous agents, one must acknowledge their right to hold views, to make choices, and to take actions based on their personal values and beliefs (p. 103). Respect for autonomy implies thaturges caregivers to respect theassist a patient in achieving? Heed? the autonomous choices of their patients. From there, patients can act intentionally and with full understanding when evaluating medical treatment modalities. Autonomy also includes a set of rules, one of which requires that providers honor patient decision-making rights by providing the truth, also known as veracity (Beauchamp & Childress, 2009, p. 103). In this case, several facets of the principle of respecting autonomy, specifically veracity, informed
To begin with the person is the centre of the plan, to be consulted with and their views must always come first: It should include all aspects of their care, and every professional should work together to provide it. (Leathard 2000) Autonomy refers to an individuals’ ability to come to his or her own decisions and requires nurses to respect the choices patients make concerning their own lives (Hendrick 2000).However Gillon Argues that the principle respect for autonomy may need some restriction, otherwise we may be morally obliged to respect an autonomous course of action with unthinkable consequences.( Gillon 1986) Every human being has an intrinsic value, they all have a right to well being, to self-fulfilment and to as much control over their own lives as is consistent with others (British Association of Social Workers 2002).Professional Judgement and patient preference cannot be suspended if practice is to be safe and effective rather than routine(DOH 2005) Alex had to attend this session as it was within his Timetable, how could it have been effective?, he was unhappy and
In today’s society, it is very important for the healthcare professional to be educated about the culture of their patients. It can be seen that the number of patients who are Muslim are increasing throughout the healthcare system. It is challenging for healthcare workers to care for the needs of Muslim patients when they don’t understand their cultural beliefs. Muslims don’t necessarily have the same health beliefs, outcomes, or priorities that their providers have, therefore making it more difficult to come to a final healthcare decision (Al-Oraibi, 2009.) “This intercultural gap in understanding between clients and providers may result in poor care services and low levels of satisfaction” (Al-Oraibi, 2009.) Muslims are
Patient’s decisions may sometimes be affected by various factors i.e. Their surroundings, they are often vulnerable and out of their normal environment. A conventional health care setting may be in a hospital environment where patients are most likely feel sensitive and insecure. Matiti and Trorey (2008:17) conducted interviews involving 102 patients in 3 different hospitals across the United Kingdom, over a period of 18 months. The purpose of these encounters was to annotate what was being said and also the fundamental meaning of how patients believed that their dignity was being put in jeopardy. One of the key aspects of patient dignity is making choices. Whilst conducting these interviews Matiti and Trorey (2008:17) discovered that despite the fact that patients accepted the loss of a little independence within the hospital surroundings, they wanted the freedom to participate in the decisions about their healthcare. Patients’ understanding in terms of choice, authority or participation in care and autonomy varied extensively. A number of patients were grateful that they were given the option to make decisions and that these were acted upon. On the contrary others considered that their right to making choices was contradicted and often their
Truth-telling is an important issue within the nurse-patient relationship. Nurses make decisions on a daily basis regarding what information to tell patients. The specific issue in question is whether a nurse should abide by the Code of Ethics for Nurses by revealing the truth to the patient or refrain from telling the truth to the patient because they are respecting the wishes of the patient’s family. Nurses and health care professionals should always tell the truth to their patients unless the patient forgoes their rights to autonomy or cannot think for themselves. By providing the patient with the truth, they allow the patient to come to terms with their conditions and give them the options for further treatment.
Autonomy explores the idea of every person having rights in regards to healthcare and decision making. “Autonomy is an agreement to respect another’s right to self-determine a course of action and support independent decision making” (Beauchamp & Childress, 2009). In 1990, the ideas of autonomy lead to the Patient Self Determination Act which allows competent people to make their wishes known about end of life. The act includes living wills and health care power of attorneys, which deals with end of
There are times that self-determination has opposition with the values and beliefs of health care providers. The five step ethical decision making model is in place for patients that are unable to make their own health care decisions due to incompetency; paternalism is not the method used anymore. “In relation to health care, paternalism manifests itself in the making of decisions on behalf of patients without their full consent or knowledge. (Burkhardt & Nathaniel, 2008). Value systems, which includes a patients and family morals, play a factor in ethical decision making.
Nursing is an all encompassing profession in which practitioners are not only proficient in technical medical functionality, they also have the obligation to remain compassionate and respectful of patients and as such are expected to adhere to pre established codes of ethics. Of these ethics, autonomy is of extreme importance as it offers patients a sense of personal authority during a time where they may feel as if their lives, or at the very least their health, is no longer under their control. Autonomy in the context of nursing allocates the patient and often their family with the final word on the course of treatment. The concept of patient autonomy is a highly variable subject in all fields of health care. It is a universal concept that varies widely in its meaning and interpretation. Autonomy in its simplest form can be defined as a state of independence or self governing (Atkins, 2006). Patient autonomy can also be defined as the ability to make once own decisions, based on one’s sound judgment. It is defined by the American Nurses Association (ANA, 2011) as the "agreement to respect another 's right to self determine a course of action; support of independent decision making." This seemingly straight forward ethical concept is rife with difficulties when one considers potential disagreements that may arise even when informed consent is provided, particularly among children or vulnerable people. Relevant research and
Health care systems across the world are facing a number of challenges, which include changing patterns of diseases, a shortage of health care professionals, inaccessibility of services, and insufficient resources. Given that an increasing population creates a greater demand for healthcare services, the shortage of hospital beds due to high admission rates and increased length of stay are some of the challenges that the healthcare system of Saudi Arabia is struggling to overcome. The Saudi Arabian government funds 244 hospitals that have a capacity of 33,277 beds (Almalki, Fitzgerald, & Clark, 2011). However, there was a forecast of bed capacity shows that, by 2013, the healthcare system in Saudi Arabia will require about 14,700 additional beds to meet the increasing demand for healthcare services (RNCOS, 2011). The shortage of beds implies that the healthcare system needs to formulate ways of increasing hospital bed capacity. The problem being investigated is the Saudi Arabian hospital bed shortage due to increased length of stay in hospitals by patients with chronic illnesses, the elderly, and the disabled. The purposes of the proposed study are to describe the post-acute care needs and also the need for effective discharge planning.
Born, raised, lived, and practiced as a physician in Iran, I would like to write about Iranian culture regarding truth telling and medical ethics.
Autonomy applies to the profession of nursing because the patient should always be allowed to make decisions regarding their care while being treated with respect and dignity; however, autonomy can serve as a limiting agent when the patient decides to refuse care that would be of benefit to them. Autonomy is a sensitive issue because it allows the patient to choose to die and all health care can do from that point is allow the patient to do so comfortably. With healthcare always being one step ahead, it allows a surrogate to serve as a voice piece for that patient when they are unable to make decisions. However, that surrogate can end up making decisions they think is best for the patient ignoring the patients’ will. The responsibility of the nurse and interdisciplinary team is to inform and educate the patient and patient’s surrogate on all aspects of care to include medical diagnosis, treatment, and care plan so that the patient and
Lying in medicine seems to be a requirement for doctors because they think that truthful information can hurt patients (Bok 222). According to doctors, while they are telling the truth, patients may have a heart attack or their psychological mechanism might be alleged. Furthermore, death comes more quickly. However, these are so rare and considering these universal is an overgeneralization. In addition, doctors consider their patient as a child and see them like a blind, suffering and passive toy (M.Smith and M.Weil 22); hence, doctors think that they can make choices for their patients without telling the truth to patients. However, this opinion just shows doctors’ paternalistic view (Bok 227).