Truth Telling : Is It Ever Acceptable?

With the development of the nurses understanding, the nurse will be able to clearly communication across relevant information. This will promote patient participation (Tobiano, Marshall, Bucknall, & Chaboyer, 2016) and empower the patients voice by actively involving them in the decision-making process. Per the Health and Disability Act (1994, as cited in Medical Council of New Zealand, n.d) patients should have their treatment explained to them, including the benefits, risks, alternatives and costs; as well as having the option to change their mind at any time. This all contributes to the development of a partnership and ensures that the patient will cooperate with tasks at hand. However, the lack of communication with the patient regarding their treatment can cause severe anxiety and ultimately a breakdown in the trust between the patient and the nurse. The successful implementation of this in practice can be seen in an observational study conducted by Tobiano et al. (2016).

Healthcare professionals have an ethical obligation to respect patient’s wishes. Consequently, many legal and ethical dilemmas arise in healthcare in response to clinical decisions related to the needs, beliefs, and preferences of patients and families. Other dilemmas result over concerns about the integrity, competence, or actions of other healthcare professionals. Preserving human dignity, relieving suffering, equality, integrity, and accountability are essential nursing values (Kangasniemi, Pakkanen, & Korhonen, 2015). Nurse leaders have an

Sule stated that, “The Patient Bill of Right adopted by American Hospitals Association states that ‘a patient possesses the right to be informed of the medical consequences of his or her actions and decisions and refuse treatment to the extent permitted by the law’. However, this is true only if the patient is in position to understand the consequences of his treatment. Incompetent, senile patients neither have the correct judgment regarding which treatment is appropriate for them, nor are they in a state of understanding the implications of their treatment. In such case, their willingness to grant or deny consent cannot dictate the course of treatment.” Problem with the Act is being able to find that the patient component enough to make such a call. Another issue that Sule stated was on confidentiality and autonomy. According to Sule, “This is another ethical issue erupting from the conflict of patient's rights and professional ethics in nursing job and profession. The Patient Bill of Right makes it mandatory for the medical practitioners to reveal the form and extent of the ailment along with the course of treatment to be undertaken by the practitioners. However, this law of autonomy clashes with the nursing ethic that the professional should maintain high degree of confidentiality regarding the patient's health and treatment.” This can cause conflicting issues in the NP’s

Another issue with the implementation of Informed consent arises when the patient waives the right to Informed consent and leaves the right to make the decision on the physician. Though legally correct, this can cause psychological stress for the physician especially when the decision is about a life threatening medical condition. Moreover, this also makes the patient vulnerable to abuse. (Manthous, DeGirolamo, 2003)

Currently, most people generally accept a doctor’s word as truth and do not question him or her. When it comes to the medical field, patients can often feel overwhelmed by all the confusing medical terms being thrown at them, so they tend to sit back and do as the doctor says. Healthcare professionals sometimes take advantage of this fact and withhold important information from their patients. For instance, a study conducted by Lisa Lezzoni, MD, and her peers states that more than half of physicians lied to their patients about their diagnosis to put a more positive spin on it (Lezzoni, Rao, DesRoches, Vogeli, and Campbell). Healthcare professionals should disclose to the patient any information pertaining to the patient.

Nurses are always the front line care giver of patients. A review of literature of nursing ethics about informed consent has been performed. It strongly demonstrates the importance of informed consent and that nurses are the key players for the advocacy role to protect the patient’s right.

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.

Patient confidentiality is a fundamental practice in healthcare and it is integral part of healthcare ethical standards (Purtilo & Dougherty, 2010). According to the American Nurses Association (ANA) code of ethics “the nurse has a duty to maintain confidentiality of all patient information” (Nursing world, p.6). Also, when a patient confidentiality is violated the nurse may risk their safety and welfare. There are a few exceptions to this obligation such as: an increase need to protect the patient and other parties or mandatory laws that protect public health (Nursing world,

Bok argues that being lied to will result in angry and disappointed patients, although they usually do not want the bad news, and the majority of patients do not want to face serious illness or death. If a patient knows the medical team is lying to them, they will lose trust in the process and the medical team. While it is true that people do not want to face their death, they would rather plan to prepare their loved ones for this, instead of not understanding what is going on with

Nurses are subject to a plethora of legal, ethical, and professional duties which can be very challenging on a day to day basis. Some of these duties include respecting a patient 's confidentiality and autonomy, and to recognize the duty of care that is owed to all patients. As nurses our duties are always professional; however there are legal implications if these duties are breached. We also must consider when it is okay as nurses to breach these duties and therefore ethical issues arise. As nurses one of our main priorities is to advocate for our patients, without our own personal feelings on the matter taking over.

At a practice level, the importance and guidance of the Code of Conduct, Code of Ethics and NPA are demonstrated on a daily basis with regard to the issues of documentation, informed consent and open disclosure, and confidentiality. With respect to documentation, nurses must be able to document patient assessments and responses in an accurate, comprehensive and confidential manner and record all observations objectively. Informed consent and open disclosure are also major legal issues nurses face daily. It refers to the communication between the patient and health professional that results in the patient's agreement to undergo a specific procedure and requires that the patient has thoroughly understood the procedure, implications and risks prior to giving written consent.

Knowledge is seen as power, patients having knowledge gives them the power to be able to make informed health decisions (Henderson, 2003). Without any or limited knowledge, patients become vulnerable and are unable to make informed decisions about their health. The nursing culture of not sharing power with patients, causing an imbalance with the nurse having the all the power and the patient feeling powerless, with a lack of control and affecting how the nurses care for these patients. Nurses and patients need to work together to achieve the best outcome for the patient (Henderson, 2003)

Yeo (2010) point out that the possibility to retain some information from patients has been ordered for long in Australian law, as in other countries for the benefit of the patient. This has now been combined with the greater autonomy acknowledged to the patient in many jurisdictions. Although a clinical approach reveals that loyalty should guide the patient-physician relationship, there are still some situations in which information consent and truth telling may be controversial: in some circumstances, the physician should or may not tell the truth. The case at hand poses a dilemma regarding the right to know (Cherry & Jacob 2008).

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).

The problem of the study is the “mismatch between patients’ desire to be informed about errors and clinical reality.” (McLennan et al., 2014, p. 17) and this was clearly stated. However, “international research on nurses’ views regarding this issue is currently limited.” (McLennan et al., 2014, p. 17) The study was undertaken with an ideological perspective that spoke for both the patient’s perspective of deserving to be aware of the error that was made as well as the nurses’ side to ensure that they feel that it is safe to share the incident that the patient was a part of.