Introduction
Patients have certain rights that medical staff must respect and protect. As a result, specialists are responsible for studying and understanding these rights and explaining them to patients. Moreover, patient treatment must comply with ethical principles to meet standards of high-quality services. However, in some cases, the situation can be ambiguous, and the decisions of patients and their families may contradict moral principles, creating ethical dilemmas.
The current paper assesses the potential dilemma of honesty versus withholding information that Psychiatric Mental Health Nurse Practitioners (PMHNPs) may face. Despite the complexity of ethically contradictory situations, critical evaluation and adherence to accepted standards and regulations can help a specialist make informed decisions.
Dilemma
PMHNPs are competent to provide necessary mental health care to patients with various disorders such as depression, substance use disorders, bipolar disorder, or other issues. In a potential scenario of an ethical dilemma, a young man, 19 years old, was diagnosed with schizophrenia. This disorder is characterized by a misinterpretation of reality, often accompanied by hallucinations; it disrupts the usual lifestyle and requires lifelong treatment (Toto et al., 2019). The patient’s family insists on partially revealing the truth about the diagnosis to the young man. As a result, there is a dilemma of honesty and withholding information.
The patient’s family presents some arguments in support of their request not to disclose all the information. Relatives are uncertain about whether to report the diagnosis to the patient, as they are afraid of accompanying stigmatization and unsure of the client’s reaction. They also fear that the lifelong need for medication significantly demoralizes the young man, making him feel helpless. However, patients have a right to complete information about their condition (Westrick, 2014).
Moreover, individuals must be carefully aware of their treatment plan (Kreps, 2018). In the case of a specialist’s lie, trust becomes impossible. Without reliable information about his condition, the patient may receive information from other sources, but its quality may be doubtful. Consequently, PMHNPs must decide how to approach the patient and their family.
Codes Application
Nurses must protect the interests of their patients and adhere to the ethical standards of practice. According to the American Nurses Association (ANA) Code of Ethics for Nurses, Provision 1.4, patients should receive complete and accurate information to make informed decisions based on all available information. Moreover, according to Provision 5, nurses are required to maintain integrity in their practice (ANA, 2015). This quality requires compliance with the nurse’s personal and professional values (Fowler, 2015).
Therefore, acting in the patient’s interests and providing complete information is necessary. Moreover, concealment of details about the condition is seen as a threat to nurses’ integrity (ANA, 2015). As a result, in the scenario under consideration, the PMHNP cannot fulfill the patient’s family’s request.
Principles and Laws
Moral principles should guide medical staff during decision-making in ambiguous conditions. There is a risk of violating these principles in a scenario of honesty versus withholding information. In particular, truth-telling and providing details about the disorder are closely related to patient autonomy. This principle assumes that people have the right to make decisions independently and have a choice (Varkey, 2021).
For decisions to be conscious, the patient must have complete information. Moreover, such a situation can also threaten freedom and fidelity. Freedom implies that the patient will be able to influence the treatment plan, and fidelity refers to the expectation that the nurse will be honest and trustworthy (Westrick, 2014). As a result, hiding information only at the family’s request violates the moral principles of medical practice.
Medical practice is also governed by laws established in the public interest. For example, patient rights are protected by the Patient Self-Determination Act (PSDA); patients are entitled to have more control over decisions related to their health following this law. The law is relevant to all providers that receive Medicaid funding. The Centers for Medicare and Medicaid Services are attentive to patients’ rights and can impose civil monetary penalties on violators (Westrick, 2014). Thus, hiding information from the patient can lead to a violation of the law.
Recommendations
The complexity of treatment and severity of diagnosis can demoralize the patient, and family participation is often vital for improving the condition. For this reason, the family’s request to withhold information creates a dilemma and can cause moral distress for the PMHNP. If the patient, based on the information received, is unlikely to harm himself or others, the best solution to the situation under consideration will be to fully inform them about the diagnosis, its characteristics, and treatment. To solve the ambiguity of the problem and potential moral distress, the practitioner can consider several recommendations:
- The specialist can inform the patient’s family that withholding information from the patient may harm their treatment decision, which is unethical and does not comply with established moral principles (Varkey, 2021).
- The PMHNP should also report that if the patient is authorized to make decisions, they have a right to receive complete information, and withholding it is a violation (Westrick, 2014).
- A nurse can provide evidence from studies demonstrating that full patient awareness is necessary for effective treatment (Kreps, 2018).
Conclusion
Thus, medical staff may face various ethical dilemmas in their practice. They need to consider existing laws and ethical codes to resolve controversial issues. In the hypothetical scenario, the dilemma of honesty versus withholding information arose. However, accepted regulations and moral principles advise disclosing all relevant information to the patient about their condition, provided there is no risk of harm. Moreover, understanding the features of the disorder and the necessary treatment measures is required to improve the individual’s condition.
References
American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. Silver Spring.
Fowler, M. (2015). Guide to the code of ethics for nurses with interpretive statements: Development, interpretation, and application (2nd ed.). Silver Spring.
Kreps, G. L. (2018). Promoting patient comprehension of relevant health information. Israel Journal of Health Policy Research, 7(1), 1-3. Web.
Toto, S., Grohmann, R., Bleich, S., Frieling, H., Maier, H. B., Greil, W., Cordes, J., Schmidt-Kraepelin, C., Kasper, S., Stübner, S., Degner, D., Druschky, K., Zindler, T., & Neyazi, A. (2019). Psychopharmacological treatment of schizophrenia over time in 30,908 inpatients: Data from the AMSP study. International Journal of Neuropsychopharmacology, 22(9), 560-573. Web.
Varkey, B. (2021). Principles of clinical ethics and their application to practice. Medical Principles and Practice, 30(1), 17-28. Web.
Westrick, S. J. (2014). Essentials of nursing law and ethics (2nd ed.). Jones & Bartlett Learning.