Introduction
The case study involves Ralph Bradley, a 90 year old man whose wife died recently. Based on the Casuistic model of ethics, the medical indications include: Bradley’s diagnosis of colon cancer and metastasis of the lymph nodes, his referral to nursing home care and the prognosis of a terminal illness with eventual death. The patient’s preferences are affected by his emotional instability hence he is incompetent to make any decisions regarding treatments. Bradley’s surrogates are his daughters. With regards to quality of life, Bradley’s condition is terminal hence there is no possibility of return to normal life. Thus, the care he receives is palliative in nature rather than curative. The goal of palliative care is to enhance the quality of life of the patient as he awaits the inevitable death. Other variables relevant to the case include family issues. The patient/daughters recently lost their wife/mother and are therefore still affected by the loss. The decisions the daughters make are based on this loss in that they do not want their father to know the truth because they believe it would adversely affect his failing health. In addition, there is a conflict between the belief of the physician and the belief of the nurse. While the physician supports the patient’s family’s decisions, the nurse is against them and believes that they would negatively affect the nursing care provided to the patient.
Ethical Issues Identified in the Case
Autonomy
Potter and Perry (2010) argue that “the principle of autonomy is based on the assertion that individuals have the right to determine their own actions and the freedom to make their own decisions” (p. 119). Respect for the individual is the keystone of this principle. Autonomous decisions are based on: individuals’ values, adequate information, freedom from coercion and reason and deliberation. Examples of autonomy in healthcare include: refusing treatment, giving consent for treatment or procedures, and obtaining information regarding results of tests and treatment options (Clark & Taxis, 2003). The lack of autonomy is well illustrated in the above scenario. To begin with, the patient is not aware of the seriousness of his condition because his physician and his family have refused to inform him about it. As a result, he is not in a position to make any decision regarding his health and medical needs or his normal life. The kind of treatment he receives is pushed down his throat by his physician. Moreover, the results of the tests he underwent were not revealed to him thus he lacks adequate information about his condition.
Beneficence
Beneficence is commonly defined as the doing of good and is often thought to be the most critical ethical principle in health care (Davis, Fowler & Aroskar, 2010). Fundamentally, the principle requires one to always consider his actions in the context of enhancing the welfare of the patient. This however becomes a challenge when what is generally considered to be good for the patient also brings harm to the patient or conflicts with the patient’s desire. Beneficence is well illustrated in the above case. By withholding the information from Bradley about his condition, the physician and the patient’s family are protecting him from further emotional distress and possible significant deterioration of his health. This is done by taking into consideration Bradley’s recent loss of his wife which had a significant effect on him. Although this action can be considered to enhance the welfare of the patient, it conflicts sharply with the ethical principle of autonomy discussed above. While withholding information from the patient does him good, it also denies him the autonomy he needs to make his won decisions regarding his health.
Veracity
Veracity is defined as “telling the truth,” (Chitty & Black, 2007, p. 120). Telling the truth has usually been regarded as a basic necessity in human relations. Ingrained in the healthcare provider-patient relationships is the assumption that the healthcare providers will be honest with their patients. However, in some cases healthcare practitioners particularly nurses are limited by an organizational system that limits them on what they can tell the patient. In such cases, the healthcare providers engage in involuntary withholding of the truth. Voluntary deception is however considered to be immoral. Persons in need of health care may also not be totally honest when giving their health information. Likewise, healthcare professionals may not be honest when responding to patients’ inquiries for information related to their treatment or prognosis. Reasons for such dishonesty include the notion that patients would be better off not knowing certain information or that they are not capable of understanding the information (Davis et al., 2010). In the above scenario, veracity is the most evident ethical principle. Veracity is lacking in the scenario because the patient’s physician and family have agreed not to tell him the truth about his health condition. However, the main reason for this is that telling Bradley the truth would further jeopardize his health condition because of his recent loss of his wife. Thus, Bradley is better off not knowing the truth about his health condition.
Informed Consent
This principle requires all patients to be granted the chance to give informed consent before any treatment is given except when there is a life-threatening emergency (Chitty & Black, 2007). The consent must be voluntary, must be given by an individual with the capacity and competence to understand, and should be based on adequate information. There is clearly a lack of informed consent in the scenario. This is because the patient is not adequately informed about his condition which in turn denies him the right to accept or reject the treatments or care he is receiving. However, the case gives rise to the issue of competence on the part of the patient. Due to his emotional instability, it can be argued that Bradley is not competent enough to give any informed consent and hence any decisions regarding his treatment and care should be made by his physician as long as it serves the patient’s best interest.
Actions I would take if I were the Nurse
If I were the nurse, I would agree not to disclose any information regarding the patients’ health condition to him. This is because by doing so I would only add to his emotional distress which in turn would further deteriorate his health condition. In addition, this decision would be based on the wishes of the patient’s family, specifically his daughters who have to take care of their dying father and are still not yet over their mother’s death. I would thus respect the wishes of Bradley’s family knowing that this would do more good than harm not only on the patient but also on his family.
Conclusion
Healthcare practitioners are often faced with similar situations like the Bradley’s case in which they are forced to violate some ethical principles in favor of others. However, in every decision made, the healthcare practitioners should have the best interests of the patient at heart. In addition to this, they must evaluate the overall good versus the overall harm. The decision of the nurse has been reached through the utilitarianism theory of ethics. This theory states that any action taken must lead to the greatest good for the majority. In the scenario, withholding of information from the patient would achieve thus because it would not only benefit him but also his daughters.
Reference List
Chitty, K., & Black, B. (2007). Professional nursing: concepts & challenges. Philadelphia: Elsevier.
Clark, A., & Taxis, J. (2003). Developing ethical competence in nursing personnel. Clinical Nurse Specialist, 17, 236–237.
Davis, A., Fowler, M., & Aroskar, M. (2010). Ethical dilemmas & nursing practice. Cambridge: Pearson.
Potter, P., & Perry, A. (2010). Fundamentals of Nursing. Philadelphia: Elsevier.