Case and Topic Introduction
A nurse in Brisbane, QLD, Australia, faced an ethical dilemma (Jie, 2015). She had to choose whether to hide the information, which she had received from a cancer patient and which was relevant to the treatment, from other nurses and doctors or to reveal it despite the patient’s expressed will to keep a secret.
Mr. Green was diagnosed with prostate cancer when he was 50 years old. He decided to refuse any conventional medical or surgical treatment. After seven years, Mr. Green’s state worsened dramatically. According to Jie (2015), cancer “metastasized to his bones, it had spread locally to his lymph nodes and the primary tumor was invading the bladder and partially obstructing the left kidney” (p. 408). For a few times, Mr. Green came to a hospital for different reasons, where the medical staff examined him to check the development of his disease. One of the tests showed that Mr. Green had 6—12 months left to live. After another test, two months later, doctors predicted that Mr. Green had only 4—6 weeks left to live. He was now diagnosed with the end stage aggressive cancer.
Such diagnosis meant that it was no longer possible to treat the tumor medically or surgically. The only service that doctors could provide to Mr. Green at this point was palliative care. After being revealed the prognosis, in a conversation with one of the nurses, Mr. Green confessed that he was planning to commit suicide. He stressed that it was a secret and asked the nurse to keep it to herself.
The ethical dilemma in this case is whether the nurse should have revealed Mr. Green’s suicidal plans or kept it a secret as the patient had asked her to do.
Problem Statement and “Road Map”
The case of Mr. Green poses an ethical dilemma to the nurse who he confided in. An ethical dilemma is defined as a situation that requires making a decision while possible options are mutually exclusive and each can be considered ethical on the one hand and unethical on the other hand (McLennon, Uhrich, Lasiter, Chamness, & Helft, 2013). Ethical decision-making constantly poses dilemmas. There are no universal rules for solving ethical dilemmas. Each case should be thoroughly considered to come up with an optimal or least harmful solution. In the presented case, on the one hand, the nurse had to respect the patient’s autonomy by keeping the secret he had shared. On the other hand, she possessed the information that could help the treatment process and thought that it was her duty to share it with other nurses and doctors. In this paper, I will argue that the most ethical decision for the nurse was to share Mr. Green’s secret with the medical team, despite violating his autonomy, because of the principles of non-maleficence, beneficence, and truth telling even against the patient’s wishes.
Argument
Solving an ethical dilemma is always associated with scrutinizing a particular case and examining the consequences of each possible decision (McLennon et al., 2013). Nowadays, ethics is regarded as an approach rather than a set of rules. Instead of rules, there are principles. These principles, however, may contradict in a given situation. The case of Mr. Green demonstrates such contradiction. The nurse’s choice was whether to keep Mr. Green’s secret or to reveal it to other health care providers. My argument is that, from the point of view of ethics, the nurse’s obligation was to reveal the secret in order to avoid inflicting harm, do good for Mr. Green, and comply with the principle of telling the truth to the patient.
First of all, concealing Mr. Green’s suicidal plans would jeopardize his life. By hiding this information from doctors, the nurse would have run the risk that Mr. Green could have harmed himself or possibly even killed himself without receiving necessary psychological help from the medical team. There is no certainty that Mr. Green indeed would have committed suicide. But the nurse’s duty was to prevent even the possibility of a suicide attempt. This duty is based on the principle of non-maleficence, which is preventing any action that can harm a patient. According to Catholic health care principles, suicide is “never [a] morally acceptable option” (Ethical and Religious Directives, 2009, p. 29).
The nurse had to reveal the secret in order to prevent suicide, even though such an action would have involved violating the principle of confidentiality. Since this is a case of preventable suicide, the nurse’s inactivity would have been equal to assisted suicide, which “Catholic health care institutions may never condone or participate in…in any way” (Ethical and Religious Directives, 2009, p. 32). It is also important that using the “ethical principle ‘do no harm’ to override a patient’s autonomous choice” (Fowler, 2008, p. 17) requires understanding that the ultimately pursued goal is the patient’s good.
The second basic ethical principle to be considered in the case is beneficence. Along with non-maleficence, it is one of the four pillars of medical ethics (Fowler, 2008). The meaning of the principle is that any action taken in the process of treating a patient should do good for the patient. In case of terminal diseases, like Mr. Green’s, “[o]ne of the primary purposes of medicine…is the relief of pain and the suffering caused by it [dying]” (Ethical and Religious Directives, 2009, p. 29). Mr. Green’s suicidal thoughts are part of the suffering caused by his grave disease. A way to relief this suffering is to provide him with psychological help and health care staff’s attention that would support him in his difficult time and make him feel better. But, for this to happen, the medical staff needs to be aware of the patient’s intention to kill himself. In order to do this good to the patient, the nurse whom he had confided in had to reveal his secret.
Finally, the ethical principle of telling the truth is also involved in the given ethical dilemma. In medicine, truth telling means more than avoiding lying to a patient. It is a much more comprehensive concept that includes establishing trust between a patient and health care providers by being truthful about the patient’s disease, its causes, development, and possible consequences (Fowler, 2008). However, the principle does not only apply to relationships between patients and nurses (doctors), but also to communications inside the medical team. The medical staff members should be truthful to each other to ensure that the treatment is optimal and not obstructed by misunderstanding, vagueness, or hidden information. In Mr. Green’s case, a piece of information could improve treatment and prevent harm, if revealed to the health care providers, so the nurse’s obligation was to be truthful about it. If the nurse had been asked whether Mr. Green had been planning to commit suicide and she had said no, although she knew otherwise, that would have been a clear violation of the principle of truth telling. But the principle does not only apply to such situation. It also implies that a nurse generally should not hide from other medical team members what he or she knows about a patient’s state and finds relevant to the treatment.
I believe that the decision to reveal Mr. Green’s secret was ethical and better than other decisions because it followed the principle of telling the truth and was aimed at preventing harm to the patient.
References
Burkhardt, M. A., & Nathaniel, A. (2013). Ethics and issues in contemporary nursing. Boston, MA: Cengage Learning.
Ethical and Religious Directives for Catholic Health Care Services. (2009). Web.
Fowler, M. (2008). Guide to the code of ethics for nurses: Interpretation and application. Silver Spring, MD: American Nurses Association.
Jie, L. (2015). The patient suicide attempt—An ethical dilemma case study. International Journal of Nursing Sciences, 2(4), 408-413.
McLennon, S. M., Uhrich, M., Lasiter, S., Chamness, A. R., & Helft, P. R. (2013). Oncology nurses’ narratives about ethical dilemmas and prognosis-related communication in advanced cancer patients. Cancer Nursing, 36(2), 114-121.