Introduction
In the medical sector, advanced practice nurses (APNs) are required to use moral compasses that do not lead to violation of ethical, legal, or moral guidelines relating to cases they handle daily. In the case scenario of whether they should withhold the information from the patient or tell them, APNs are expected to consult the American Nurses Association (ANA) Code of Ethics for Nurses and legal provisions. Nursing practitioners (NP) can make rightful decisions by reviewing the nurse ethical codes and the laws that guide nursing practice.
Case Scenario
James Wesley, an 80-year-old, walked into our department with his daughter for a medical check-up. Wesley lives with his daughter at home, who is also a nurse. Wesley’s daughter explains that he has angina, and he also experiences difficulty in walking and maintaining balance, which may be due to his old age. Moreover, the daughter said that his father was suffering from depression and recently, he started experiencing increased shortness of breathing (SOB).
Wesley affirms that he has a smoking history, which dates back to 61 years. Having this in mind, as an NP, I instructed the radiologist to perform a computed tomography (CT) scan of his chest. The results read by the radiologist revealed that it was most likely a cancerous nodule. Acting in the capacity of a NP, I had to share the results with Wesley through his daughter. After sharing the information with Wesley’s daughter, she barred me from informing her father. She advised that her father was fragile and might be shocked by the diagnostic information.
The Ethical Dilemma
Deciding whether to tell Wesley the truth about the results or withhold it as requested by his daughter is regarded as an ethical dilemma. I am required to review and weigh with more consideration between the daughter’s concern and giving the patient his diagnosis as much as it is required that medics uphold the patient’s autonomy (Qin, 2019), it is not an easy decision to make since I should also not be responsible for any harm to my patient. I am therefore required to make an ethical decision and offer good care to my patient. Withholding the information takes away the patient’s rights and the ability of a patient to make an informed decision which is against the eight Amendment and may result in a civil legal case (Grace & Uveges, 2022). Therefore, deciding on this scenario requires much consideration of the ANA codes of conduct and ethical principles.
Ethical Principles and Principles
ANA believes that protecting confidentiality and privacy through sharing information is essential for maintaining trusted relationships between patients and NPs. Under the ANA code (principle 4), a patient has a right to access personal health information, alongside getting an opportunity to supplement logical reasoning to arrive at informed healthcare decisions (Ceylan & Cetinkaya, 2019). This principle resonates with the US’s law regarding health information privacy, security, and confidentiality.
The US law also includes provisions that regulate the conduct of NPs when handling patient information. NPS is expected to “Health Insurance Portability and Accountability Act” (HIPAA) privacy rule, which binds them to allow patients access to their health information (Qin, 2019). This law obligates NPs to avoid disclosing information about healthcare operations, treatment, or payment to a third party without the patient consent. According to HIPAA rule 5 CFR §§ 164.400-414, patients are required to report health information breaches for prosecution (Tovino, 2022). When dealing with malignancy diagnosis, NPs are advised to play safe by protecting patients from the reach of information with the potential to invoke emotions such as sadness, shock, and fright, which might result in loss of hope in the treatment process.
As observed by Hauk et al. (2021), responding to these emotions is vital when passing unsettling information that would probably impact a patient’s trust in NP, while adjusting to illness and treatment. Adhering to confidentiality and privacy principle and law caused ethical controversy since protecting a patient from getting shocked as a result of malignancy diagnostic information is as good as adhering to their right to access it.
Moral Considerations
In every decision made concerning a patient’s condition, healthcare practitioners are guided not to lie to the patient. This is not adhered to in the current case and such decision-making can lead to moral distress, as suggested by Fourie (2017), since it is morally challenging. Deciding on this case scenario would require integrity and prevention of any legal or ethical violation of the codes of conduct. That explains how challenging it is to handle this case at hand.
The Decision-Making Process
As NP, I may not honor the daughter’s request to withhold the findings due to legal and ethical reasons. In this case, it is advisable to use good modeled steps for moral problem-solving as provided by Tulchinsky (2018). These are listed are recommendations that will resolve an APN’s moral distress in the above-stated dilemma. First, an APN should rely on personal judgment for moral decisions and use it wisely in Wesley’s case without being compromised by his daughter. Secondly, an APN should review legal and ethical thoroughly before deciding on actions to take. Lastly, an APN should evaluate the potential outcome of sharing information about malignancy diagnosis with the patient, which includes anticipated reactions and emotions. This will help the patient strike an emotional balance during the diagnosis, treatment, and healing processes.
Conclusion
In summary, all healthcare professionals have dealt with an ethical dilemma. Nurses and other medical practitioners should consider the ANA code of ethics stating that information withheld from a patient is a violation of the right to self-determination. The practitioner therefore should be responsible to protect themselves from violating the code of ethics and also avoid any harm to their patients. James Wesley has the right to know the truth about his health condition. The daughter’s concern should be validated and made of the moral implications that may arise from her request.
References
Ceylan, S. S., & Çetinkaya, B. (2019). Attitudes towards gossip and patient privacy among paediatric nurses. Nursing Ethics, 27(1), 289-300. Web.
Fourie, C. (2017). Who is experiencing what kind of moral distress? Distinctions for moving from a narrow to a broad definition of moral distress. AMA Journal of Ethics, 19(6), 578–584. Web.
Grace, P. J., & Uveges, M. K. (2022). Nursing ethics and professional responsibility in advanced practice. Jones & Bartlett Learning.
Hauk, H., Bernhard, J., McConnell, M., & Wohlfarth, B. (2021). Breaking bad news to cancer patients in times of COVID-19. Supportive care in cancer, 29(8), 4195-4198. Web.
Qin, F. (2019). The Debilitating Scope of Care Coordination Under HIPAA. NCL Rev., 98, 1395. Web.
Tovino, S. A. (2022). Health privacy, security, and information management. Laws of Medicine, 223-238. Web.
Tulchinsky, T. H. (2018). Ethical issues in public health. Case Studies in Public Health, 277. Web.