Knowledge Of Information Essay, Research Paper

Knowledge of Information

DESCRIPTION OF THE CASE:

Ralph is a recent widower in his midi-60’s, who was diagnosed with

metatastasized colon cancer. He is a home health agency patient, and his primary

caregivers are his two daughters. Ralph is unaware of the severity of his

condition and wanted to know what his state of health and prognosis were. The

nurse evaded his questions initially, and his daughters did not want to tell him

that his cancer was terminal. The nurse’s position was not to continue providing

care for Ralph, as she would be deceiving him by not telling him the truth.

When the nurse consulted with Ralph’s physician, he agreed with the family’s

decision, as he felt that they needed time to accept their mother’s recent death

and Ralph’s impending death. The doctor ordered the nurse not to oppose him and

not to disclose any further infomation to Ralph.

THE PRINCIPLE: TRUTH-TELLING & DECEPTION (Should be “FIDELITY”)

In most cases, a rational person has a right to truthful information and

avoidance of deception, which will allow him to decide which course of treatment

to follow. A patient’s right to decide includes the right to know the truth, not

be brainwashed, and not be lied to or deceived by having information withheld

that is relevant to his own health. There is a moral standard that condemns lies,

deception and withholding of relevant information. To tell Ralph that

“everything was all right and he would be up and around the house in no time at

all” is deceptive, as his condition is terminal, although he does not yet

realize it.

The ANA Standards of Clinical Nursing Practice states that clients should be

educated about ther illness, which is subsumed within Standards of Care (p3).

In Standard V-Ethics (p15), measurement criteria #3 states that “the nurse acts

as a client advocate” and #5 states the “nurse delivers care in a manner that

preserves and protects client autonomy, dignity and rights”.

The “Patient’s Bill of Rights” cites somes cases that justify overriding a

patient’s autonomy rights, however. Considering that Ralph has recently lost

his wife and that he is still working through his own grief may present a

morally compelling reason for withholding information and considering Ralph’s

best interests. His emotional status may need to be assessed to assure that he

would not be suicidal or lose interest in the remaining quality of his life,

also to determine his ability to cope, before telling him the truth, and

prevention of harm overrides autonomy rights.

If I were involved in Ralph’s care as his nurse, I would have great difficulty

with deceiving or withhold information from him, but considering the impact of

his wife’s death, combined with the knowledge of his own inevitable demise, I

would take into consideration his emotional state first, as his advocate, and

work with his daughters in establishing a set time to inform him of his

condition, assuming that he has at least a few months to live. This will

hopefully allow the daughters more time to accept their mother’s death and their

father’s condition. We would have to agree not to lie to Ralph outright, but

to encourage him to participate in his own care as much as possible, as well as

perform his own ADL’s as tolerated. By so doing, Ralph would be able to

maintain his dignity, his daughters would be placated, and a lawsuit hopefully

avoided.

References:

American Nurses Assoc (1991). Standards of clinical nursing practice. american

Nurses Publishing. Washington, DC.

Bandman, E. & Bandman, B. (1995). Nursing ethics through the life span.

appleton & Lange. Norwalk, CT.