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Withholding Information Dilemma in Healthcare

The dilemma of withholding information has caused several heated debates in healthcare studies. Many people would consider concealing information from the patient a serious offence which can cause serious harm. Moreover, withholding information can be regarded as undermining of patient’s independence and later can place mistrust in doctors which is crucial for the success of treatment. Furthermore, patients also require integrity because they feel especially vulnerable in their condition. They want their doctors to be honest about the health status of patients. However, some situations present great difficulty for the doctor to be sincere. According to Green et al. (2015), “keeping secrets and withholding information creates internal conflict in the nurses as they balance the principle of confidentiality with the right to know information” (p. 485). That is why an efficient, ethical code for nurses must offer guidance on dealing with ethical problems that occur during the process of treatment. The aim of this paper is to present a case of an ethical decision-making dilemma, where a code violation can be conducted. Moreover, a decision and recommendations will be listed in this paper.

For example, a patient who has suffered from opioid addiction has some sort of physical injury that requires surgery. After the surgery is performed, the physician does not prescribe any pain-relieving medication. Instead, he orders acetaminophen, hoping that the patient will get a placebo effect. His concerns are understandable as the doctor does not want to fuel the addiction. Nevertheless, a patient suffers from agonizing pain; the acetaminophen has no effect on him. He wants to know what a nurse is giving him and why it does not work.

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In this case, a nurse faces a complicated situation that requires a prompt solution. It cannot be done without considering ethical code and possible legal consequences. The immediate issue that occurs in this dilemma is if a nurse should conceal the truth from the patient. Moreover, along with the physician, a nurse should consider if this is an appropriate use of placebo since a patient suffers immensely. The issue of patient’s independence arises too since the autonomy in managing his own pain is stripped of him. If a patient or his family finds out about it, the doctor may face legal repercussions such as a claim for negligence and breach of contract. Such violation is not likely to constitute a criminal act since the medical staff’s actions does not lead to the death of a patient.

Nevertheless, it can be enough to constitute a civil act. In order to prevent this from happening, the code of ethics (2015) provides guidance on such questions. First of all, Provision 1 explains that “the nurse practices with compassion and respect for the inherent dignity, worth and unique features of each patient” (Bell, 2015, p. 1). Concealing the truth from the patient while he suffers from excruciating pain and depriving him of his right to plan his own care violate all these goals. Moreover, as Provision 5.4 indicates that by deceiving patients the integrity of patients is threatened (Bell, 2015, p. 20). This case, however, is controversial since a physician ordered to withhold information because he hoped for a placebo effect. Besides, there is a serious concern regarding the opioid addiction of a patient. While such medication can help to deal with pain, in the long run, it could lead to a relapse of addiction.

As for recommendations for resolving moral distress, it should be pointed out that this dilemma cannot be solved by a nurse alone. The reason for this is the fact that a nurse is only allowed to give medication to patients, not prescribe it. It is evident that the process of solving this dilemma should involve a physician since he has the authority to change the prescription. In their research, Epstein and Turner (2015) suggest informing the patient that “the physician has prescribed saline in the hopes that he would have a placebo effect” (p. 3). This would mitigate the concern about the threat of deception to patient’s integrity that is described in Provision 5.4. However, this decision will undoubtedly damage a patient’s trust in the medical staff. Moreover, it may undermine the relationship between the nurse and the doctor. Nevertheless, as it was mentioned earlier, the ethical code recommends being honest with patients.

Another method of solving the issue is to engage in a conversation with a physician. A nurse should indicate her concerns about the condition of a patient and try to convince the physician that the placebo effect is not possible in this case. This conversation can provide a positive outcome not only for a patient but for the relationship between the physician and a nurse as well. Together they can figure out more a more proper treatment plan. However, if the physician refuses to collaborate and insists on using the acetaminophen, a nurse should report the matter to the authorities. In such circumstances, the physician would be forced to work out a different treatment plan or pass this patient to another doctor.

In conclusion, it would appear that despite the duality of the situation, honesty and following ethical code would seem like an appropriate answer to the issue. All in all, integrity plays a significant role in the medical and nursing profession. Nonetheless, it is also crucial to balance honesty with hope so the patient’s mental condition is not harmed, and his trust in medicine is not lost.

References

Bell, L. (2015). Code of ethics for nurses with interpretive statements. American Nurses Association. Web.

Epstein, B., & Turner, M. (2015). The nursing code of ethics: Its value, its history. OJIN: The Online Journal of Issues in Nursing20(2), 1-10.

Green, J., Darbyshire, P., Adams, A., & Jackson, D. (2015). A burden of knowledge: A qualitative study of experiences of neonatal intensive care nurses’ concerns when keeping information from parents. Journal of Child Health Care19(4), 485-494.