Ethical decision-making in the nursing practice is an integral part of all of their activities every day. Ethics permeates the nursing profession, affecting virtually every action, as this vocation itself is primarily guided by the concept of not harming in any way. Taking into account not only the desires but also the needs of the patient is at the heart of this profession. At the same time, the nurse should be aware that sometimes the desires and personal needs of the patient can come into conflict with what seems to be essential for saving the patient’s life. Of course, it may seem that such situations cannot arise since the patient should be maximally interested in preserving their own life. However, it is possible to imagine cases of a specific nature in which the nurse finds themselves in a quandary regarding the patient’s perceived well-being.
One example of conflict situations where logical thinking is required over-emotional reactions is the opposition of sincerity and information retention. Due to humanistic considerations or personal beliefs about honesty and duty, healthcare providers may face a dilemma regarding patient information. One can imagine a situation where information about the tragic state of health of a patient can potentially cause him psychological damage. As is widely known, psycho-emotional damage, especially in the case of the patient’s already poor health or his tendency to nervous experiences, can cause a physical reaction.
For these and many other situations, the first guidelines for ethical decision-making for healthcare professionals were developed in the 1950s. With the updating of methods of collecting data, the complication of the ethical code, and the improvement of methods of storing information, these recommendations have also changed (Haddad & Geiger, 2017). Over the past decades, many different ethical programs and algorithms have been developed based on the comparison of various surveys (Park, 2012). At the moment, there are even consolidated recommendations based on several methodologies at the same time.
The situation when the question of hiding information may arise must be considered in several contexts since there can be many particulars in this problem that affect the decision-making. If the patient is in old age, this adds additional complexity to the issue of withholding diagnoses. It is difficult to imagine what kind of blow information about a serious or potentially fatal illness can inflict on an elderly patient, whose health is already extremely vulnerable. Psychosomatic damage is unpredictable, and its consequences can potentially be catastrophic for the patient’s physical health. At the same time, the patient’s lack of information about their own condition can harm no less, if not more. If the patient neglects a healthy lifestyle or the necessary medication diet, thinking that they are not sick, this can also lead to irreparable consequences. Thus, the population that is affected by this common problem and the ethical implications that it carries in itself are determined.
Many researchers and methodologists who created popular nursing guidelines in the twentieth century cite deontology as one of the main guiding principles. The term “deontology” implies an ethical attitude in which the patient and his personal needs are perceived as a kind of thing in itself, an inviolable constant (Da Silva et al., 2017). According to this rule, the doctor does not have any ethical right to interfere with the patient’s health if they do not require it or do not give clear consent to it. Thus, solving the problem, in any case, would imply the need to inform the patient about the state of health in all details. The task of the doctor would be to inform the patient as much as possible about their health while explaining this very clearly. Thus, the doctor will give the patient the full opportunity to make decisions with full awareness of the problem.
The rule of veracity has traditionally been considered to be at the heart of the nurse’s code of ethics, but it is still possible to surmise the details of the situation that could complicate this principle. In particular, if the patient is many years old, telling them about their illness may not help but only hasten the death, depriving the motivation even to live out the allotted time. One alternative approach to this problem may be to use family members to report the medical condition in order to soften the blow. Family members could find an approach to the patient’s feelings in order to explain to the patient why they are still needed in this world and why it is necessary to continue to fight. If someone raises doubts about the success of this program, it can be argued that the ethical responsibility for withholding or disseminating this information lies with the family. It is the relatives who should know better how to dispose of this information in such a way as to cause less damage than an emotionally uninvolved medical worker could do.
Thus, guided by the information provided in the methodological strategies, a coherent plan can be developed to identify and eliminate an ethical problem in medical practice. There is an opportunity not only to collect and distribute all the necessary information but also to consider alternative methods to solve the problem. In this case, an indirect and original method of solving the problem, that is, involving family members, is more effective than the one dictated by the direct logic of the doctor.
Da Silva, T.N, Freire, M. E. M., De Vasconcelos, M. F., Da Silva Junior, S. V., Da Silva Araujo, P., Assis Eloy, A. V. (2017). Deontological aspects of the nursing profession: understanding the code of ethics. Revista Brasiliera de Enfermagem. 71(1). Web.
Haddad, L. M., & Geiger, R. A. (2020). Nursing ethical considerations. StatPearls. Web.
Park, E.-J. (2012). An integrated ethical decision-making model for nurses. Nursing Ethics 19(1), 139-159. Web.