Ethical Dilemma Of Patient Information Sharing In Palliative Cancer Care Essay.

Importance of patient education for safe and effective care

Question:

Discuss about the Ethical dilemma in health care.

Patient education can be considered one of the prime importance when providing safe, effective and person centred care to the patients. It has to be mentioned that patient education had been central to the nursing practice philosophies, and according to the nursing practice standards providing adequate information, specially relating diagnoses, has become a crucial ethical aspect of holistic health care practice (Tariman, Doorenbos, Schepp, Singhal & Berry, 2014). However, it has to be mentioned in this context that there are many scenarios and challenges that can arise that complicates effective information sharing with the patients. For instance, in cases of palliative or critical care settings, providing authentic diagnostic information to the patients can be counterproductive to optimal health and welfare of the patients (McCarthy & Gastmans, 2015). This essay will focus on a case study that represents an ethical dilemma concerning patient information sharing in the palliative cancer care setting.

The case study selected for this assignment represents a middle-aged female patient diagnosed with gastric carcinoma had been admitted to the health care facility for the purpose of operatic reduction of stenosis, however her prognosis reveals that she is going to survive only three to six months. However, the professional ethical dilemma in the case study arises with the fact that the patient had not been informed about the diagnostic condition that she had been suffering with. The rationale that the patient family members provide was the fact that she had a phobia of the term cancer, and her family members had expressed desires of keeping the diagnostic information from the patient to save her from being traumatized and scared in the last few months of her life. Considering the morality of the family members, their decision to spare the patients of the grief, the preconceived fears, and trauma by telling her about her condition can be considered morally correct (Matsuyama, Kuhn, Molisani & Wilson-Genderson, 2013). However, in case of the nursing professional providing care to the patient, this situation represents a great professional ethical dilemma. The ethical principles of autonomy, non-maleficence and beneficence apply to this case scenario.

In order to decide the best course of action in this case the help of two core and ethical theories can be taken. The very first theory that can be associated with this case scenario is the consequentialist theory, the actions of any individual can only be considered as right or wrong when the consequence of the action is considered with the actions taken (Li et al., 2011). On a more simplified note, this theory justifies actions as right if the consequences of the said actions are right. According to this theory, the decision of the family members of the patient to not convey to her the diagnosis and possible consequences can be justified as right decision, given the fact that the consequence of the action saved the patient from the terror and grief of the cancer prognosis. On the other hand, the deontological theory states that there are some actions or decision that are inherently good regardless of the consequences that they arrive to. According to this theory, conveying the truth to the patient regardless of any consequences it may have is an essential duty of the health care professional (Chen & Schonger, 2017). It has to be mentioned in this context that NMBA codes of nursing ethics and professional conduct are based on this theory; hence, the possible course of action for the patent must also abide by this theory as well.

Case study on ethical dilemma of patient information sharing in palliative cancer care

According to the NMBA standards of professional ethics, the major ethical principles include autonomy, non-maleficence, beneficence, justice, veracity and fidelity (Nursingmidwiferyboard.gov.au., 2018). Each principle guides the health care professionals to decide their course of action while maintaining the professional ethics and integrity. The principles of autonomy, non maleficence and beneficence are related to the case study effectively. On a more elaborative note, the principle of autonomy states that the patient’s rights to self-determination should be respected at all costs. This principle dictates that the patients must be able to control the decision-making involving them and be able to have all information regarding their own health and wellbeing.

Under the ethical code of practice of autonomy it is mentioned that any health care practices only acceptable when it does not adversely affect the rights of others. It has to be mentioned that autonomy as an ethical code incorporates optimal respect for different individuals did patients on their family members and their personal space and need for empowerment. Whereas the family members of the patient had a right to protect the psychological well-being and hope of the patient, the patient on the other hand had equal rights to have the correct and authentic information about the diagnosis and the treatment fate that he she might have (Nursingmidwiferyboard.gov.au. 2018). The ethical code of autonomy is also reflected in the health law, most importantly in relation where the right of a patient's to consent to any treatment procedure before the patient is taken to the procedure is an optimal health law and along with that it is a lawful right of a patient to receive authentic information about his prognosis and his treatment. Hence, despite the patient family members plea to hide the diagnostic information about the patient, the ethical practice within health care law mandates informing the patient rightfully.

The next ethical principle that can be associated with the case study is the principle of non maleficence. This code emphasizes on not doing any harm about everything and is considered a very strong principle in terms of healthcare. This principle is based on a fundamental idea that the duty of care in any nursing professionals responsibilities is that if the nursing professional is not able to do any good at least they should not be involved in any practices that will harm the patient. When considering this article code of practice, economic and face the decision making of the nursing profession. Informing the patient about her cancer diagnosis has little chances of doing her any good but it can be potentially harmful to her psych and mental health (Nursingmidwiferyboard.gov.au. 2018).

Consequentialist and deontological theories and their application to the case study

The third and most interesting ethical practice code can be considered the beneficial which has been pegged as the chemical code of practice that motivates most of the healthcare professionals. The ethical code explains that it is very important for business and professional still remember that what is considered good or harmful information might vary vastly depending on the personal perception and preferences of the patient. Elaborating more, it can be mentioned that it relies completely on the patient and her own decisions whether any information reveal to her will be beneficial or harmful. Hence, based on the codes of Autonomy and beneficence, it can be stated that the patient had right to decide whether the information about her diagnosis is good or bad, however everything, she had the right to know the truth.

Conclusion:

On a concluding note, it has to be mentioned that the patient already had been in anxiety, unrest due to not understanding what was being kept from her, and why she was not being told what her prognosis was. It has to be mentioned that in this case, the anxiety and helplessness can be detrimental to her psychological health further deteriorating her condition. And as per the principles of the nursing professional ethics, the patient had every right to know the truth of her diagnosis, so that she can be empowered even in the face of such a devastating disease and can peacefully say her goodbyes to her loved ones before her eventual demise.

References:

Aitamaa, E., Leino-Kilpi, H., Puukka, P., & Suhonen, R. (2010). Ethical problems in nursing management: the role of codes of ethics. Nursing ethics, 17(4), 469-482. Doi: 10.1177/0969733010364896

Chen, D. L., & Schonger, M. (2017). Social preferences or sacred values? theory and evidence of deontological motivations. Retrieved from https://users.nber.org/~dlchen/papers/Social_Preferences_or_Sacred_Values.pdf

Kalajtzidis, J. (2013). Ethics of social consequences as a contemporary consequentialist theory. Ethics & Bioethics (in Central Europe), 3(3-4), 159-171. Retrieved from https://www.unipo.sk/public/media/25954/Ethics%202013%203-4%20final.pdf#page=53

Li, P. W., So, W. K., Fong, D. Y., Lui, L. Y., Lo, J. C., & Lau, S. F. (2011). The information needs of breast cancer patients in Hong Kong and their levels of satisfaction with the provision of information. Cancer Nursing, 34(1), 49-57. doi: 10.1097/NCC.0b013e3181ef77a0

Matsuyama, R. K., Kuhn, L. A., Molisani, A., & Wilson-Genderson, M. C. (2013). Cancer patients’ information needs the first nine months after diagnosis. Patient education and counseling, 90(1), 96-102. DOI: https://doi.org/10.1016/j.pec.2012.09.009

McCarthy, J., & Gastmans, C. (2015). Moral distress: A review of the argument-based nursing ethics literature. Nursing Ethics, 22(1), 131-152. Doi: 10.1177/0969733014557139

Nursing and Midwifery Board of Australia - Home. (2018). Nursingmidwiferyboard.gov.au. Retrieved 7 February 2018, from https://www.nursingmidwiferyboard.gov.au

Tariman, J. D., Doorenbos, A., Schepp, K. G., Singhal, S., & Berry, D. L. (2014). Information needs priorities in patients diagnosed with cancer: a systematic review. Journal of the advanced practitioner in oncology, 5(2), 115. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4042668/