Running head: ETHICAL DECISION MAKING: DISCLOSING INFORMATION 1

Ethical Decision Making: Disclosing Information

Selina Dykes

Grand Canyon University: NSG436

August 8, 2020
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Ethical Decision Making

Making decisions for a patient if one of the top priorities for a nurse. Determining the

course of treatment and how each patient gets individualized care can affect their outcome. The

American Nursing Associations Code of Ethics outlines how nurses should handle and care for

patients when an ethical dilemma is involved (Duquesne University: School of Nursing, 2020).

Ethics are composed of individual morals and perspectives on certain scenarios and how one

feels about it. One ethical dilemma that has been prominent in the nursing field is the prevalence

of disclosing terminal diagnoses to patients. This has become an ongoing issue due to the

contrast of beneficence as well as privacy. This paper will analyze the ethical decision, a

decision model in addition to possible solutions and personal leadership style.

Ethical Dilemma and Justification

When disclosing a diagnosis to a patient, it can be easy for these patients to make

decisions quickly and recklessly. Patients can easily think of the worst-case scenario and scare

family members into thinking the same way. Eventually, these thoughts and rash decisions can

lead to more harm than it can good. Because patients should focus on their treatment and

prognosis, it can be difficult to deliver a terminal diagnosis due to the severity of the situation.

The ethical dilemma at hand is whether to disclose terminal diagnoses to patients or keep the

information from them in hopes of sparing their feelings and impulsive decisions. In a study

called, “Assessing the decision-making capacity of terminally ill patients with cancer”, the

authors determined that 90% of the terminally ill patients were not capable of making and

understanding decisions at this stage of their cancer (Kolva, E., Rosenfeld, B., & Saracino, R.,

2018). Additionally, creating rapport with patients is a vital factor in maintaining trust. When a

severe illness such as cancer is present, it can cause patients to make decisions based on fear
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rather than reasonably which is why rapport is important. If this relationship between the

multidisciplinary team and patient is broken, the patient will not trust the nurses to help make

decisions, which is typically why family members want to keep this information confidential.

Furthermore, while keeping diagnoses from patients aid in emotional trauma, patients are entitled

to become knowledgeable about their illness as well as treatment options. Notifying the patient

about their illness can create a healthy relationship with the nurse as well as inform the patient to

their rights. Additionally, patients have the right to self-autonomy which allows them to make

decisions for themselves no matter their diagnosis. Furthermore, it is important to allow patients

to become aware of their illness and it is up to them to allow their family members to become

informed or not. Although the preservation of emotions can be hard for a nurse to overcome, it is

not right to withhold terminal diagnosis’.

Standard Application and Providing Safe Client Care

Being a nurse can become very difficult when a physician decides to withhold

information from a patient because it prohibits the nurse from fully being honest. This can create

controversy within the multidisciplinary team due to differing perspectives. It would become

difficult for a nurse to uphold the physician’s decision if it went against their own. Various

organizations such as the American Nurse Association (ANA) believes that patients have the

right to autonomy as well as guiding nurses to advocate for these patients. This organization

believes that notifying the patient about their illness as well as symptoms, treatments and

limitations, are part of a nurse’s responsibilities to ensure safety and a healthy rapport in terminal

patients (ANA, 2016). Furthermore, the American Nurse Association believes that patients have

the right to their personal health information in addition to added data about the illness when it

comes to making decisions (ANA, 2015). A nurse leader could navigate the standard by referring
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to the American Nurse Association as well as hospital guidelines. A nurse manager could then

put this into effect by understanding their own beliefs and morals before taking on a patient that

might carry emotional trauma. In addition to this, a nurse can ask for a reassignment if they

cannot handle the characteristics of a terminally ill patient. By using these techniques and

strategies, nurses can navigate proper paths into providing the best care for patients.

Ethical Decision-Making Skills

Morals play a huge part in scenarios regarding ethical decisions. Although it is difficult to

incorporate both sides of the scenario, nurses have many resources to guide them. These

resources include the ANA as stated before, as well as nurse managers and other nurses on the

floor. While sharing information with patients that is upsetting can be difficult, it is always

important to understand that the patient has rights. It is the nurse’s job to provide the best

individualized care no matter the prognosis. In addition to this, the nurse manager can provide

education to the family if need be as well as guide the patient into making decisions about their

treatment and/or end of life care. Veracity is one of the biggest decision-making skills in this

scenario because telling the truth is the foundation of a healthy rapport. Patients trust nurses to

lay out all the routes possible for treatment and end of life options, and this would not be

possible without disclosing the information to them. Some other skills that are involved in these

situations include proper communication, continuous education to family members, being open

to all course of treatments as well as remain unbiased in the situation. By having an unbiased

stance, nurses can support either route the patient decides to take. Additionally, this allows for

the patient to take control and make decisions after finding out their diagnosis rather than

keeping it from them. These strategies and methods will provide the best care to the patient as

well as map out the illness for the patient.

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Solution and Leadership Influence

One of the largest issues that arise from disclosing terminal diagnoses to patients is the

interaction of the family. These members can try and sway a nurse one way or another to distract

from the deliverance of information. Because of this, the nurse needs to take charge of the

situation and inform the family that the patient has the right to know. When all members of the

multidisciplinary team as well as the family are on the same side, it can be easier to deliver his

news to the patient. By expressing that the nurse is on the patient side and is intentionally caring

for the patient, family members can be put at ease. A solution to this problem is telling the truth

to the patient in order to decrease the risk of nonmaleficence. Additionally, by getting the family

members to realize that allowing the patient to make their own decisions about their illness is

vital, it can help with the solution. As a leader, nurses need to lead by example and uphold the

guidelines of the ANA and code of ethics. By putting the patients’ needs and wants above their

own, nurses become active leaders in the situation. Additionally, a leader realizes when they

cannot handle an assignment both mentally and physically, so coming forward to the nurse

manager to switch patients can be beneficial.

Conclusion

When in a hospital, patients already feel as if they are not in control of their health. By

not disclosing certain information to them such as terminal illnesses, self-autonomy is

overlooked. Although there are many factors that can cause a nurse to stray away from telling a

patient this difficult information, it is important to understand that patients deserve the right to

self-determination. Additionally, guidelines such as the ANA code of ethics can help nurses

explain these methods to family members. By doing so, the nurse is providing education to the

family members as well as allowing the patient to have control over their illness and their
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decision-making processes. Overall, allowing patients to fully understand and digest their

diagnosis allows for healthy rapport and upholds a nurse’s ethics.

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References

American Nurses Association. (2015). Privacy and Confidentiality. Retrieved from:

https://www.nursingworld.org/~4ad4a8/globalassets/docs/ana/position-statement-

privacy-and-confidentiality.pdf

American Nurse Association. (2016). Nurses’ roles and responsibilities in providing care and

support at the end of life. Retrieved from

https://www.nursingworld.org/~4af078/globalassets/docs/ana/ethics/endoflife-

positionstatement.pdf

Duquesne University: School of Nursing. (2020). Ethical issues in nursing: Explanations &

solutions. Retrieved August 09, 2020, from https://onlinenursing.duq.edu/blog/ethical-

issues-in-nursing/

Kolva, E., Rosenfeld, B., & Saracino, R. (2018). Assessing the Decision-Making Capacity of

Terminally Ill Patients with Cancer. The American journal of geriatric psychiatry: official

journal of the American Association for Geriatric Psychiatry, 26(5), 523–531.

https://doi.org/10.1016/j.jagp.2017.11.012