THE ETHICS OF TRUTH-TELLING IN HEALTHCARE BY TONIA BUTLER

TRUTH-TELLING EXPECTATION ESTABLISHES RELATIONSHIPS NURSES ARE FACED WITH DILEMMAS OF TRUTH-TELLING OMISSION WITHHOLDING CERTAIN INFORMATION LYING CONSIDERATIONS EMOTIONAL WELL-BEING COGNITION PROTECT THE PATIENT

CASE STUDIES GENETICS TESTING IN SICKLE CELL DX 2 YEAR OLD AFRICAN AMERICAN/TEEN PARENTS/HS GRADS/NO MEDICAL BACKGROUND SX: SEVERE PAIN, DIFFICULTY WALKING, CRYING TESTING AND FAMILY HISTORY DX WITH SICKLE CELL DX MOTHER-TRAIT FATHER-NON CARRIER CANCER DX IN THE ELDERLY 89YO WIDOWED/ INDEPENDENT MILD COGNITIVE DISORDER/CONTINUES TO DRIVE/FORGETFUL AT TIMES WEIGHT LOSS/GI DISTRESS FURTHER TESTING DX STOMACH CANCER FAMILY: CANCER DX WITHHELD HOSPICE

Laws? Laws versus Morality Misattributed paternity Fundamental Right Varies in cultures/nations Learning of cancer dx improves cooperation and survival period Misattributed paternity keeping the family unit intact providing the child with the necessary care he or she needs saving or protecting the life of the mother and child protecting the dignity of the mother beneficence and nonmaleficence autonomy and informed consent (Tuskeegee)

VIEWS OF UTILITARIANISM In case #1, happiness of the presumed father is spared, the happiness of the biological father and the child is foresaked. In case #1, it totally disregards the child's right to decreased mortality or to a better quality of life.  In both cases, Decision to withhold information fails to align with truth and autonomy. Opponents of Utilitarianism: full disclosure of the information would impose on the well-being of the mother and daughter as well as the confidentiality of the mother, specifically sexual infidelity. Potential serious or life-threatening consequences of informing the father as it relates to the existing relationship. Concept of consequentialism is considered determines moral reasoning by considering consequences. In consequentialism, actions are morally right when the outcomes produced are good. subjective approach in determining what is defined as being good. The idea of being good is defined differently by different people and outcomes are difficult to predict, making the consequences hypothetical at best.  The main idea of Utilitarianism is to maximize happiness.  fails at respecting the rights of individuals. fails to accept consequences and it focuses on the greater good versus the greater number of people to benefit. totally disregards the rights of the individual and their feelings. values each person's interest as equal. both case scenarios represent an omission of information from the authoritative healthcare professionals which places more value in failing to disrupt the patients' social relationships that currently exist.

KANT’S RIGHTS PERSPECTIVE All rational beings deserve dignity and respect. Kant does not justify lying, even if that truth results in fatal consequences. The morality and duty of truth-telling far outweighs the consequences and that anything less violates the principle of right. Kant rejects the use of consequentialist grounds in moral decision making because it provides an escape from morality based on exceptions. Kant also rejects utilitarianism as a basis for personal morality and law,  citing that maximizing utility must not interfere with basic rights both cases #1 and #2, requires society to make the decision to affirm or accept one’s happiness over others. Places values on the happiness of some, while disrespecting the rights of others. Requires assumptions that the value placed on the lie or omission of the facts is the overall desire of all parties involved.

CONCLUSION Truthful communication between the nurse and patient is imperative Establishes a sense of trust between the two Violating trust further violates the relationship between patients and the healthcare institution.  In respecting the principle of autonomy, it allows the patient and as in case #1, interested parties, to have control of their lives as much as possible In both cases, there is a fundamental right to the complete truth and knowledge of all information provided by the results of each test. Is it ethical to forego truth-telling in healthcare? Is it ethical to withhold information to all interested or authorized parties? Does taking a consequentialist approach to ethical decision making outweigh the responsibility of healthcare workers to tell the truth? Does the nurse or the provider have the right to determine which approach to consider when debating on whether the truth should be disclosed?  In case #1, Is it a required duty to tell the truth since the findings of paternity were incidental to the results of the genetic testing? In case #2, Should the rights of the elderly with regards to the diagnosis of dementia be considered when determining the need to tell the truth?  

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