1. THE ETHICS OF TRUTH-TELLING IN HEALTHCARE
BY TONIA BUTLER

2. 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

3. 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

4. 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)

5. 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.

6. 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.

7. 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?  

8. THANK YOU