To Disclose or to Not Disclose: Nursing and the Ethics of Nondisclosure in the Dying Patient
To Disclose or To Not Disclose:
Nursing and the Ethics of Nondisclosure in the Dying Patient
Kally L. Price
Samuel Merritt University
Abstract
In nursing, the practice of nondisclosure is an ethical issue that calls into question the founding principles of trust, integrity, and autonomy in the nurse-patient relationship. Although the decision of nondisclosure to the terminal patient is the physician's, the nurse must follow and support this decision. The right of the patient to have control over their own healthcare information, and their right to know their diagnosis and prognosis and make treatment decisions are supported by the American Hospital Association, The Patient Self Determination Act, which requires education on advanced directives, California's 2008 Terminal Patients’ Right to Know End-of-Life Options Act, and by the practices of obtaining informed consent before any procedure/surgery (Cochella & Pederson, 2003, Krisman-Scott, 2000). The dying patient deserves the right to know their condition so they can make preparations (financial, spiritual and personal and interpersonal) for death and make appropriate treatment decisions.
To Disclose or To Not Disclose: Nursing and the Ethics of Nondisclosure in the Dying Patient
i. Introduction In medical practice, disclosure refers to the physician's act of revealing a diagnosis, treatment options, risks, and prognosis to the patient. Therapeutic nondisclosure (sometimes called therapeutic privilege) is the act of a physician withholding a diagnosis or prognosis because the patient is perceived to be psychologically or emotionally incapable of coping with the news. Therapeutic nondisclosure can also refer to the withholding of a diagnosis or prognosis for other reasons, such as familial request, which often involves cultural considerations. (Goldberg, McCabe, Wood, 2009) In Oken's 1961 study of 218 physicians, 90% did not disclose cancer diagnoses to patients. The ethical
Nursing and the Ethics of Nondisclosure in the Dying Patient
Kally L. Price
Samuel Merritt University
Abstract
In nursing, the practice of nondisclosure is an ethical issue that calls into question the founding principles of trust, integrity, and autonomy in the nurse-patient relationship. Although the decision of nondisclosure to the terminal patient is the physician's, the nurse must follow and support this decision. The right of the patient to have control over their own healthcare information, and their right to know their diagnosis and prognosis and make treatment decisions are supported by the American Hospital Association, The Patient Self Determination Act, which requires education on advanced directives, California's 2008 Terminal Patients’ Right to Know End-of-Life Options Act, and by the practices of obtaining informed consent before any procedure/surgery (Cochella & Pederson, 2003, Krisman-Scott, 2000). The dying patient deserves the right to know their condition so they can make preparations (financial, spiritual and personal and interpersonal) for death and make appropriate treatment decisions.
To Disclose or To Not Disclose: Nursing and the Ethics of Nondisclosure in the Dying Patient
i. Introduction In medical practice, disclosure refers to the physician's act of revealing a diagnosis, treatment options, risks, and prognosis to the patient. Therapeutic nondisclosure (sometimes called therapeutic privilege) is the act of a physician withholding a diagnosis or prognosis because the patient is perceived to be psychologically or emotionally incapable of coping with the news. Therapeutic nondisclosure can also refer to the withholding of a diagnosis or prognosis for other reasons, such as familial request, which often involves cultural considerations. (Goldberg, McCabe, Wood, 2009) In Oken's 1961 study of 218 physicians, 90% did not disclose cancer diagnoses to patients. The ethical
References: American Nurses Association. (2001). Code of ethics for nurses with interpretive statements. Retrieved June 29, 2010, from http://nursingworld.org/ethics/code/protected_nwcoe629.htm Cochella, S. E. W., & Pedersen, D. M. (2003). Negotiating a request for nondisclosure. American Family Physician, 67(1), 209-211. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=mnh&AN=12537182&site=ehost-live Goldberg, R. M., McCabe, M. S., & Wood, W. A. Commentary: Disclosure in Oncology—To whom does the truth belong? Oncologist, 14, 77 - 82. Hallenbeck, J., & Arnold, R. (2007). A request for nondisclosure: Don 't tell mother. Journal of Clinical Oncology, 25(31), 5030-5034. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=rzh&AN=2009747802&site=ehost-live Jones, J. M. U.S. clergy, bankers see new lows in Honesty/Ethics ratings. http://www.gallup.com/poll/124628/Clergy-Bankers-New-Lows-Honesty-Ethics-Ratings.aspx Krisman-Scott, M. A. (2000). An historical analysis of disclosure of terminal status. Journal of Nursing Scholarship, 32(1), 47-52. doi:10.1111/j.1547-5069.2000.00047.x Morrow, A. California 's terminal patients’ right to know end-of-life options act: A patient 's right to know. Retrieved June 29, 2010, from http://dying.about.com/od/ethicsandchoices/a/AB_2474_CA.htm