Even though modern medicine has become innovative and advanced over time, the ethics related to the medical field is still held in higher regards and generally debated topic in the world of medicine, due to the involvement of human life. The health care providers are highly trained to make medical decisions to deal with the issues in hospital settings. Even though, sometimes they face dilemmas to conclude, as their decisions may result in the lasting act on their profession and personal life.
Having said that, it is clear that the ‘Code of ethics’ plays a very important place in health care delivery. Generally, the most challenging and confusing bioethics for health care providers are truth-telling and confidentiality. Truth-telling means providing the client with enough information simply to help the patient to make an informed decision about their health conditions, and to explain the current situation. Telling- the truth is the tool to initiate a healthy therapeutic client relationship between the client, and the health care provider and helps to foster trust and shows respect on the client.
Additionally, ‘Right to know, and Right to teach’ are the rules in medicine when caring for a patient. “Confidentiality involves keeping personal information private” (CNO practice standards, ethics, pg.7). It means, ensuring that the information about the client is kept as a secret with exceptions to the appropriate person mentioned by the client. Maintaining the confidentiality between the client and the health care provider helps to treat the patient easily, and they will assure that the client is benefiting from full disclosure.
This honesty developed by maintaining confidentiality will build trust and it is the essential key to form a therapeutic nurse-client relationship. Thus, even though it is said that truth-telling and confidentiality help to improve the therapeutic client relationship, there are some exceptions where the health care providers must withhold following the bioethics for the wellbeing of the client.
As the scenario is given, Maria aged 50 who was presented to the hospital after an MVA, undergone surgery following five transfusions where she wasn’t informed or taken a consent about what happened. Additionally, the daughter of the patient died in the accident and the truth was withheld from the client. There are two important situations during which it is justified to withhold patient information from the client. If there is a chance where telling the truth will do real and predictable harm, truthful disclosure may be withheld. Secondly, in such situations where the patient gives consent to not to know the truth and requests to tell the information to the family member, it is withheld respecting the wish of the client and shared with the family member as she/he indicated. In the scenario, the health care providers didn’t tell the truth to the client because the client was mentally and physically unstable and the truth-telling would do more harm than before. Additionally, when supporting the fact that truth-telling can be held on for such reasons which would save the client, ethical principles play their role to support the fact. Non-maleficence, the duty to no harm, and Beneficence, the duty to act for the benefit of the others are few ancient ethical roots that help the decision. Accordingly, ethical values of CNO, client well-being, fairness, and respect for life have been followed to save the life of the client. Additionally, with the client-centered care one of the ethical theories, Utilitarianism supports the action to the greatest possible outcomes of the client or the least possible balance of bad consequences. This theory identifies and enforces the good with utility, where it is better to hold on to the truth rather than giving more harm to the client physically and mentally by telling the truth.
Thus, when thinking from the patient’s perspectives, telling the truth would have fostered trust and showed respect for the client regarding the patient’s interest in their own health condition. Breaching the confidentiality of the client is considered disrespectful of their own privacy and intervening in the right to autonomy. According to the ethical principle fidelity, respect for confidentiality is important for a therapeutic- client relationship in the field of medicine. Fidelity ensures that the health care providers should remain faithful to the commitments they made and keep the promises and truth-telling. Withholding the truth from the patient may also harm the client in many ways such as, the client will fail to receive the medical need and attention which they should be receiving. According to the ethical principle of veracity, it is referred that, it is the duty of a health care provider to tell the truth and not to lie or deceive the clients. Having said that, withholding the truth from the client shows that values of CNO such as client choice, truthfulness, privacy and confidentiality, and maintaining commitments can be violated. In regards to the ethical theory Deontology, it is defined that humans have the capacity to think through problems and determine the right action. The duty of the health care provider is to protect the confidentiality of the clients, where it is centered based on the duty and not on the consequences.
Moreover, when the health care providers were withholding the truth for the client’s wellbeing, they should have continued until she cures better to receive bad news which may affect her physic again. So, when a friend of the client came to visit, they should have informed her about the health conditions and about holding the truth from her until she heals. The CNO value of confidentiality is violated by the health care member, by failing to keep the information personal. Client realizing the truth from the third person would have led to a bad therapeutic- client relationship and would have broken the honesty and trust that they had towards the health care professionals.
Thus, as a conclusion, truth-telling and confidentiality are considered as the important code of ethics in the field of making decisions and fostering trust and honesty, it is also important to save the life of the client as the major consequence. When it is said that the patient was brought into the trauma, she lost a lot of blood and was in shock. So, when the client is unstable, it is legal to take a medical decision as the health care provider with another health care provider co-signing it. It is also said that she was in a coma for 3 days after the surgery and had five transfusions, she is still considered unstable to hear any bad news that will affect the body condition. Studies have said that the survival rate of a patient increase as the patient is not given any bad news before or after surgery. Even though the trust of the patient is broken and the confidentiality is violated, it is acceptable when it is for the better outcome of the client’s wellbeing. According to the ethical principles’ beneficence and non-maleficence, health care providers have chosen to no harm and safe the life rather than the following deontology and telling the truth to the patient and making her health condition even worse. Finally, even though it is said that truth-telling and confidentiality helps to improve the therapeutic client relationship, there are some exceptions where the health care providers must withhold by following the bioethics for the wellbeing of the client.
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