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Deceit an Ethical Dilemma among Nurses

Kirstyn Cassidy
James Madison University

INTRODUCTION

Nurses often face deceit, a common ethical dilemma. There are many definitions
of deceit, but Merriam Websters dictionary defines it as, dishonest behavior that is
meant to fool or trick someone. Deceit can enter the medical field with various
situations, such as withholding information, lying to patients, etc. With the scenario of
lying to a patient, it is hypothesized that, patients today, more than ever, experience
serious harm if they are lied to (Drane, J., n.d.). Often times when nurses and nursing
students, like myself, are faced with having to lie or be deceitful towards a patient many
are unsure of how to handle such situations. In the American Nurses Association Code of
Ethics, it is stated that, The nurses primary commitment is to the recipient of nursing
and healthcare services the patient whether the recipient is an individual, a family,
a group, or a community (ANA, 2015).
With this in consideration, how does one handle a situation when the patient and
the family are at odds? When the nurse feels like the family may not be acting in the best
interest of the patient and requires them to lie or be deceitful to the patient. Those who
advocate for patient autonomy believe that everything should, be revealed because only
the patient can determine what is appropriate (Drane, J., n.d.). It is also stated in novel,
Morals and medicine: The moral problems of: The patient's right to know the truth,
contraception, artificial insemination, sterilization, euthanasia by Fletcher that when
caring for patients, The treatment of a disease may be entirely impersonal; the care of a
patient must be completely personal (Fletcher, 1979). These difficult and uncomfortable
situations cause many nurses to ignore them and simply do as they are told. With such an
important issue, it is imperative to look at situations involving deceit more closely and
discuss the ethical dilemma at hand.

BACKGROUND
One day at clinical, an occasion involving deceit occurred. There was a patient
who was at the hospital receiving care on the Medical Surgical unit, and the nurses in the
hallway began discussing the patients condition. This itself can be an ethical dilemma;
however, what they discussed later, which involved withholding information from the
patient is the ethical dilemma I am focusing on. Apparently, the patient was dying of
cancer, however the family had chosen to hide from the patient that his medical condition
was deteriorating. The patient was receiving care for the initial hospital visit and knew of
his cancer diagnosis, however doctors soon realized that within the next few months he
would die. He was not informed of this. The patient even stated one day while a nurse
was present, I dont think I am going to beat my cancer like Matt* (name changed for
confidentiality) did, with the family in the room. When I heard this I remained silent and
did nothing in response. In reflection, my action would be to ask questions. I wish I
would have done this and helped better understand the reasoning on both sides.
This situation caused me moral distress, which is defined as a situation that
occurs when one knows the ethically correct action to take but feels powerless to take
that action (Delgado & Epstein, 2010). I was dissatisfied with the way the healthcare
system worked in this situation. I understand that maybe I did not know the entire facts of
this case/situation, because this was not my patient (my clinical duties involved someone
else); however, I was mystified and confused on why the patient was not being told his
diagnosis. Some people feel that ignorance is bliss, however I feel that in the area of
health, this is not the case. It is everyones right to know and understand his or her own

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personal health and diagnoses. I also did not understand how the family felt it was
helping the patient by keeping pertinent medical information away from him. Ultimately,
while nurses and staff were doing their jobs and following policy, I felt it was ultimately
failing and harming the patient.
METHODS/FINDINGS
Using the JMU 8 Key Questions, I will analyze the ethical dilemma (James
Madison University, n.d.). The JMU 8 Key Questions asks specific questions focused on
analyzing multiple facets of a situation. When thinking about the potential outcomes in
this situation, there are multiple. One outcome is possibly getting in trouble for telling the
patient his medical diagnosis. Another action, which results in a long term outcome, is
not telling the patient and allowing him to be ignorant of his medical diagnosis and
allowing the family to continue with its plans. The question of fairness asks how can I act
equitably and balance all interests. In order to balance all interests, there should be an
ethics meeting with the doctor, nurse, and the patients to understand their decision, what
is ethical, and can be legally upholded. When asking who the authorities involved in this
situation are, there is the law, ones personal God, and then my personal expectations.
The JMU question of Liberty asks one to consider what principles of freedom and
personal autonomy apply. Every individual has a right to freedom and personal autonomy
to know his or her personal health.
The fifth JMU Key question suggests considering what rights exist in the
situation. Innate rights allow the patient to know his health and medical diagnoses. There
is a right to follow the law, the durable power of attorney, and other powers. Social rights

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can be vague and go both ways to answer this dilemma, thus rationale is varied. When
considering the question of responsibilities there are multiple answers about what duties
and obligations. One answer is that duty and obligation lies with the patient and his or her
needs. However, there is also an obligation to the hospital that needs to be maintained.
With the question of empathy I would most definitely tell my family member, the
patient, about the medical diagnosis. In relation to the last JMU key question relating to
character I would tell the patient of his medical condition. Personally, being my ideal self
would involve being truthful and promoting the best interest of the patient.
CONCLUSION
This ethical dilemma helped me learn, most importantly, never to be afraid to ask
questions. If I had asked questions I would have understood this situation more. In the
future I will remember to ask questions, so that I fully understand a situation. However, it
also made me realize not to be afraid to stand up for how I feel and what I believe. I think
the ethical implications of this impact the larger nursing profession in that while
following hospital protocol and procedure is important standing up for the patients
autonomy is the most important. I think having a meeting with the family and the hospital
and having a discussion of the ethical implications is the best way to do this. It allows the
nurse to be the patients advocate and allow a reevaluation of the decision. Discussion of
such ethical dilemmas can allow everyone to be more enlightened in such situations.

References
American Nurses Association. (2015). Code of Ethics for Nurses with Interpretative
Statements. Silver Spring, MD: Author.

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Drane, J. (n.d.). Honesty in Medicine: Should doctors tell the truth? Retrieved November
20, 2015, from http://www.uchile.cl/portal/investigacion/centro-interdisciplinariode-estudios-en-bioetica/publicaciones/76983/honesty-in-medicine-should-doctorstell-the-truth
Epstein, E.G., & Delgado, S. (2010). Understanding and Addressing Moral
Distress. Online Journal of Issues in Nursing, 15(3). doi:
10.3912/OJIN.Vol15No03Man01
Fletcher, J. (1979). Human Rights in Life, Health, and Death. In Morals and medicine:
The moral problems of: The patient's right to know the truth, contraception,
artificial insemination, sterilization, euthanasia. Princeton, NJ: Princeton
University Press.
James Madison University. (n.d.). The Madison Collaborative: Ethical Reasoning in
Action. Retrieved from http://www.jmu.edu/mc/8-key-questions.shtml