All civilization has encountered health difficulties from traditional times to the present. In traditional practice, ethicist usually used casuistry case-based strategy as a method of analysis for centuries in Jewish medical ethics. Therapeutic paternalism assumed as typical practice by most healthcare pros and their patient's thought that whatever done by healthcare team will be better for them. Hence, the questions of medical ethics have been argued because the early development of Western medicine. "Ethics is a philosophical procedure that covers entire associations of stuff and involved with bad and the good, moral duty, obligations and beliefs" (Lindberg, J. B. et al 1994). Potter and Perry, (2010) present that it is a human fundamental right and moral decisions in health care should be utilized by four guidelines. Beauchamp and Childress attended to the four moral and healthcare principles.
Scenario: "a nurse can be an assigned to an individual who may have been identified as having an inoperable tumor and is terminally unwell. The medical staff and the family insist that she is not to find out about her prognosis. She continues requesting the nurse, "Am I dying". What should the nurse do in this situation?"
Consideration of the ethical concern using the Four Principles framework
Respect for autonomy: Respect for patient autonomy. It means that the patients hold the rights to choose, which track of action best for them. The idea of autonomy is a basis and keystone of nursing practice as a anticipated respect for patient. Autonomy theory is nothing. Pass up Y may not be independent rather than legally capable to value for autonomy, but this does not mean that ethically her views shouldn't be considered and well known so far as possible. She has spoken her wish clearly; she wants to learn about her condition.
Beneficence: The ethics of beneficence such as honest behavior is obliged to prosper.
The great things about acting beneficently would have to be weighed up against the dis-benefits of failing to respect Pass up Y's autonomy. (From a legal viewpoint the wants of a competent patient cannot be override in her best interests).
Non maleficence: the moral responsibility to do no harm is familiar within both medical and nursing practice. Here, Miss Y would be harmed by showing about her end stage of disease. Which course of action would cause the greatest injury?
Justice: the process of justice shows that ethical action is a manner that treats people pretty ("Ethical issues, " 2001).
Moreover in the framework of Pakistani system, Pakistan Nursing Council (PNC) offered the professional code of ethics with job description for documented nurses. It offers way for decision-making regarding moral matters and functions for self-evaluation and reflection regarding ethical medical practice.
Compare and comparison between four moral principles
Nurses are ethically compelled to deliver secure, experienced and moral health care to all or any patients. These main beliefs give us understanding about the type of obligations associated with these principles. (Facts) Beauchamp and Childress clarify that ethics leads us to proceedings, but we still need to guage an ailment and express the right response. This common sense and response study from training up to from moralities (Limentani, 1999).
According to given circumstance, as patient is at critical condition with diagnosed case of cancers and in the level of terminally unwell. Nurse may not determine either she should provided the answer or not. With this critical condition, may answer create emotional tragic situation to the individual and may patient ailment are more deteriorate due to emotional disturbance or in this situation therapeutic flexibility seems sensible. In addition, the notion of ethical request in serious condition is the total amount between esteem for autonomy of the patient and wish to do in a beneficent frame of mind may brings about dissimilarity and tension (Campbell 1994).
This kind of moral dilemmas arise due to clashes between moral guidelines, such as truth sharing with decisions, autonomy, commitments of beneficence and non-maleficence. These three ethical codes can build discord with the rule of justice. Mostly two types of issues happen from medical practice. There's a conflict between obligations to value of autonomy and obligations of beneficence and non-maleficence. In reality, there are many other types of situations in which this type of discord occurs, such as nourishing, providing medication to a patient against their desires, and trying to prevent a patient from committing suicide etc. It really is remarkable that conflicts happen in healthcare institutions across the country on a regular basis. Although most health care professionals are now trained communication skills, they aren't taught the compromise and conciliation had a need to offer with severe disagreements.
One drawback of the "Four Ideas" procedure is that whenever different persons in an moral decision might vary about the exclusive weight to each code. For instance in confirmed scenario, an individual who wants to find out about their critical condition and asking you "Am I dying?" This may be arguing that the theory of autonomy should be uppermost, as the other clinical personnel may maintain beneficence and non-maleficence at the top priority. The health care rules do not portray and point out a hierarchical buying by them. In this particular example, if patient need spiritual and religious support and nurse decides to inform them simple fact in the favor of admiration of autonomy, they will lose the role of paternalism. In this way, autonomy will be high weighed and patient may be getting a golden chance to do pray for forgiveness from Allah. If they do not inform the real situation to the patient and keep a paramount of beneficence and mal-eficence then paternalism will be weighed but patient might be up to now to pray and some special spiritual practice. Actually, there will be no justice for the process of justice. In nursing, justice often focuses on equitable usage of care and attention and fair scarce reference distribution. It is the requirement of nurses to concentrate on the patient's particular care and attention needs, vision, personal preferences and to recognize the individual's unique practice (Wilson-Barnett 1994).
Arber and Gallagher (2004) mentioned that any news which is not warmly accepted is actually a bad news. Any insensitive way increases the suffering of recipients of bad media, can exerts a long lasting impact on their capacity to modify and adjust, can result in anger and increased risk of legal action. Furthermore, the problem becomes more difficult because some patients misinterpret messages that they hear. For breach bad news, strong communication are needed which should bottom on both compassionate and kind attitude.
Analysis
Not to telling a truth, is an essential skill for doctor because many of them think it is challenging to speak bad information, particularly when will involve a life-threatening situation. Some feel untrained while some fear the news will be distressing and adversely have an impact on the patient, family, or the healing relationship. Some co-workers go on a very positive strategy; giving the individual and relatives manufactured expectation and thinking that the individual is more ideal in her ignorance. Some of them take a middle pathway and explain all the reality to the family while keeping the individual in the dark. Mohandas (1995) stated that, few describe at some extent about their judgment regarding patient's prognosis, and the severity of disease, expected likelihood of treatment, adverse effects, financial burden and brief and permanent prognosis. In this regard they annoyed some patients and individuals. The persons associated with this situation where my patient with a cancer tumor diagnosed lady and me (as a staff nurse). The honest principles involved with this example where my patient's autonomy and veracity verses non-maleficence. The ethical dilemma confronting to me that if I (as an employee nurse) didn't deliver the news then might I was not following the honest rule of veracity and patient's autonomy. However, if I disclose the news to the individual i quickly would be violating the concept of non-maleficence. Veracity (telling the reality), although distressing for a while, but will result in more gain than injury in the long-term (Sokol, 2006). Keeping the rule of non-maleficence in my own mind if I delivered the information to the patient intentionally then it would be resulted the intrinsic effect of harming the individual that violates the negative work not to harm.
Arguments and counterarguments
The literature support that it's ethically to tell the reality to the individual. Sokol (2006) referred to that not revealing the truth may breach the trust of patient-nurse romantic relationship and causes loss of trust. Veracity, although upsetting for a while, but will direct result more good than harm over time. The patients must have full disclosure of awful news should tell the truth if this is their wish in line with the scenario. Disclosing the info prevent further argument and loss of trust if the patient later uncover the truth. The Islamic viewpoint regarding veracity is clear as, it was narrated that "Abd-Allaah ibn Mas'ood said: The messenger of Allah (PBUH) said: "Truthfulness is righteousness, and righteousness causes Paradise. Lying is evildoing, and evildoing leads to Hell". If patient is in severe condition and exposing the truth may affect unfavorable consequences, it could cause an abnormal psychosocial or religious burden on patient. On this critical situation then not revealing the simple truth is advantageous for the well-being of patient (Tse et al. , 2003). The restorative privilege provides opportunity to the doctor in few conditions when expose the simple truth is forbidden as it resulted in real and expectable destruction in patient's health position. It is also an undeniable fact that doctors don't have a duty to disclose the whole facts about a patient's condition in respect of beneficence and maleficence.
Advantages of fact sharing with: Disclosure is vital to future educated consent. The individual who are not communicated about their prognosis, and kept unaware may be vulnerable to future misdiagnosis. Veracity encourages trust between patient and health care providers. Truthful disclosure may reduce the probability of legal responsibility.
Disadvantages of truth revealing to: Patient may misinterpret the information. The other possible injury may be patient lose the hope. Patient health is the main issue for medical care provider, that can be affected by truth telling, and patient may go to distress. Patient may develop stress and anxiety.
Implementation
Veracity (telling the reality) to the individual needs extraordinary focus, because now a day's patients are, relatively to preceding, more susceptible to face serious harms if they are not completely recognized regarding their health status. Not merely patient's self-government destabilized, as well as patients who are not informed the real real truth about an involvement, practice a loss of fact which is mandatory for remedial process. Integrity counts to patients because they are not well subjected to the disease, and disturbed with lots of questions in their head which require veracity. An awful news is obviously a bad media. But the way it is conveyed can have a serious effect on both patient and medical care supplier. Breaking bad news suggested a strategy which supports the health care providers to tell the truth in the critical circumstances.
Buckman (2005) advised the S-P-I-K-E-S standard protocol a strategy to disclose the bad information and tell the reality by lessening the hazardous ramifications of bad reports. In this value, the most crucial factor is setting up. It offers isolation, participation of the significant relative and kind and calm habit. Before breaking the news headlines, a precise patient's perception is necessary. It facilitates the health good care providers a idea, that how patient view this is of the problem and calculate the facts and shape of the medical situation. What have you think something is certainly going on together with you? Such kind of open ended question is helpful to understand patient's perception. Request the patient through indirect permission, and value the patient's to know and have for example that, how much extent you required information relating to your treatment and diagnosis? Before providing information, supply the patient a few occasions that she prepared psychologically. The past treatment is empathetic response. Empathetic approach can stabilize the patient's feelings through acknowledge that you are feeling their feelings.
Conclusion
Keele (2008) identified that corresponding to Kant, veracity is a very important to discover that is categorical in characteristics, you need to do their obligation even it harm others. Veracity is the medical concept which matter for the sake of the patient. However in spite of all these facts matching to health care system and the medical profession in our framework, trust is the essential element to develop therapeutic romantic relationship with patient. The image of healthcare providers would be destroying if indeed they would not stand for the true situation before patient. Truthful visibility of relevant information is a legal and moral duty of medical professionals to be explored before patient. In this manner, there is absolutely no final summary and nurse must do accordingly by their experience, honesty, intelligence and use the futility and theory of utilitarianism.
