Howfeasible is veracity in nursing ethics?
Nursingpractice is popularly referred to as “a calling” to emphasize thelevel of commitment and dedication required. What escapes many isthat the field is characterized by a wide range of ethical and moralissues that influence conduct of nurses and delivery of services.Majority of these ethical requirements are based on medical ethicsthat apply to physicians and healthcare professionals at large. Theyinclude non-maleficence,beneficence, veracity, respect for persons and justice (Benjamin &Curtis, 2010). However, nursing ethics differs to some extent fromthese largely medical ethics in that nursing ethics places moreemphasis on human relationships, human dignity and collaborative care(Ward, 2012). A fundamental and sensitive aspect in relating withpatients is trust and truthfulness. In nurse-patients relationships,it is very important that patients feel that they can trust nursesand the services that they offer. In most cases, patients feelvulnerable due to information asymmetries, inadequate knowledge onthe element of risk, and their dependence on a third party and hencethey need to trust someone besides friends and family to give themproper care and furnish them with the truth (Lachman, 2012). Nursesare guided by a range of ethics in creating and developing trustingrelationships with patients. A key component of this trustingrelation is trust and truthfulness (veracity). However, in somecircumstances, nurses betray this trust either knowingly orunknowingly by withholding some information or modifying it. To do sowillingly is driven by some needs and desire on the nurse. The choiceto tell the truth or not can be a source of moral distress or ethicaldilemma. Various codes of ethics provide different views on the same.This paper assesses four differing views on nursing ethics, namelypersonal, professional, institutional and religious (Christianity)with a view to show for the good of patients, veracity can beabandoned in given circumstances.
Definingtrust, trustworthiness and the truth
Veracityis a core ethical code that calls for telling the truth. It appliesin medical practice and nursing as supported by informed consent(McLennonet al., 2013).Information to patients influences their perceptions towards medicalprofessionals, healthcare institutions and even influenceswillingness to stick to medical plans. Fluent and open communicationswhere nurses answer patients’ questions characterize veracity. Truth is one of the subsidiary features of trust. Other subsidiaryfeatures include communication, satisfaction, competency and privacy.Patients trust nurses that they are competent in their profession,can communicate and tell the truth, can respect and observe privacyand at the same time satisfy patient needs. But what is trust? Trustis defined as an attitude that one has towards another person orother people while trustworthiness is simply ownership of this virtuecalled trust.
AlbertEinstein once stated that “whoever is careless with the truth insmall matters cannot be trusted in important matters.” It thereforegoes without saying that the ability to tell the truth always makesone trustworthy while being trusted by a person obligates one toalways tell the truth at least to the trustor. Today, trust andtruthfulness are rare virtues though highly regarded by nearly allmodern and traditional cultures.
Trustis a very delicate issue in human relations. While trust is earnedover a long period of time usually after observing consistency,breaking that consistency can lead to irreparable image on trustbuilt over the years. In fact, in some societies, trust is held inhigher regard than love. However, (McLennonet al. (2013indicates that the value of trust does not largely vary withsocieties and cultures but rather by circumstance. This nature of arelationship and circumstances surrounding it determines theinstrumental and intrinsic value attached to trust. The value of thetrust shared also varies with the individuals. For instance, thetrustor may attach a different degree of trust to the trustee of theother way round. This difference is largely determined by thediffering perceptions toward the goods or benefits emanating fromsuch a trust-based relationship. Instrumental goods includeknowledge, autonomy, self-respect and moral maturity (Lachman, 2008).Intrinsic goods are largely based on the fact that trustworthiness initself is considered a virtue in most societies and religions.Several professions including nursing also recognize trust as a keyingredient in disseminating their duties. The American NursesAssociation (ANA) acknowledges that joining the profession isindicative of accepting the trust associated with nurses. Theassociation also notes that telling the truth is an integralingredient for nurses. Being able to always tell the truth goes along way in earning the trust of other people. Society and professiontherefore value and bestow respect on persons who tell the truth.However, in nursing profession, certain circumstances result in adilemma on whether to tell the truth or not.
Personalviews on ethics
Personally,I believe nurses are bound by their profession to be truthful. Infact, the truth is identified as a very admirable personal traitamong people. For nurses who are entrusted with the health andwell-being of patients, it is even more important. Nonetheless, ingiven circumstances, nurses can withhold the truth in considerationof other issues such as the psychological and emotional well-being ofa patient. The principle of non-maleficence plays a key role here inthat it requires nurses not to do harm to anyone (Sullivan, etal.2001). As the common adage goes “the truth hurts”, diverging someinformation to patients can result to unintended harm. As such,nurses must consider the potential harm that the truth can causedepending on circumstances. In some cases, physicians are forced towithhold information regarding patient diagnoses especially in casesof terminal illnesses and thus nurses are bound by the same ethicalprinciple to withhold the truth (Lachman2012).I therefore believe that in such a case where a physicianstrategically chooses to limit some truth, nurses should not act in acontradictory manner and reveal what the physician choose not toreveal. I believe that such a move would affect delivery of servicesand would also create mistrust between the patient and medics or theinstitution at large.
Advancedcommunication skills play a key role in ensuring that nurses meettheir obligation to tell the truth and do justice to the trust shownto them by patients. While professionals are bound by a professionalcode of ethics, personal skills in executing the ode comes in handy.Kirklin (2007) says that for medical professionals, communicationskills are instrumental in delivering messages especially thosepertaining to bad news such as death or unexpected diagnoses andprognoses. The author specifically cites use metaphors in telling thetruth rather than use of ‘insensitive” language of being bluntwith the truth. Metaphors are used by medic to soften the blow orexplain complex medical terminology. The author argues that use ofcomplex medical terminologies in communicating with patients canamount to withholding the truth or some information because very fewof them are likely to understand complex medical times and what theyimply.
Theprinciple of non-maleficence as earlier mentioned provides forsituations where veracity is limited. While a large majority ofnurses are trained on these ethical principles, they apply themdifferently. A study by Sullivan etal.(2001) examined three groups, physicians, nurses and patients ontheir views regarding being given all information pertaining todiagnoses. For the registered nurses 99% of them believed thatpatients have a right to be fully informed while 46% of them believedthat patients expected general information. Regardless of whatpatients expect, nurses have an obligation to reveal information topatients. The ANA insists that nurses’ primary responsibility isthe patient. Accordingly, nurses are required to inform patients whenadministering a placebo to ascertain the validity of symptoms.However, the professional acknowledges the importance of usingplacebos in medical studies. The American Society for pain managementnursing (ASPMN) introduced a policy statement that prohibits use ofplacebos in pain management without the patients’ knowledge.
Alarge number of healthcare institutions report having a code ofethics. These institutional code of ethics are largely based on thegeneral nursing ethics and also guided by professional ethics asoutlined by professional bodies such as ANA. Institutional ethics arecontrolled and set by ethics committees set up by individualinstitutions to offer a guideline on enforcing ethics. In some cases,institutional ethics may fail to tally with institutional ethics. Forinstance, the law in some states in the US (Washington, Oregon,Montana and Vermont) and other countries such as Belgium, Netherlandsand Switzerland openly support euthanasia. Such a stand can be codeof ethics for hospitals in those regions. However, this ethicalstandpoint on euthanasia is not supported by professional bodies andmay also be against the personal ethics of some nurses. For instance,ANA clearly states that nurses are prohibited from any participationin euthanasia or assisted suicide through a taskforce’s findingsrelease in December 1994. Such situations cause ethical dilemmas andmoral distress for the nurses.
Institutionalethics are most likely to be infiltrated by organizational politicswith impact on professional and professional ethics. This is a verysensitive issue facing nurses all over the world. As employees ofgiven healthcare instructions, the management of such organizationsexpects loyalty and nothing less from employees who also happen to beprofessionally and ethically obligated to patients. When theinterest of nurses and patients and healthcare instructions collide,nurses are faced with a dilemma. A good example is a situation wherea nurse is aware of the poor record of a resident surgeon in a givenhospital. Such information is not always readily available topatients. However, a patient might seek such information from nurses.It must be noted that any rational patient will tend to prefer aphysician with a good record and in this case a surgeon who haverecorded more successes in surgery than failures/death. In this case,information revealed might save the life of patient of the patentseeks treatment elsewhere and the hospital loses a client or thenurse can direct loyalty to the hospital and withhold or lie to thepatient to retain a client (McLennon, 2013).
Nursesare also likely to be involved in errors. When this happens, nursesare bound by a moral obligation and institution ethics that emphasizeon reporting to the necessary authority. Johnstone and Kanitsaki(2005) argue that nurses should not be shamed or reprimanded in sucha way that it discourages and jeopardizes future probability ofself-reporting. On the other hands, nurses should not report suchmistakes to patients to avoid causing panic and also avoid legalproceedings against the nurse and the institution. When this is done,it amounts to withholding information to patients and probably lying.
Christianviews on veracity
Christianityis one of the most popular religions around the world and thedominant one in western world. The teachings of Christianity,contained in the Bible hold in very high regard truth. The truth isassociated with holiness and righteousness. In fact, God the creatoris likened to the truth in Bible while lies and all that is not trueis likened to the Devil and all that is evil. Telling a lie is thusperceived as siding with the devil while telling the truth isperceived as doing what God intends us to do (Pesut, etal.,2008).The virtue of veracity is also supported by other teachings inChristianity such as loving you neighbor or anyone in need. In thiscase, where patients are in need of actual information, nurses shallnot distort the information or withhold the truth. However,Christianity does not address the issue of omitting some informationand neither does it liken it to lying. This therefore allows nurses aleeway through which they can achieve non-maleficence by protectingpatients by withholding some information.
Christianityemphasizes on the need of telling the truth always from aconsequentialist point of view. Several bible verses likenrighteousness or God to the truth. The book of Mathew22:16, says “Andthey sent their disciples to him, along with the Herodians, saying,“Teacher, we know that you are true and teach the way of Godtruthfully, and you do not care about anyone’s opinion, for you arenot swayed by appearances.” Other books severally emphasize on theneed to speak the truth always. In Zechariah8:16 “Theseare the things that you shall do: Speak the truth to one anotherrender in your gates judgments that are true and make for peace.” An almost similar message in contained in Ephesians4:25 andreads “Therefore,having put away falsehood, let each one of you speak the truth withhis neighbor, for we are members one of another.”
Fromthese verses, it is clear that speaking the truth always is a way ofachieving righteousness and being closer to God. The Bible clearlycurses lies and all that lie to God or to one another. In Psalms101:7, it says "He that worketh deceit shall not dwell within myhouse: he that telleth lies shall not tarry in my sight." InPsalms 109:2, it says Psalms 119:163, "I hate and abhor lying:but thy law do I love." Proverbs 6:16-19, also adds "Thesesix things doth the LORD hate: yea, seven are an abomination untohim: A proud look, a lying tongue, and hands that shed innocentblood, A heart that deviseth wicked imaginations, feet that be swiftin running to mischief, A false witness that speaketh lies, and hethat soweth discord among brethren." There are other countlessinstances that the Bible rebukes and curses lying and those that lie.This implies that for Christian nurses, they should never considerlying for whatever reason. Ethicalframework: Utilitarianism
Thisis one of the core theories/models of ethics applicable to variousfields. The theory posits that the morality of an action is bestjudged on its usefulness or the utility it provides. This theory hasits origins in philosophy and a number of early scholars such as JohnGay, and Jeremy Bentham have been linked to developing the theory.From the early beginning, the theory was based on the belief that allhuman actions should be geared towards promoting happiness (Benjamin& Curtis, 2010).Therefore, any action was judged on its ability to promote happiness:ethical deeds promoted happiness whilst unethical deeds diminishhappiness. In the case of nurse-patient relationship, happiness canbe replaced with the health a patient. Based on the earlier statementthat nurses’ primary responsibility is to patients, it thereforeimplies their ethical behavior as far as telling the truth isconcerned should be judged on its impact on the health of patients.
Anotherobligation that comes into play in determining the actions of nursesin telling the truth under utilitarianism involves relating withpatients on a personal and professional level (Ward,2012).Nurses are bound by duty to not only provide nursing care but alsooffer emotional support to patients and their families. This couldimply that nurses take the perspectives of therapists in regards toethics in relating with patients. For nurses, this means that thetruth or information that they should disclose to patients should belimited to beneficial information only that also does not affecttheir emotional wellbeing negatively (Lachman,2008).Any information that is not useful to them or that which worsenstheir situation should be abandoned. In so doing, patients will bebetter off with the truth or additional information or better offwithout it.
Fromthe discussion above, it is clear that nurses are faced by ethicaldilemmas in everyday practice. The various approaches to ethicsprovide different views on telling the truth. Professional ethics andChristian teachings call on telling the truth always. These positionsdo not consider the impact of such truths on patients, the healthcareinstitutions nurses. The personal and utilitarian approaches toethics take different stands in arguing that the choice to tell thetruth, omit some information or change some facts depends onprevailing circumstances. Where patients are concerned, it isimportant to consider the impact of such information to the patientand the family and also to the healthcare institution and thenurse(s) involved. If such information benefits the patient, itshould be given but if it does not, it should be withheld or evendistorted to protect the patient. It is ascertained that variousethical backgrounds have different views on telling the truth.However, the utilitarian approach which considers the circumstancesand the impact of truth on patients and other parties is the bestapproach in assisting nurses to make ethically and morally sounddecisions.
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