Telling the Truth - A Tussle between Four Principles of Ethics

Abstract

Volume 5 • Issue 2 • 1000172 J Clin Res Bioeth ISSN: 2155-9627 JCRB, an open access journal autonomy could prove to be beneficial to the patient as the patient feels more confident in deciding her course of life. However, there is another side of the coin too. The patient may not react in the way explained earlier; the patient may end up in severe depression and resentment – a rift of autonomy with beneficence and non-maleficence. The latter concepts believe in weighing the benefits and risks for the patients and then taking appropriate decision for the patients [2]. If declaring poor prognosis to the patient could harm the patient then distorting patient autonomy could be a better option. This is because, the patient is dying and by making the patient more depressive, a nurse can further elongate the suffering of the patient, further increasing the disgrace. No doubt the patient has to die but death with dignity is the right of the patient. In this case respecting patient autonomy could not beneficial as it could distort the benefits that the patient could acquire without knowing the reality of the disease. But can this situation be practical? If the nurse decides to distort patient autonomy as the risk of the truth outweighs the benefits then the nurse is residing towards the stigmatized principle of paternalism. The nurse in this situation assumes that the patient will benefit if the disease is not disclosed to her but can one generalize the implications of truth to all the patients? Generalizing the findings that truth telling will definitely cause harm to patient is incorrect (Woodward, 1998) [3]. and against the code of ethics which constantly focuses on treating patients as individuals with separate identities. Furthermore, the relatives in this scenario are asking the nurse to remain quiet about the disease to the patient; but who can judge the grounds of relatives' requests. It may be beneficial and maybe evil. If the nurse decides to remain quiet and support the relatives then the paternalistic approach proves positive. The nurse is imposing her decision on the patient and if later on the relatives declare the truth to the patient, then a mistrust relationship would develop between the patient and the nurse. The patient may die with the belief that the nurse did not tell her anything despite knowing the truth. On the other hand, the nurse may feel guilty of hiding the truth from the patient which could lead to job dissatisfaction, stress and frustration. Thus declaring the truth could harm the patient and hiding it would also hurt the patient.