Question

Geraldine (Gerri) Bowen is a 74-year-old woman living with dementia. Her husband passed away one year ago. He was her primary care giver, although he had contracted for a daily caregiver to help Monday through Friday with Gerri’s activities of daily living and so that he could run errands such as banking, grocery shopping, etc. Since his death, the family (three sons and their wives) set up 24-hour care giving because Gerri wants to live at home and not in an extended care facility. Recently, Gerri had complained of abdominal discomfort and has frequent diarrhea. After some diagnostic tests (a lower GI, a CT and abdominal MRI) she was diagnosed with Stage 3 (late stage 3) colon cancer. In addition, Gerri has a right lower lobe lung lesion. The surgeon feels that it is most likely not metastasis, but a second primary cancer. The surgeon recommends palliative surgery, since Gerri will not benefit from radiation or chemotherapy. You are the nurse caring for Gerri after her colon resection and overhear the family discussing what they should be telling their mother. Gerri asks you, “no one is telling me what is going on. It’s not right. I don’t want to stay here (the hospital) I just want to be at home. I don’t like all these people around me.” You tell the oldest son that Gerri has asked questions about her condition on several occasions. He tells you that he and his brothers cannot agree whether Gerri should be told about her condition (the cancer). He advises you to tell Gerri that nothing is wrong. While two of the sons want their mother told, the third son feels it would be cruel to tell her because she isn’t completely “there”. Gerri recognizes her family and recalls the past all the time. She often has difficulty expressing her feelings and recalling the immediate past. But it is your opinion that she does understand some things.

What is the dilemma and relevant facts in this case? What ethical principles are pertinent to this case?

Answer 1

The above case presents many ethical dilemmas for the nurse being questioned by the patient Gerri. Some of the dilemmas are:

Should the nurse declare the disease status and about colon resection to the patient?

Should the nurse lie or remain quiet as been told by patients son?

do her son know patient better than her and hiding truth is required?

What would be the implications if the nurse declares the truth to the patient?

What would be the result if the nurse remains quiet and moves ahead with the way things are?

How should nurse deal with such an ethical dilemma?

The ethical dilemmas to this case involve following ethical principles: Respect for autonomy and justice; Non-maleficence; Beneficence. Respect for autonomy requires the nurse to provide complete information to the patient and not hide anything so that the patient knows about her disease status. It would mean that the nurse declares the truth to the patient about her prognosis and ultimately bear the consequences. The principle of beneficence supports the autonomy of the patient as in this case telling truth to the patient and respecting her autonomy could prove to be beneficial as Ms. Gerri would feel more confident in deciding her course of life.

However, by telling the truth the patient may end up in severe depression and resentment – a rift of autonomy with beneficence and non-maleficence. Thus its important to weigh the benefits and risks for the patients and then taking appropriate decision for the patients. If declaring poor prognosis and colon resection to the patient could harm her then distorting patient autonomy could be a better option. As patient is already sick and by making the patient more depressive, a nurse can further elongate the suffering of the patient

Furthermore, Gerri's sons are asking the nurse to remain quiet about the disease to the patient. It may be beneficial and maybe harmful. The nurse could decide to remain quiet and support the sons decision or impose her decision on the patient. If nurse supports sons decision and hide the truth, and if later sons declare the truth to the patient, then a mistrust relationship would develop between Mrs. Gerri 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 stress and frustration. Thus declaring the truth could harm the patient and hiding it would also hurt the patient is the major Delima faced by the nurse