Scout Oath
On my honor I will do my best
To do my duty to God and my country
and to obey the Scout Law;
To help other people at all times;
To keep myself physically strong, mentally awake, and morally straight.

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Ethical Controversies

Paternalism

PATERNALISM

This scenario was adapted from Ethics in Nursing by M. Benjamin and J. Curtis. (New York: Oxford, 1986)

Position One: Tell Her

Kim Holt was assigned primary nursing responsibility for Ann Hernandez, a divorcee in her mid-forties who had just been diagnosed as having cancer of the colon with metastasis involving lymph nodes. Kim had cared for Mrs. Hernandez for three days before the operation and had established good rapport with her.

Two days after the operation it became apparent to Kim that, while Mrs. Hernandez had been informed that she had cancer, she had not been informed about the seriousness of her condition or of her poor prognosis. Shortly thereafter, one of Mrs. Hernandez's daughters approached Kim and urged her to assure her mother that everything was going to be all right. She explained that Mrs. Hernandez had just gone through a long and unpleasant divorce, and that she and her sister wanted their mother spared the further pain of learning that she was terminally ill and that no proven, effective treatment was available.

Deeply troubled, Kim discussed the situation with Dr. Shaeffer, Mrs. Hernandez's physician. Dr. Shaeffer said he had informed Mrs. Hernandez that she had cancer but, to spare her unnecessary anxiety, he had allowed her to maintain her belief that it could be effectively treated, a belief 1not supported by the facts in her case. He added that if she told Mrs. Hernandez the truth it would be inconsistent with the well-being of the patient and Kim's role as a nurse.

Kim has an obligation to tell Mrs. Hernandez the truth. No medical person has the right to withhold this kind of information from patients. Doing so violates their dignity and their right to self-determination. The Patient's Bill of Rights says the patient has the right to "complete current information concerning his diagnosis, treatment, and prognosis in terms the patient can be reasonably expected to understand."

Withholding the information also compromises Kim's relationship with the patient, detracting from her integrity, since she is being asked to lie. Most dying patients are able to figure out their true status from other sources since it is difficult to hide something so serious. Finding this out could make it worse, since patients will know they have been deceived.

Position Two: Don't Tell Her

Kim Holt was assigned primary nursing responsibility for Ann Hernandez, a divorcee in her mid-forties who had just been diagnosed as having cancer of the colon with metastasis involving lymph nodes. Kim had cared for Mrs. Hernandez for three days before the operation and had established good rapport with her.

Two days after the operation it became apparent to Kim that, while Mrs. Hernandez had been informed that she had cancer, she had not been informed about the seriousness of her condition or of her poor prognosis. Shortly thereafter, one of Mrs. Hernandez's daughters approached Kim and urged her to assure her mother that everything was going to be all right. She explained that Mrs. Hernandez had just gone through a long and unpleasant divorce, and that she and her sister wanted their mother spared the further pain of learning that she was terminally ill and that no proven, effective treatment was available.

Deeply troubled, Kim discussed the situation with Dr. Shaeffer, Mrs. Hernandez's physician. Dr. Shaeffer said he had informed Mrs. Hernandez that she had cancer but, to spare her unnecessary anxiety, he had allowed her to maintain her belief that it could be effectively treated, a belief 1not supported by the facts in her case. He added that if she told Mrs. Hernandez the truth it would be inconsistent with the well-being of the patient and Kim's role as a nurse.

It is in the interest of the patient to withhold information because this prevents pain and suffering. To tell her might increase her depression about her divorce and make it less likely she will respond well to treatment. It is the physician's responsibility to decide what is in the best interest of the patient.

The right to know is not an absolute right. The right to know is not absolute because it is part of the responsibility of the caring professional to decide in the best interests of the patient how, when, and how much to tell.