Download Veracity and Truth-Telling in Healthcare: Ethical Dilemmas and Cultural Considerations and more Exams Nursing in PDF only on Docsity!
Veracity is often thought of simply as honesty is the best policy, or the idea that one should tell the truth, conform to the facts, report things accurately. Veracity is somewhat more complex and can be thought of as the principle of truth telling as “grounded in respect for persons and the concept of autonomy.” Autonomy requires that a person has sufficient relevant information, presented as clearly and easily understood as possible, in order to make informed decisions. Veracity, or truth telling, is violated by lying, which is deliberately providing erroneous information. It can be violated by an act of omission by deliberately withholding all or some of the truth. It can also be violated by using language or jargon in such a way that it cannot be understood by the other party or that intentionally attempts to mislead. (Ethics, n.d.) In the context of health care as in all professions, the concept of veracity can be related to basic honesty in documentation, regulatory compliance, professional relationships, etc. However, it is equally or more important in the relationship between health care professionals and their patients and the patients’ families. The fundamental ethical principle is respect for persons, and truth-telling appears to obviously support this principle, as it does respect for autonomy, which includes informed consent which requires that sufficient and correct information be provided. However, the application of veracity to patient care can lead to ethical dilemmas in a number of situations, including end-of-life treatment. Some patients expect to be provided with all information, positive and negative, about their situation so that they can make informed decisions. Other patients or patients’ families have a different relationship with health care issues and do not want to be directly told the truth. This places a nurse or other professional in the situation where “the duty to obtain informed consent is compromised by the wishes of the patient or family.” (Ethics, n.d.).
The Position Statement of the American Nurses Association regarding the provision of expert care and counseling at the end of life restates the fact that nurses have always cared for the dying. Their role in providing the highest quality of remaining life and support at the end of life for both patients and their loved ones is traditional, accepted, and expected. The nurse’s fidelity to the patient requires the provision of comfort and includes expertise in the relief of suffering, whether physical, emotional, spiritual, or existential. (American Nurses Association, 2010). During the process of end-of-life care, nurses must provide the best possible care within each unique patient/family/social system with the goal of providing a comfortable death or of dying well. (Dahlin, 2004). Nurses in the United States and most other western countries are educated to understand that veracity and fidelity are the ethical principles that form the foundation of trust. However, the mechanics of how truth telling is to be applied to individualized and sensitive patient care can be problematic. For instance, supporting the autonomy of the patient and his or her right to informed consent requires complete disclosure. But this is not necessarily appropriate in cultures which place decision-making in the hands of one or more family members rather than the patient. This is an especially critical area in cases where a new prognosis is terminal and for end-of-life care. American nurses have been taught to give control to dying patients by providing them with information. Some cultures may feel that it is better to protect the dying patient from anxiety and distress by withholding information. (Maier-Lorentz, 2008). Other cultures, such as the Navajo, avoid talking about death or terminal illness at all because they believe that the discussion itself could cause an earlier death. (Srivastava, 2007).
veracity can be used to justify the choice to provide full information to the father, regardless of the position taken by the daughter. (Carter and Johnston, n.d.). However, the principle of beneficence can be applied to the same situation, in which case the benefits and risks of harm must be balanced and consideration must be given to how the father can best be helped. The decision might be made to withhold the information, at least temporarily. Another case study is that of a Hispanic male in his seventies who had been hospitalized for seven months with what was determined to be advanced stage pancreatic cancer. He had twelve children who had never used the word “cancer” in front of him, instead referring only to his abdominal pain, and they had been unequivocal in keeping his prognosis from him. One day he asked his nurse directly if he was dying, but before she even had a chance to respond, he explained that he did not want his children to suffer additional pain because of his disease. He believed that if they knew that he also knew, it would cause them suffering. He chose to pretend he was ignorant about his disease rather than be open about his knowledge. He expected the nurses to protect his confidence, and they did so. They had previously been withholding information from him, a failure of veracity, out of respect for the values of the family’s culture. Going forward, they chose not to practice veracity with the patient’s family. (Galanti, 2015). The principles of confidentiality, the duty to respect privileged information, and fidelity, the duty to keep promises, conflicted with and in this case overrode the principle of veracity as applied to the patient’s family. Lachman wrote regarding a different case study that, “The duty to tell the truth (veracity) is an ethical obligation, and this case requires that all who are involved have the endurance for
truth seeking.” (Lachman, 2007, p. 12). Truth seeking implies seeking a greater good, incorporating to the best of one’s ability all the essential ethical principles of the profession. Nurses in end-of-life care face tremendous challenges regarding communication. Cross- cultural communication can be among the most demanding situations. A study was done of examining physicians and their attitudes toward end-of-life care, and as part of that study, 19 primary nurses who were caring for the same patients were interviewed regarding their attitudes toward transculturalism and whether it helped or impeded their care for the patients. “These nurses expressed the transcultural awareness that communication is central to effective end-of- life care because, while all cultures have end-of-life practices and rituals, each death is unique to the patient and family who experience it.” (Mitchell, Gale, Matzo, McDonald, and Gadmer, 2002 , p. 28). This still leads to the question of whether all practices are permissible, simply because they are accepted and expected with a certain cultural context. Complying with the family’s request can be seen as withholding the truth, but going against their wishes can be viewed as imposing the truth. It is possible that a compromise position can be found in offering complete information, the truth, and “allowing the person to define the level and explicitness of the information they require to interpret care options.” (Srivastava, p. 95). It is not only in deciding between family members and patient that the end-of-life nurse might face an ethical dilemma regarding veracity: Nurses experience ethical concern when faced with consensus-building activities to establish goals of care, uncertainty about capacity and/or patient wishes, futility, withhold/withdraw life-sustaining treatment decisions, aggressive symptom management, addressing concerns of significant others, and varied spiritual or cultural beliefs. There
References ANA Position Statement. (2010, June 14). Registered nurses’ roles and responsibilities in providing expert care and counseling at the end of life. Boyle, D. A., Sheridan, A., McClary, J., & White, J. (2002). A multifocal education strategy to enhance hospital-based cultural competency in professional staff. Oncology Nursing Forum, 29 (5), 764-768. doi: 10.1188/02.ONF.764-768. Carter, J. & Johnston, R. (n.d.) Foundational ethical concept of veracity. [PowerPoint Presentation]. Retrieved from: http://roxannejohnston.yolasite.com/ resources/Veracity.pdf Dahlin, C. (2004). Ethics in end-of-life care. Journal of Hospice and Palliative Nursing, 6(1), 2-
- Retrieved from: http://www.nursingcenter.com/journalarticle?Article_ID= Ethics at a Glance: Veracity. (n.d.). Retrieved from Regis University Rueckert-Hartman School for Health Professions: http://rhchp.regis.edu/hce/ethicsataglance/Veracity/Veracity.pdf Galanti, G-A. (2015). Caring for patients from different cultures. Fifth edition. Philadelphia: University of Pennsylvania Press. Hayes, C. (2004). Ethics in end-of-life care. Journal of Hospice & Palliative Nursing, 6 (1), 36-
Lachman, V. D. (2007, Spring). Moral courage: Clinical case example. American Society for Bioethics and Humanities. Retrieved from: https://idea.library.drexel.edu/ islandora/object/idea%3A2026/datastream/OBJ/download/Moral_courage__clinical_case _example.pdf
Lachman, V. D. (2008). Making ethical choices: Weighing obligations and virtues. Nursing 2008, 38 (10), 42-46. Retrieved from Lippincott Nursing Center: http://nursingcenter.com/ journalarticle?Article_ID= Maier-Lorentz, M. M. (2008, Spring). Transcultural nursing: Its importance in nursing practice. Journal of Cultural Diversity. 15 (1). 37 - 43. Mitchell, A. M., Gale, D. D., Matzo, M. L., McDonald, M. C., & Gadmer, N. (2002). Critique of transcultural practices in end-of-life clinical nursing practice. Nursing Forum, 37 (4), 24 -
Srivastava, R. H., Ed. (2007). The Healthcare Professional’s Guide to Clinical Cultural Competence. Toronto: Elsevier Canada.
