Disclosing information to the patient is a cardinal rule in the United States and other Western nations. However, it is not a moral stance that is shared globally due to the diversity of culture and beliefs. The honest disclosure of terminal prognosis and diagnosis is vital in preparing for the end of life. Despite this, concealing of the truth is a common practice in Asian and Muslim cultures who consider illness as a shared family problem (de Pentheny O’Kelly, Urch & Brown, 2011). Decision-making is considered to be family-centered and beneficence and non-malfeasance play a key role in their ethical model which is in contrast to patient autonomy in Western cultures. There is a belief that grave diagnosis and or prognosis will extinguish the patient’s hope thus making the families protect the sick members from the truth. Due to this, the patients expect aggressive futile treatment.
In this case, where the family does not want to disclose the truth to the patient, it would be important to respect their decision and establish a negotiated mechanism of informed decision making that incorporates the family. The ANA code of ethics (2014) stipulates that when planning, the patient, family, and other factors such as culture, lifestyle, religious beliefs, and value system should be considered. In traditional Chinese culture, it is taboo to disclose information on a death to the patient (Dong, Zheng, Chen, Wang, Zhou & Sun, 2016). This hinders effective communication with patients. It is important for me as a nurse practitioner to establish if the family holds such beliefs and not just jump into conclusions. Since they believe that truthful disclosure is harmful to the patient, then I would withhold the tuberculosis diagnosis. My decision is influenced by the family’s cultural considerations.
References
American Nurses Association, (2014). The Code of Ethics for Nurses with Interpretive Statements. Retrieved from https://homecaremissouri.org/mahc/documents/CodeofEthicswInterpretiveStatements20141.pdf
de Pentheny O’Kelly, C., Urch, C., & Brown, E. A. (2011). The impact of culture and religion on truth-telling at the end of life. Nephrology Dialysis Transplantation 26(12), 3838–3842.
Dong, F., Zheng, R., Chen, X., Wang, Y., Zhou, H., & Sun, R. (2016). Caring for dying cancer patients in the Chinese cultural context: A qualitative study from the perspectives of physicians and nurses. European Journal of Oncology Nursing, 21, 189-196.