dishonesty in diagnosis

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if a patient is in end stage CA, and the location of the CA will cause significant psychological harm, can patient be told that the primary is in a different location, so long as the CA is not hereditary? patient has psych illness.

Specializes in NICU.

What kind of psych illness? Not that it changes my answer any, but I was curious.

You can't deny people the right to be stewards of their own care, and make decisions for themselves....unless they are legally proven unable to do so. If this person is unable to handle their own healthcare decisions, they should have a POA....be it a family member or another entity.

Even if it's completely believed that the patient is a total nutbag, it's not within the provider's right to deny the patient their own personal information. What a slippery slope to start on. I would imagine that some people think I'M a total nutbag, KWIM? There's no law/rule that says, "I don't think this person can't handle the truth, so I can lie." Eep.

And on a more personal note: I believe in the power of prayer, and that education about an illness is one one of the best ways to help the situation. It would stink to be denied accurate information based on someone'e opinion of my mental health, and praying for the wrong thing....or believing the wrong thing....or spending hours Googling the wrong thing. Yeah...the whole thing makes me feel ooky.:nono:

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it is never ethical to lie.

morally, it may be the kinder action.

but regardless of a pt's mental/psych status, everyone has the right to know the truth-

unless, they state they don't want to know.

but even then, an omission is not the same as skewing the facts.

leslie

:yeahthat:

no.

As usual, I agree with Leslie!

mc3:nurse:

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Specializes in OB, M/S, HH, Medical Imaging RN.
if a patient is in end stage ca, and the location of the ca will cause significant psychological harm, can patient be told that the primary is in a different location, so long as the ca is not hereditary? patient has psych illness.

if the patient is in end stage ca what difference does it make where the primary is? the patient has end stage ca. that's the diagnosis.

lying that the primary is in a different location is unacceptable.

why does the patient have to be told where the primary is anyway?

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Can you give us a little more detail, OP, about the primary site and the psychiatric issue, or is this hypothetical?

If the pt. has had a psychosis for years that he has evil aliens living in his head and he has a primary brain tumor...that could be a real problem.

Or a patient w/ a history of sexual abuse and/or self-blame who had a primary cervical CA...again I can see a real problem.

Is the pt. asking about the primary? How soon is death expected? Will the pt. have time and resources to therapeutically work through the info?

Sometimes, where being "ethical" and strictly and explicity truthful would be plain cruel, and not relevant to care or decision making, reluctant fudging of the facts might just be in order...

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this is all of the story that i have

a 34year old with possible terminal cancer and 3 children under 4 was undergoing tests to locate the primary. at this point there was a lot of suspicion that the ca was terminal, but without finding the primary tumor the doctors didn't want to make a solid statement.

the patient had presented to the a&e several months prior with serious back pain, and after x-ray was found to have several tumors on a number of vertebrae. the pt's medical history was four elective terminations of pregnancies, one when she was 18 and another at age 20, 21 and 24. post the second termination she suffered complications relating to retained fetal parts, and post the fourth termination had suffered a serious of ovarian cysts.

her children were born after the fourth termination.

anyway, long story short, the doctors eventually found the primary - it was located on uterine scaring, the doctors were all in agreement the primary cancerous growth was caused by the terminations. (it was a lot more complicated and lengthy explanation).

here's the ethical problem - the pt had suffered post abortion depression and had made 3 suicide attempts within months of the first three terminations. the pt explained that she'd continued to have top because she had wanted to get pregnant again after each top because she felt "empty" and was hoping the soul of the babies she'd "murdered" would return to her, but each time she got pregnant the circumstances which "required" the top still existed.

anyway, she had made comment to myself, and several other nurses and doctors that she believed her cancer was a punishment from her dead babies for killing them.

so, the doctors told her they had found the primary on her verta brae and it was no where near her uterus to ensure she didn't get "depressed" or blame her tops for her "death sentence". however, the pt asked on occasion to check the uterus for cancer, as she thought it might have been there, because of all her tops.

she wasn't an adherent to any major religion, but was very "spiritual" and followed a bunch of varying beliefs she had taken from a lot of asian and pagan religions.

sadly, the woman died several months after my clinical finished

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Specializes in ICU.

hmm. truth.

besides, can we ever really assume how anyone will react?

the best we can offer is team collaboration to ensure good care and safety of the patient.

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Specializes in LTC,Hospice/palliative care,acute care.
this is all of the story that i have

anyway, long story short, the doctors eventually found the primary - it was located on uterine scaring, the doctors were all in agreement the primary cancerous growth was caused by the terminations. (it was a lot more complicated and lengthy explanation)....

....so, the doctors told her they had found the primary on her verta brae and it was no where near her uterus to ensure she didn't get "depressed" or blame her tops for her "death sentence". however, the pt asked on occasion to check the uterus for cancer, as she thought it might have been there, because of all her tops.

..sadly, the woman died several months after my clinical finished

i've never heard of this-i'll have to do a bit of research-that is a sad diagnosis.but-how dare those doctors withhold such info-i find that reprehensible.of course she would get depressed-wouldn't anyone intitally after receiving a terminal diagnosis?? she was robbed of the chance to make peace-fruitcake or no,she deserved dignity dying and i don't think she really got it.

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Specializes in Med-Surg.

That's a very interesting case and I can understand the dilemma of the health care team in not wanting to make her end days so miserable, providing she was told it was a terminal case and she was dying. Still, it's not their role to sugar coat the truth.

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Thanks, Meganm. I never heard of TOP causing uterine CA - related to the retention of fetal parts that one time? If you can provide a litte more of the doctors' explanation I would appreciate it as I'm interested in pursuing CNM/women's health later on.

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This is a very bizarre story.

So what exactly would her physicians have done if she had requested treatment? How do you consent someone for a hysterectomy and tumor debulking when they think they have a "vertebrae primary".

In an era where everyone and their mom reads about their diagnoses on the internet, it wouldn't have taken this woman long to learn that she had been lied to. Lucky for her doctors she didn't research her own condition.

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