Ethical dilemma, tell me your thoughts.

[FolksBtrippin, BSN, RN]

Background: I work on an ACT team, which is the highest level of outpatient psychiatric care. We go to our patients homes, help them maintain housing, advocate in criminal matters, etc.

My patient, in her 70s, has been declining over the past year and we think she has some comorbid dementia, however her PCP disagrees. What is certain, is that she has significant short term memory loss.

Trying to avoid too many background details for privacy. Suffice it to say that she is currently in a subacute medical facility, and her husband who was her primary caretaker has died. Her son asked a member of our team not to tell her that her H passed and that team member agreed for the time being not to say anything.

However, it has now been 2 weeks, and this stipulation is being held, that we are not to discuss this with her, and my supervisor agrees.

I do not agree. At all. I plan to call a meeting to address the problem. I am confident in the team's respect for me. But I feel so strongly about this that if I can't get them to change their minds, I really don't know what to do.

I would appreciate your input.

[OldDude]

So is the line of thinking that she'll return to a normal mental capacity, be discharged, and thus be in a better frame of mind to take the news of her husbands death?

I completely agree with you. It's not your right to betray the terms of matrimony she and her husband vowed to however many years ago. "...in sickness and in health, to love and to cherish, till death do us part."

She probably already knows anyway.

[TriciaJ, RN]

Even if she has some dementia, surely she's noticed by now her husband isn't around. The hardest thing about having any type of mental impairment is not being able to trust one's own judgement. Imagine how much worse it must be if the people closest to you, whom you trust, are not being truthful. Most people, even impaired people, can deal with the truth much more easily than having to sort through fibs and obfuscations.

Maybe a care conference with the son would help. Ask him how long he plans to keep his mother in the dark, and whether it will be even worse news to find her husband has been dead for some time. She might not remember what she had for lunch, but something like this might have a bigger impact than we think.

Hopefully you can persuade him that it's better in the long run to come clean so she can be supported while she grieves. For all anyone knows, she might be grieving already with no support.

[ruby_jane, BSN, RN]

Has this person totally lost her mental capacity to take care of herself and is the son making those decisions legally? It doesn't sound like it.

Ethics consult, stat. Because you don't need to be in the middle of this. I am assuming you have some kind of ethics board at your workplace....if you don't then I would definitely elevate this up the chain of command.

You're a good nurse and you want to do the right thing by your pt. Best of luck.

[pixierose, BSN, RN]

I agree with you, 100%.

They have no right to keep this information from her.

How does her son play into this? Does he have any legal rights to make such decisions for her, because, like Ruby says, it sure doesn’t sound like it?

If there is an ethics board, this is the perfect situation to bring up them. Comorbid dementia presenting as short term memory loss and psychiatric disability does not prevent one from learning the love of her life is gone from this earth. She probably knows anyway, or has a feeling, and people - everyone - lying to her will make those s/s of those diagnoses so much worse.