Ethical issue?

[nursesmatter]

Hello. I have a question to ask because I have been reading about ethical issues and moral distress. I recently experienced an event on my unit which caused multiple staff including myself to feel frustrated and somewhat angry. I cared for one member of an elderly couple that were involved in an accident. Unfortunately, the woman's husband passed during the accident. She survived and I cared for her for 2 days immediately after the event. Her adult children were present at her bedside throughout her hospitalization for her emotional well-being. Upon arrival to my unit, one of her family members pulled me aside and told me (not asked) not to disclose her husband's death because they wanted her to get well first, then eventually tell her. Family members also told each staff that provided her care the same thing. During the 2 days I cared for her, multiple times she asked me about the condition of her husband. Whenever she asked me this, I looked at her family members and they would glare at me. So I ended-up distracting her or would tell her to focus on her healing first. Not telling her what happened to her husband ate me inside. If that were my significant other, I would want to know right away. Finally, the family told her about her husband's death on her 5th day of hospitalization.

I'm not sure but I feel as though this type of situation may be more common than I think. But my question is: Do you think this is an ethical issue that could have initiated an ethics consult??? Thanks for your input!

[Castiela]

That is a hard situation to be in. On ine hand, it really isn't your position to tell her that her husband died. I imagine that would be more the social workers/ family's role. You could have requested an ethics consult; however, i find they generally will just outline the ethical principles and hilight potential consequences of telling vs not telling.

Would the stress of finding out her husband had died have negatively affected her condition? I have been in that situation in ICU and The team withheld information about the fate of a co passengers fate, as we operating under the principle of beneficence/ non malificence. The family did tell the patient. I understand your distress.... But I honestly think you did the right thing by letting the family to be the ones to break the news.

[nursesmatter]

Hi, thanks for sharing your thoughts and support. I have never been involved with an ethics consult so your experience with them is greatly appreciated! But yes, those were 2 difficult 12-hour shifts to endure.

[morte, LPN, LVN]

she knew, she wanted confirmation.

[elkpark]

morte said:

she knew, she wanted confirmation.

Yeah, usually people already know (or, at least, strongly suspect) what their families are so determined to keep from them.

[MunoRN, RN]

I've had a number of families make this request, but I've never worked anywhere that was any consideration to abiding by the request. We're happy to tell the patient with whatever support and family they would like to be present, but it's extremely unethical to withhold this information, particularly for five days.

I have had patients that come from cultures where it's customary not tell someone when they are actively dying, I have seen information withheld from these patients but only when the patient explicitly agrees to being kept in the dark.

[missmollie, ADN, BSN, RN]

I've had a similar issue, and you find that you respect the wishes of the family. I took the family into a conference room to discuss why they didn't want to tell her, how they were going to handle it when they did tell her, and if they need someone else to speak to concerning the decision. I coordinated time for the family to speak with a resident and had a chaplain available when they felt she was ready. I emphasized the need for that grieving process to begin, but ultimately it was their decision. I do my best and I don't lose sleep over patients, families, or their issues.

[nursesmatter]

thanks everyone for sharing your thoughts!

[JKL33]

missmollie said:

I've had a similar issue, and you find that you respect the wishes of the family.

As a general rule? Absolutely not.

The ED deals with this (and similar) situations not infrequently.

False hope about whether one's dear loved one (in this case, life partner) is alive or not is absolutely cruel. When patient condition permits, the best thing is to have every resource at the patient/family/staff's immediate disposal and undertake efforts to proceed with the truth, and really to assemble these resources as soon as possible so that not much time is wasted allowing the family to linger with the belief that they control what information the patient can have.

Withholding such information ethically (and maybe legally?) is not an option more times than most people think. Yes, it is devastating, but that is not a reason for everyone else to start making executive decisions on behalf of the patient.

I've had some experiences with this that I don't think I'll forget as long as I live.

[MunoRN, RN]

missmollie said:

I've had a similar issue, and you find that you respect the wishes of the family. I took the family into a conference room to discuss why they didn't want to tell her, how they were going to handle it when they did tell her, and if they need someone else to speak to concerning the decision. I coordinated time for the family to speak with a resident and had a chaplain available when they felt she was ready. I emphasized the need for that grieving process to begin, but ultimately it was their decision. I do my best and I don't lose sleep over patients, families, or their issues.

It's not "ultimately their decision", your responsibility is to your patient and to abiding by basic ethical principles regarding advocating for your patient and their rights, not appease their family's request to intentionally deceive a patient about the fate of their spouse.

[nursesmatter]

Just wondering... Is telling the patient allowable in our professional practice or should this be more of a responsibility for the attending MD? I was surprised that the physician got bullied by the family and didn't say anything either. I know through our education we learn ethical concepts, but I feel as though the multiple ethical concepts sometimes contradict themselves and offer a gray area sometimes. Damned if you do, damned if you don't??? At the time, I wasn't sure if I could be putting my job (and personal safety from an angry grieving family) in jeopardy if the family or MD reported me, so I just kept my mouth shut.

Thanks again for the feedback!

[nursesmatter]

Yes, it's probably time I revisit ethics 101 again. Thank you starting my review.