Volume 22, Issue 11 (February 2025)
Nursing and Midwifery Journal 2025, 22(11): 919-922 |
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Abdollahi R. LYING OR EXPEDIENCY? THE ETHICAL CHALLENGE THAT NURSES FACE WHEN TELLING THE TRUTH. Nursing and Midwifery Journal 2025; 22 (11) :919-922
URL: http://unmf.umsu.ac.ir/article-1-5271-en.html
URL: http://unmf.umsu.ac.ir/article-1-5271-en.html
Nursing PhD student, Faculty of Nursing and Midwifery, Urmia University of Medical Sciences, Urmia, Iran , rezaabdollahi97@yahoo.com
Abstract: (281 Views)
In some situations, nurses inevitably resort to lying when caring for patients, while according to the ethical principles of caring for patients, it is necessary to be honest and tell the truth. This issue can become a complex and multidimensional ethical challenge for nurses. Truth-telling about the treatment process to the patient, regardless of his age, gender, and social and cultural backgrounds, should be considered an ethical principle. Although truth-telling is not considered one of the four principles of biomedical ethics, nevertheless, it is evaluated at the same level of importance as benefit, non-harm and justice (1). Expressing the truth is different according to the physical and mental conditions of each patient and does not follow a uniform pattern. Truth-telling about treatment to the patient helps to consciously search for the appropriate treatment, preserves independence and reduces his fear and anxiety, but at the same time it can be challenging for both patients and nurses (2).
Although healthcare team members, especially nurses, generally agree on the importance of truth-telling in the treatment process, sometimes the truth is not told to the patient. The main argument of nurses in justifying hiding the truth or telling an expedient lie is a type of deception in the interaction, which aims to prevent grief and protect unpleasant feelings in the patient (3). The motivation for using this deception is to protect the benefit of patients and prevent them from becoming more confused in stressful situations. Plato also believed that a lie about the origin of the disease sometimes acts like a medicine and prevents unwanted reactions in the patient (4).
Various studies have highlighted situations and conditions where expedient lying is common and usually unavoidable. Special conditions, including patients with cognitive disorders. These patients are not able to understand all or part of the existing truth, and if they know the truth of their illness, they become anxious or restless or have the possibility of harming themselves and others, so nurses inevitably resort to expedient lies (5). Similarly, due to children's inability to correctly understand information and older children, because in many cases they become disappointed and reduce cooperation with nurses after hearing the truth, nurses have no choice but to resort to expedient lies to gain children's trust and cooperation (6). End-of-life patients are another group where nurses sometimes have to tell expedient lies while taking care of them. In these people, when all the treatments have been unsuccessful, telling the truth will have the opposite result and will disturb the patient's mental peace (7).
Several reasons justify the use of expedient lying, which according to various studies can be mentioned such as considering the patient's interest. The most important point that should be taken into account when considering the expediency of the patient to tell an expedient lie is to consider the coordination of the definition of expediency from the point of view of the patient and the nurse. The best expedient is to consider the preferences and wishes of the patient and special attention should be paid to it (8). Another reason for using an expedient lie is the creation of inappropriate and unbalanced situations for the patient. Expedient lying in this situation can help stabilize the patient's mental and psychological conditions and reach a suitable position. Revealing the unfortunate truth in inappropriate circumstances is not only unhelpful, but also adds to the instability of the situation (9). Additionally, prioritizing the therapeutic goal to the principle of honesty is one of the cases in which expedient lies are used. Perhaps this can be justified by the fact that there are situations in which, knowing the truth, patients distance themselves and the treatment team from reaching the treatment goal, and the possibility of non-cooperation and not reaching the treatment goals and recovery of the patient is reduced by telling the truth. finds (10).
This article highlights that the truth-telling in some situations is a moral challenge faced by nurses. Trust arising from adherence to telling the truth is considered the most important factor in the success of nurse-patient relationships and is considered a kind of moral value. However, in certain situations, adherence to this moral value can be accompanied by difficulties. Factors like special conditions of patients and treatment goals play a crucial role in determining whether to tell the truth. While truth-telling is generally mandatory except in special cases, but it should not be forgotten that among the desired truth, there may also be bitterness for the listener; Therefore, what can be considered essential in telling the truth is considering the patient's condition and treatment goals. Although providing absolute solutions for this ethical dilemma is very difficult and complex and requires consensus with experts in the field of ethics as well as considering all dimensions and conditions of the problem, but in order to reduce physical and mental injuries in patients, nurses should receive the necessary training on ethical communication and learn about this and try to minimize the unpleasant side effects of knowing the truth by using the correct methods. In this direction, the necessity of providing correct information to patients as an ethical principle, compiling a guide for providing information in special conditions and situations of patient care, and using up-to-date models with a focus on respecting patients' rights are some of the proposed solutions to promote telling the truth to patients.
Although healthcare team members, especially nurses, generally agree on the importance of truth-telling in the treatment process, sometimes the truth is not told to the patient. The main argument of nurses in justifying hiding the truth or telling an expedient lie is a type of deception in the interaction, which aims to prevent grief and protect unpleasant feelings in the patient (3). The motivation for using this deception is to protect the benefit of patients and prevent them from becoming more confused in stressful situations. Plato also believed that a lie about the origin of the disease sometimes acts like a medicine and prevents unwanted reactions in the patient (4).
Various studies have highlighted situations and conditions where expedient lying is common and usually unavoidable. Special conditions, including patients with cognitive disorders. These patients are not able to understand all or part of the existing truth, and if they know the truth of their illness, they become anxious or restless or have the possibility of harming themselves and others, so nurses inevitably resort to expedient lies (5). Similarly, due to children's inability to correctly understand information and older children, because in many cases they become disappointed and reduce cooperation with nurses after hearing the truth, nurses have no choice but to resort to expedient lies to gain children's trust and cooperation (6). End-of-life patients are another group where nurses sometimes have to tell expedient lies while taking care of them. In these people, when all the treatments have been unsuccessful, telling the truth will have the opposite result and will disturb the patient's mental peace (7).
Several reasons justify the use of expedient lying, which according to various studies can be mentioned such as considering the patient's interest. The most important point that should be taken into account when considering the expediency of the patient to tell an expedient lie is to consider the coordination of the definition of expediency from the point of view of the patient and the nurse. The best expedient is to consider the preferences and wishes of the patient and special attention should be paid to it (8). Another reason for using an expedient lie is the creation of inappropriate and unbalanced situations for the patient. Expedient lying in this situation can help stabilize the patient's mental and psychological conditions and reach a suitable position. Revealing the unfortunate truth in inappropriate circumstances is not only unhelpful, but also adds to the instability of the situation (9). Additionally, prioritizing the therapeutic goal to the principle of honesty is one of the cases in which expedient lies are used. Perhaps this can be justified by the fact that there are situations in which, knowing the truth, patients distance themselves and the treatment team from reaching the treatment goal, and the possibility of non-cooperation and not reaching the treatment goals and recovery of the patient is reduced by telling the truth. finds (10).
This article highlights that the truth-telling in some situations is a moral challenge faced by nurses. Trust arising from adherence to telling the truth is considered the most important factor in the success of nurse-patient relationships and is considered a kind of moral value. However, in certain situations, adherence to this moral value can be accompanied by difficulties. Factors like special conditions of patients and treatment goals play a crucial role in determining whether to tell the truth. While truth-telling is generally mandatory except in special cases, but it should not be forgotten that among the desired truth, there may also be bitterness for the listener; Therefore, what can be considered essential in telling the truth is considering the patient's condition and treatment goals. Although providing absolute solutions for this ethical dilemma is very difficult and complex and requires consensus with experts in the field of ethics as well as considering all dimensions and conditions of the problem, but in order to reduce physical and mental injuries in patients, nurses should receive the necessary training on ethical communication and learn about this and try to minimize the unpleasant side effects of knowing the truth by using the correct methods. In this direction, the necessity of providing correct information to patients as an ethical principle, compiling a guide for providing information in special conditions and situations of patient care, and using up-to-date models with a focus on respecting patients' rights are some of the proposed solutions to promote telling the truth to patients.
Type of Study: Letter to editor |
Subject:
پرستاری
References
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