Journal of Clinical Research & Bioethics

Veracity or Beneficence: Ethical Conundrum

Ina Abdul Majeed^*, Kiran Karim, Farida Bibi Mughal, Kanwal Karim, Sabeen Shamsher Ali and Naureen Mistri School of Nursing and Midwifery, The Aga Khan University, Karachi, Pakistan
^*Correspondence: Ina Abdul Majeed, School of Nursing and Midwifery, The Aga Khan University, Karachi, Pakistan, Email:

Received: 09-Jan-2023, Manuscript No. JCRB-23-19556; Editor assigned: 12-Jan-2023, Pre QC No. JCRB-23-19556(PQ); Reviewed: 26-Jan-2023, QC No. JCRB-23-19556; Revised: 03-Feb-2023, Manuscript No. JCRB-23-19556(R); Published: 11-Feb-2023, DOI: 10.35248/2155-9627.23.14.454

Description

A young primigravida developed complications during labor and underwent an emergency cesarean section. The baby was stillborn. The patient was discharged but developed post-partum hemorrhage and was taken to a tertiary care hospital where doctors advised a hysterectomy. Consent was not taken from the patient as she was physically and mentally distressed but from her husband and family for whom it was a difficult decision. The patient was grieving due to the loss of her baby and had already suffered a lot so the family requested to hide from the patient that she has to undergo a hysterectomy.

This clinical scenario poses different ethical issues which need to be viewed in the light of ethical principles to draw better conclusions. If the patient is competent but emotionally upset, should autonomy be the priority? In distressed patients, is it acceptable to hide the treatment plan?

Adult and conscious patients have a complete right to know and give consent about the treatment. Moreover, there are instances where surrogates can also give consent on behalf of the patient when they are unconscious or incapable to give consent. Here the issue is that consent was taken from her surrogate even though she was an adult and conscious.

Hiding the bad news from the patient and surrogate decisionmaking in surgery is unjustifiable. I believe that healthcare professionals should give patients a chance to make their own decisions. This paper aims to reflect on the above example from different ethical paradigms and to share viewpoints based on ethical theories.

Veracity

The principle of veracity entails telling the truth and providing accurate information to the patient [1]. It forms the foundation of autonomy for the patient and patients get a chance to involve in their own decisions. Moreover, informed consent can only be exercised when patients are fully aware of their disease and plan of care [2]. It helps the patients to be aware of the risk and benefits of the treatment and they can decide for themselves. This might build a trusting relationship with the health care provider which will help them to express their feelings easily and get required support timely. The above patient also has a complete right to know the truth of her treatment plan because she is young, and her future generation is dependent on it. However, the patient will know the truth in near future and it can create chaos in her life. Moreover, opting to not tell the patient about the surgery which is violating the principles of veracity will delay the grief.

Autonomy and respect for a person

Respect for a person acknowledges autonomy which means individuals should be dealt with as autonomous beings [3]. Autonomy is one of the principles of biomedical ethics which is also referred to as respect for a person [4]. Autonomy always allows the individual to make their own decisions about their health without any coercion. It results in taking ownership of both positive and negative consequences and also helps in gaining satisfaction in the end. In addition, suppressing a person’s autonomy is to neglect their goals. Multiple aspects influence the decision like patients not only suffering from the disease but the realization that they will also face limitations due to that disease will affect their decision. Involving the patient in the decision-making process can support the patient to consider these factors. As in the above scenario, the patient will identify about the hysterectomy which will create more grief and prolong the denial phase if the procedure underwent without her consent.

Counter argument

Paternalism: Beneficence versus Autonomy: In bioethics, paternalism is the opposite of autonomy. It refers to actions or decisions that are made in the interest of the patient but without or against the person’s informed consent [5]. In the above scenario, the patient was presently grieving as she has faced the death of a child so to maintain the psychological health of the patient it was the better option for the family to hide the situation and allow them to perform the surgery with surrogate consent. This supports the theory of ethics of care which enacts the family to accomplish their duty [6]. The husband and family wanted to hide the truth from the patient for her beneficence to prevent further emotional distress and grief which is supporting the theory of ethics of care. Although the patient’s autonomy and veracity are violated, the patient’s psychological health can be maintained and life will be saved.

One of the exceptions to informed consent includes the inadequacy of time to decide on life-threatening conditions [7]. As in the above situation, patient was bleeding and at any time condition can deteriorate. So, saving a life is more important and the urgency of the situation influenced the family to decide on the behalf of the patient to give consent and withhold the truth from the patient. Moreover, according to the legal approach, if the patient is psychologically unfit so; the state of law should follow the hierarchy to decide on a surrogate to give consent [7].

Justification for my position

In the aforementioned scenario, I ponder that my position sounds more ethically suitable and it is following ethical principles which are in favor of the patient. It is important to know the patient’s values and beliefs and their perspective before performing any procedure. Even if the procedure was performed for the patient’s beneficence, they fail to consider the patient as an autonomous being. Hence, the paternalistic approach was followed without considering the patient’s autonomy.

Conclusion

In the eastern view, family plays a crucial role in the decisionmaking process in individuals who are suffering from any health concern whereas the patient’s autonomy should be the prime focus in concluding any decision. In addition, healthcare professionals should be skilled to assess psychological distress. They should be competent in communication skills particularly in breaking bad news and should be aware of the ethics of veracity. Healthcare professionals can ask the distressed patients about their wish to identify disease process and treatment plan or a surrogate can make decisions for them. Also, including the patient in the decision-making process will promote respect for autonomy. The involvement of an ethical review committee should be implemented during a stressful situation.

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