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Difficulty: Very hardEthical Practice

A competent older adult client is admitted with advanced pancreatic cancer. The client's adult children urgently tell the nurse, "In our culture, telling someone they have terminal cancer destroys their spirit. You must not tell our parent the diagnosis." Furthermore, the children request that the unlicensed assistive personnel (UAP) administer the client's oral antineoplastic medications so the client does not ask the nursing staff questions about the pills. Later, the client asks the nurse, "The doctors are speaking in medical jargon. Am I dying?" Which of the following is the most appropriate ethical action by the nurse?

  1. A
    Delegate the administration of the oral antineoplastic medications to the UAP as requested, and reassure the client that the medical team is doing everything possible.
  2. B
    Question the family by asking, "Why do you believe hiding this diagnosis is appropriate?" and then provide the client with full disclosure of their terminal prognosis.
  3. Decline the medication delegation request and ask the client, "What is your understanding of your condition, and how much information would you like me to share with you?"Answer
  4. D
    Respect the family's cultural traditions by withholding the terminal diagnosis and assure the client by stating, "Your family is managing your care, and everything will be alright."

Answer

The correct action is to decline the inappropriate delegation of medication administration to the UAP and to assess the client's individual preference for receiving health information.
The correct action addresses both the legal and ethical components of the complex scenario. The nurse must decline the family's request to have the UAP administer medications, as this directly violates the RN's scope of practice. When a competent client asks a direct question about their prognosis in a cross-cultural context, the most ethical approach is to uphold autonomy and veracity by assessing the client's individual desire for information. Asking how much detail they wish to know allows the client to control the flow of information, honoring their personal values and readiness without stereotyping.

Step-by-Step Solution

1
Identify the delegation conflict.
Recognize that administering oral antineoplastic medications is strictly outside the scope of practice for a UAP.
The nurse retains accountability for medication administration and must adhere to legal scope of practice boundaries, regardless of family requests.
2
Analyze the ethical dilemma regarding truth-telling (veracity) versus cultural beliefs.
Determine that the nurse cannot automatically withhold information based solely on the family's cultural claims.
The principle of autonomy requires that the competent client's individual preferences take precedence over family directives.
3
Formulate a therapeutic response to the client's direct question.
Select an open-ended statement that explores the client's readiness and desire for information.
Asking the client how much they want to know respects both their autonomy (right to know or right to refuse information) and individual cultural values without making stereotypic assumptions.

Key Concept

Ethical Practice: Upholding Veracity, Autonomy, and Scope of Practice in Cross-Cultural Contexts
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Ethical Practice

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