As the nurse caring for Robbie, the 14-year-old boy with terminal leukemia, it is crucial to approach this sensitive situation with empathy and honesty.

QUESTION

Pediatric Ethical Case StudyInstructions

For the case study provided, respond to the critical thinking questions using a Microsoft Word document.

Case Study

Meet your client, Robbie.

Robbie, a 14-year-old boy, is hospitalized for leukemia after a failed bone marrow transplant. The family has been told his condition is terminal; there is nothing more to be done except keep him comfortable. His mother is distant, uncommunicative, and rarely visits.

When she does, she doesn’t touch Robbie or speak to him. She sits in a recliner by the window, reading novels and requesting cokes multiple times per visit. The staff calls a family meeting, but the mother is conspicuously absent. Robbie’s father is frantic, demanding further treatments, regardless of the low likelihood of efficacy. During the family meeting, he directs the team NOT to tell Robbie he might die, as he would lose hope. He states: “In our culture, we keep this news from patients to avoid upsetting them.” You are the nurse. When you are alone caring for Robbie, he asks you, “Am I dying?”

Critical Thinking Questions

1. How should you respond?
2. What are three options you could select? Cite the advantages and disadvantages of each.
3. How does the Code of Ethics for Nurses guide you in the virtue of truth-telling?
4. Who is the authorized decision maker in this case?
5. What other considerations play a part in your response?

ANSWER

As the nurse caring for Robbie, the 14-year-old boy with terminal leukemia, it is crucial to approach this sensitive situation with empathy and honesty. When Robbie asks, “Am I dying?” it is essential to acknowledge his question and respond in a compassionate manner that respects his autonomy and dignity.

Three options to respond to Robbie’s question are as follows:

Honesty and Openness: The nurse can choose to be honest with Robbie and gently inform him of his prognosis. This approach allows Robbie to have a clear understanding of his situation and enables him to make informed decisions about his care and express his wishes. Advantages of this approach include fostering trust between Robbie and the healthcare team, promoting open communication, and respecting his right to know the truth. However, the disadvantage is that it may cause emotional distress and anxiety for Robbie, potentially challenging his ability to cope with the reality of his condition.

Partial Disclosure: Another option is to provide Robbie with partial information, acknowledging that he is seriously ill without explicitly mentioning that he is dying. This approach aims to balance the need for truth-telling with the desire to protect Robbie from overwhelming emotions. Advantages include potentially reducing immediate distress while still respecting Robbie’s autonomy to some extent. However, the disadvantage is that he may still have unanswered questions or feelings of uncertainty.

Deflection: The nurse might choose to deflect Robbie’s question by saying that they will discuss it later or redirecting the conversation to a different topic. This approach seeks to protect Robbie from the harsh reality and allow him more time to process his emotions. Advantages include short-term emotional relief for Robbie, but the disadvantage is that it could lead to mistrust and hinder open communication in the long run.

The Code of Ethics for Nurses guides the nurse in the virtue of truth-telling by emphasizing the importance of providing honest and accurate information to patients. According to the Code, nurses have a moral and ethical obligation to respect patients’ autonomy, promote informed decision-making, and maintain trust through open communication.

In this case, the authorized decision maker is not explicitly stated, but the father is currently taking the lead in making decisions on Robbie’s behalf. However, it is essential for the healthcare team to recognize that as Robbie is 14 years old, he should be involved in discussions about his care and allowed to express his wishes and preferences.

Other considerations that play a part in the nurse’s response include cultural and family dynamics. The father’s request to withhold information from Robbie is based on cultural beliefs, but the nurse must consider the ethical principles of beneficence and non-maleficence while balancing the family’s values with Robbie’s right to know the truth about his condition.

In conclusion, the nurse’s response to Robbie’s question should prioritize honesty, compassion, and respect for his autonomy. While there are different options to consider, the ethical principles and the Code of Ethics for Nurses should guide the nurse in providing the best possible care for Robbie during this challenging time.