Ethical Dilemmas in Truth-Telling and Decision Making in Pediatric Nursing

Nursing is both a science and an art, particularly when dealing with complex ethical dilemmas. One of the most sensitive challenges involves deciding how much truth to disclose when children face serious illnesses. This issue becomes especially significant when the illness is life-threatening. The case of a 15-year-old girl diagnosed with a malignant brain tumor demonstrates this challenge. It raises two crucial questions: Who should be told the truth—the patient or the parents? and How should healthcare providers balance honesty with emotional well-being?

The Challenge of Truth-Telling in Pediatric Care

In this case, the young patient presented with severe headaches and menstrual irregularities. A CT scan revealed a malignant brain tumor. The healthcare team, including neuro-oncologists, faced the ethical dilemma of how much to disclose. Her parents requested that their daughter not be told the full extent of her illness. While the patient sensed something was wrong, she was unaware of her diagnosis.

This raised a key ethical question: Should minors be told the complete truth about their condition, or should parents retain control over disclosure? The situation exemplifies the tension between protecting a child emotionally and respecting her right to know.

Parental Rights and Patient Autonomy

The dilemma centers on balancing parental rights with patient autonomy. Parents usually have the legal authority to make medical decisions for their children and may wish to protect them from distressing information. In this case, the parents believed that withholding the truth would preserve their daughter’s emotional stability.

However, the adolescent also had growing rights as an individual capable of understanding her condition. She noticed changes such as fatigue and hair loss, leading to confusion and anxiety. As a nurse, I faced the ethical conflict between honoring the parents’ wishes and recognizing the patient’s emerging autonomy. This prompted further consideration: Would disclosure empower the patient, or would it cause undue psychological harm?

Ethical Decision-Making and Moral Distress

Nurses often experience moral distress when truth-telling conflicts with family wishes. They must advocate for their patients while also respecting parental authority. Research indicates that concealing diagnoses may reduce immediate anxiety but can damage long-term trust in healthcare providers (Chaudhury et al., 2016). Moreover, withholding information can hinder the patient’s ability to prepare for treatment or engage in meaningful decisions about their care.

Ethical Considerations in Disclosure

The following table illustrates the ethical factors involved in balancing truth-telling and emotional protection:

Table 1

Ethical Factors Influencing Disclosure in Pediatric Nursing

This comparison demonstrates how nurses must evaluate both perspectives before reaching an ethically balanced decision.

The Role of Nurses in Ethical Decision-Making

Nurses serve as patient advocates but often lack the final authority in disclosure decisions. In this scenario, my role was primarily supportive—providing comfort, facilitating communication, and ensuring compassionate care for both the patient and her family. Institutional policies and family preferences often guide disclosure practices (Emo, Bankas, & Espedido, 2010).

The family-centered care model emphasizes the family’s central role in decision-making while also recognizing the child’s emotional and developmental needs. Nurses must carefully balance professional ethics, family dynamics, and sensitivity to ensure that the patient is not left feeling isolated or misinformed.

Balancing Truth-Telling with Emotional Well-being

Truth-telling in pediatric nursing requires empathy, timing, and cultural sensitivity. Research indicates that when disclosure occurs in a supportive environment involving family members, it can actually reduce emotional trauma (McElvaney, 2014). In this case, withholding full disclosure may have been intended as a compassionate act, aligning with the parents’ desire to protect their daughter.

Nurses must depend on ethical frameworks, clinical judgment, and evidence-based guidelines to balance honesty with emotional protection. The ultimate goal is to act in the best interests of the child, even when doing so causes moral discomfort for the healthcare team.

Conclusion

Truth-telling in pediatric care remains an ethically complex issue. It involves balancing the rights of the child, the preferences of the parents, and the emotional outcomes of disclosure. While withholding the truth may temporarily protect a child, it can also create confusion and mistrust. Nurses play a vital role in advocating for patients, supporting families, and applying ethical reasoning to navigate such dilemmas. In this case, respecting the parents’ wishes may have preserved emotional stability but also left the healthcare team with ethical unease. Ultimately, compassionate communication and family involvement are essential for resolving such challenges effectively.

References

Chaudhury, S., Kirk, C., Ingabire, C., Mukunzi, S., Nyirandagijimana, B., & Godfrey, K. et al. (2016). HIV status disclosure through family-based intervention supports parenting and child mental health in Rwanda. Frontiers in Public Health, 4, 138. https://doi.org/10.3389/fpubh.2016.00138

Emo, M., Bankas, D., & Espedido, B. (2010). Truth-telling and an adolescent diagnosed with a malignant brain tumor: Who are we protecting? Canadian Journal of Neuroscience Nursing, 32(3).

NR 501 Week 2 Reflective Essay

McElvaney, R. (2014). Disclosure of child sexual abuse: Delays, non-disclosure and partial disclosure. What the research tells us and implications for practice. Child Abuse Review, 24(3), 159–169. https://doi.org/10.1002/car.2280