Nursing Ethics: Advance Directives and Medical Disclosure

Introduction to Nursing Ethics and Advance Directives

The healthcare proxy and the living will are two ways in which a patient can express advance directives relating to healthcare and/or end-of-life treatment should that person become incapacitated. The utilitarian justification for advance directives is that the end justifies the means — in other words, the greatest good for the greatest number of people. If an advance directive is given, it covers all the people involved and lets the patient's wishes be known ahead of time in case there comes a moment when the patient cannot speak for him or herself. The doctors and caregivers will be obliged to accept this as the greatest good, because it relieves them of any duty to provide care (if the directive specifies that it should be refused) and vice versa.

The Kantian justification for advance directives is that they respect the autonomous position — that is, the individual's right to refuse treatment, should that be the patient's choice. The individual makes this known ahead of time in the living will, for example, and this is respected because Kantian philosophy upholds autonomy as a basic right.

Medical Error Disclosure: Ethical and Legal Obligations

Disclosure involves stating everything that went wrong in a medical error to the patient, even if the patient does not fully understand the details. This can often be problematic because it can seem simpler to correct the error without informing the patient. From a utilitarian perspective this behavior might be justified, but not from a Kantian perspective. For the sake of integrity and ethical treatment, it is in the interest of the doctor to fully disclose any medical error — even if it is easily remedied, no lasting harm results, and the explanation requires considerable effort. Full disclosure helps avoid future litigation, which can be far more costly in terms of time and money (Gallagher, n.d.).

As Philipsen and Soeken (2011) note, it is the clinician's duty and ethical responsibility to inform the patient of any medical error in treatment, even if the error is "insignificant." The patient still has a right to know, as do all individuals impacted by the error, including staff members. This allows the medical community to remain transparent, which is a foundation of trust in the staff-patient relationship. The ethical implications of disclosure versus non-disclosure are clear: to withhold information about a medical error is to act unethically and to violate the transparency and loyalty owed to the patient as well as to fellow staff members.

The legal implications of disclosure versus non-disclosure are equally significant. The severity of the error is most likely to affect the outcome if the error becomes known and no disclosure was made initially. However, legal action is also less likely to be pursued when disclosure is immediate and the severity of the error is not significant (Edwin, 2010; Tabler, 2006).

Conclusion

Throughout these cases and ethical scenarios, the tension between utilitarian and Kantian frameworks reveals the complexity of clinical decision-making, particularly when patient autonomy and the duty to disclose are at stake. Advance directives, full medical error disclosure, and the evidentiary standards applied in cases such as Cruzan all reflect the fundamental ethical principle that patients retain the right to guide decisions about their own care. Clinicians and courts alike are obligated to honor that right through transparency, documentation, and respect for individual autonomy.