When asked to divulge information about another patient, our response is usually: ‘I can’t discuss it.’ In this situation, however, there are no right and wrong answers nor is there a formula that can be applied in every case. What is required is a caring, ethically sound response.
We could ignore the question, pretend we haven’t heard it and walk away, believing silence is necessary to protect the deceased’s confidentiality.
But what is confidential about a death in a ward – a public place?
Neighbouring patients will have observed the patient’s decline and the family’s distress. If the death was sudden, they will have seen the crash team arrive. A covered trolley will arrive and depart and in a couple of hours’ time, the curtains will be drawn back to reveal a clean, empty bed.
Where is our authenticity if we ignore the question and pretend nothing has happened?
Alternatively, we could say: ‘Yes, I’m afraid Mrs X has just died,’ mindful that such news might leave patients feeling unsettled and in need of reassurance and comfort.
The patients know the answer – the question is an opening gambit, indicating a need to talk. Denying and hiding the truth, thus preventing patients expressing feelings, might be perceived as disrespectful – even harmful – even though this is not our intention.
Answering the question honestly and sensitively, without divulging personal or diagnostic information, allows for both the confidentiality of the deceased and respect for the living; a caring, ethically sound response.
Sometimes we prefer not to answer because we’ve found a death upsetting. If so, let’s be honest and not hide behind confidentiality when we are protecting ourselves.
Ethical practice is about making choices that are relevant to all in the ward, ourselves included. In the end, it is not how we should respond but that we do respond.
Catherine Wilson is senior lecturer in cancer and palliative care, Faculty of Society and Health, Buckinghamshire New University, Chalfont St Giles, Bucks