NU 305 Unit 3 code of ethics applied to a situation example

"Please Don't Tell My Mother": Applying the Code of Ethics When a Daughter Asks the Nurse to Withhold a Cancer Diagnosis

Student Name

Department of Nursing, Herzing University

NU 305: Professional Role Transition

Instructor Name

February 2, 2026

"Please Don't Tell My Mother": Applying the Code of Ethics When a Daughter Asks the Nurse to Withhold a Cancer Diagnosis

The Situation

Mrs. T., a composite 78-year-old woman who emigrated from Korea 40 years ago, was admitted to my medical unit with weight loss and abdominal pain. A biopsy showed pancreatic cancer. Before the oncologist arrived to discuss the results, her daughter, who is her mother's primary caregiver and was present at every visit, took me aside and said, "Please don't tell my mother it's cancer. Where we come from, nobody tells a sick person that word. It will take away her hope. We will decide what to do." Mrs. T. was alert, oriented, and capable of making decisions; she spoke English, though she preferred Korean for complicated conversations. She had not said anything to me about how she wanted to receive information. I was the nurse who would be with her for the rest of the shift, and the oncologist asked my opinion before going in.

Why This Is an Ethical Problem

Two obligations pulled against each other, and neither was obviously wrong. The first is respect for Mrs. T.'s autonomy and her right to make decisions about her own care, which requires that she have information about her condition. The second is respect for her as a person embedded in a family and culture in which, for many people, protecting a sick person from a frightening diagnosis is an act of love and the family shares in decisions. This was not a case of a daughter behaving badly; she was acting on values that research has documented among many older adults from several ethnic backgrounds, who are less likely than European American older adults to believe that a patient should be told a terminal diagnosis or should make decisions alone (Blackhall et al., 1995).

The Provisions That Apply

Provision 1 of the nursing Code of Ethics grounds practice in compassion and in respect for each person's dignity and individuality, and its interpretive statements take up the right to self-determination, including the patient's right to be given accurate, complete, and understandable information in a manner that facilitates an informed decision (American Nurses Association [ANA], 2015). Read alone, this provision points toward telling Mrs. T.

The second provision places the nurse's first loyalty with the patient, however the patient is defined, from one person up to a whole community. Its interpretive statements recognize that patients' interests may conflict with those of family members and direct the nurse to address such conflicts while keeping the patient's interest primary. The same provision recognizes family as part of the context of care. Read alone, it points toward involving the family but reminds the nurse that the primary commitment is to Mrs. T., not her daughter.

Provision 1's interpretive statements also describe respect for the patient's values, culture, and ways of making decisions. Here the two provisions and the two readings of Provision 1 meet: autonomy includes the right to decide how much to know and who should decide, but that choice belongs to Mrs. T., not to her daughter on her behalf.

What I Did and Why

The principle that resolved the tension was that the person who decides how much Mrs. T. knows should be Mrs. T. Autonomy, as ethicists describe it, includes the right to waive information or to delegate decisions to family, but only if the patient chooses to do so (Beauchamp & Childress, 2019). I told the daughter that I understood her wish to protect her mother and that I would not force information on her mother, and that I needed to ask her mother how she wanted to be told about her results. With the daughter's agreement and a Korean-language interpreter by phone, the oncologist and I asked Mrs. T.: "Some people want to know everything about their illness, and some prefer their family to hear the details and make decisions. How would you like us to handle your test results?"

Mrs. T. said she wanted her daughter to hear the details first and to decide with the doctors, and that she wanted to be told what she needed to know to be comfortable and to plan for her grandchildren. That answer honored both obligations. She chose delegation, which is an exercise of autonomy, not a violation of it. The oncologist met with the daughter, and later Mrs. T. asked the oncologist directly whether she would get better; she was told honestly that the illness was serious and could not be cured, in words she and her daughter had helped choose.

The Options I Rejected

Two other responses were available, and naming why I rejected them is part of the analysis. The first was to tell the daughter that the law and the code require full disclosure to the patient and to let the oncologist proceed as usual. That response would have respected Mrs. T.'s autonomy in the abstract while ignoring the possibility that she herself preferred her family to lead, and it would have damaged the daughter's trust in the team at the moment the family most needed it. The second was to agree to the daughter's request and say nothing. That response would have made the daughter, not the patient, the decision maker, without any sign that Mrs. T. wanted it, and it would have left me and the oncologist unable to answer Mrs. T. honestly if she asked a direct question. Both responses resolve the tension by choosing one obligation and discarding the other. Asking the patient kept both in view, which is why it was the better answer rather than a compromise.

What the Case Taught Me About the Code

I had thought of the code as a set of rules that, applied correctly, produce the answer. This case showed me that two provisions can each be applied correctly and still point in different directions, and that the code's guidance is sometimes to find a process that respects both, rather than to choose one. It also showed that the answer I would have given reflexively, telling the patient because that is her right, would have imposed my culture's version of autonomy on a patient who might not have wanted it. Asking her was what the code, read as a whole, required.

References

American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. American Nurses Association.

Beauchamp, T. L., & Childress, J. F. (2019). Principles of biomedical ethics (8th ed.). Oxford University Press.

Blackhall, L. J., Murphy, S. T., Frank, G., Michel, V., & Azen, S. (1995). Ethnicity and attitudes toward patient autonomy. JAMA, 274(10), 820-825. https://doi.org/10.1001/jama.1995.03530100060035