Are You Morally Resilient?
Consider the following questions:

1. Can you think of practice situations that caused you moral distress?
2. Do you consider yourself to be morally resilient?
3. Which of the 12 traits of moral resilience discussed in Lesson 2.3 do you possess?
4. Which of these traits would you like to cultivate?

2 Peer-reviewed journal within 5 years

Case Study: Withholding Information at the Request of the Family

Karen Gill is an acute care nurse practitioner. Karen is employed by the only group of pulmonologists in a medium-sized city in Texas. Karen sees patients in the office and rounds at a level 2 hospital where she was the first APRN granted privileges.
Mrs. Liu is a 72-year-old woman who moved to the United States from China 16 months ago after the death of her husband to live with her son and her daughter-in-law. Prior to immigrating, Mrs. Liu had complained of respiratory symptoms and consulted the village doctor, who diagnosed a minor ailment. Recently, her episodes of coughing, chest tightness, and wheezing worsened. After Mrs. Liu developed fever and weight loss, a chest X-ray ordered by her son’s family practice physician revealed a pulmonary mass. Mrs. Liu was referred to Karen’s practice, where she underwent a biopsy. The pathology report revealed pulmonary tuberculosis.
Karen called the son’s house and left a message for Mrs. Liu to schedule an appointment so that Karen could explain the results of the biopsy and the treatment plan. She received a phone call from Mrs. Liu’s son, who asked that the diagnosis be withheld from his mother. He explained that in the rural area of China where his mom is from tuberculosis is considered fatal and to tell her would be like giving her “a death sentence.” He also said tuberculosis is considered “not a nice thing” to have. Karen reviewed the literature on perceptions of tuberculosis in rural China and found considerable social stigma attached to the disease with loss of social connections common after the diagnosis.

What to do

• make the case if it is ethical or not ethical to withhold the diagnosis from the woman at the request of her family, incorporating and citing appropriate ideas. Remember to explore Chinese cultural beliefs and practices related to disclosure of diagnoses
• Does mandated reporting to the public health department impact your decision?
• End your discussion with 2 (two) thought-provoking follow-up questions designed to expand the discussion topic in new ways.
  Reference three or more relevant, within 5 years, peer-reviewed journals