Truth Telling and Collusion
Nurses are sometimes asked to withhold the truth from a patient. This is referred to as collusion, and can easily create a scenario of secrecy and mistrust. These requests are often made in relation to disclosing a life-limiting illness such as cancer, or even imminent death, and can be made by a family member or by the patient themselves.
In western society, it was common in the past to exclude a patient from the truth, but the trend has moved away from this in recent years. However in many cultures, it may still be common practice to keep distressing news from patients. Illness can be viewed as a family concern and autonomy may not be recognised.  In these instances it is important to understand and respect the cultural beliefs and collaborate with an ‘elder’ or significant person, while keeping the patients interests foremost. The ethical principles of beneficence (to do good) and non-maleficence (to do no harm) would apply.
The role of the nurse in this context is a difficult one. The majority of patients prefer to be told the truth about what is happening to them. Many will know or guess the truth and also realise that this is being kept from them. Others will not want to know, and this is their choice.
The nurse patient relationship will suffer if the patient feels that they are being lied to or kept from knowing the truth. Culturally acceptable communication is usually the best policy, and discussions within the multidisciplinary team can help to clarify what is happening, why it is happening and whether it is in the best interests of the patient.
A useful framework for nurses to avoid potentially distressing disclosures is to ask the patient: 'What do you know about your illness and what is happening at the moment?' and equally important: 'How much would you like to know?'.