2: Solomon

Solomon is 13 years old. Six years ago (aged 7) he was diagnosed with a life-limiting condition. Since then his mobility has decreased until, over the last couple of months, his only way of getting around is through the use of a wheelchair. Solomon’s condition is now beginning to affect his upper limbs and he is finding it impossible to pick up small items and increasingly difficult to grip cups, etc.

Ever since his diagnosis Solomon’s parents have refused to allow him to be told that his condition is life limiting. They believe that he should be protected from information of this nature and that it is better he does not know.

On one of Solomon’s many admissions to the children’s ward, a nursing student was measuring his vital signs. His mother, who was always resident with him on the ward, had gone to the restaurant to get some lunch. Solomon turned to the nurse as she finished her observations and asked ‘Nurse, am I dying?’

  • How could the student nurse respond to this question?
  • Is there a clear correct way to respond?

› Suggested answers

There is no one correct way to respond. A number of things need to be taken into account here:

  • Solomon’s clear need for information
  • His parents’ expressed wish that he should not be told about the nature of his condition
  • Professional values and guidance

For a young person to ask this question, they must already have some inkling that theirs is not an ordinary illness. However, Solomon’s parents do not wish him to know that his condition is life limiting. In addition, it is clear from professional guidance (in accordance with most nurses’ moral code) that it is not appropriate to lie to any patient. Therefore, most nurses would say that it is not right to simply respond to Solomon by saying ‘No, you are not dying’.

The student nurse could use a question of her own in order to enable her to determine the reason why Solomon is asking this question (e.g., ‘What makes you think that?’). This may be sufficient to deflect further questioning at this time. Given his parents’ views, it would not be appropriate to simply say ‘Yes, you are.’ The student nurse needs to explain to Solomon that she is unable to answer his question and then seek advice as to how this question should be managed.

Solomon’s parents must be told that he is asking questions and there needs to be consultation as to how this should be managed, with it being made clear to his parents that nurses will not lie to him. In the scenario above, nurses talked to Solomon’s parents about the situation and discovered that his parents were scared to tell him as they were afraid they would be unable to manage his response. The nurse offered to be with them and facilitate the conversation they needed to have with their son. Rather than be angry when his mother told him all about his condition and confirmed that he would eventually die as a result of it, Solomon simply said ‘Thank goodness you told me the truth – I knew it, but didn’t want to tell you in case you didn’t’.