Nursing Ethics

So this past week has gotten me thinking about nursing school and when we talked about nursing ethics and the role of a nurse.  We were informed that we would see many ethical issues and we would not always agree with the way things were handled in the practice.  To make this easier on us to decide whether something was ethical or if it was our own personal biases and feelings making us feel uneasy, we were taught about the different principles of nursing ethics: autonomy, veracity, justice, non-maleficence, fidelity, paternalism and beneficence to name a few.  
Of course I have faced many issues where I wondered if nursing ethics or medical ethics were being forgotten, but none quit like this one patient I cared for this week.
She was an elderly lady who was in with a bad prognosis.  She was dying of cancer...stage IV.  There was nothing else that could be down and in fact the treatment was only prolonging her misery.  She was alert and oriented during the day, but at night she experienced sun-downers and would quite often forget where she was and have to be re-oriented. 
Her family was great and took turns in a rotating schedule staying by her side at all most all times.  However, they felt that she should not be told the truth of her condition.  They did not want her to know that she was dying and that the treatment was not helping.  They ordered the doctors and nurses to not say a word about the prognosis and in fact to tell her that she was getting better.  The doctors tended to agree saying "she's confused anyway so what difference does it make...she's not aware of what is going on". 
I was very disturbed by the response of the doctors because I knew from first hand expierence that the patient was in fact mentating and did know what was going on around her, thanks to many great conversations. 
One night while I was in the room doing a dressing change, the patient asked me, "I'm dying aren't I?  This is the end, I can feel it."  I looked up at the daughter and had to make a decision quickly about how I was going to answer it.
I'm not usually one to beat around the bush, or not be direct when a patient asks me a question but I knew that I had to tread carefully with this answer.  I looked her in the eye and told her something like "Well honey, you know your body and mind better then anyone else, and many times, the feelings we get are our mind's way of telling us the truth about our health."  She sighed and nodded her head. 
Her daughter walked out of the room, and while I finished the dressing change, we made small talk.  When I left the room, the daughter was waiting for me, with a very unhappy look on her face.  She immediately began to say how it was inappropriate for me to tell her mother that and i had no right. I looked at her and said, "Your mother knows more then you think...she knows that you aren't telling her the truth...she also knows that you guys love her very much and it's hard for you...but what you guys are forgetting is that...by not telling her and not letting her decide to quit the care...you guys have managed to take away the dignity of your mother."  She looked at me and nodded and said she hadn't thought of it like that.  She went and called the rest of her family.  Within an hr, she came back and asked for the doctors to come in and talk to her mother. 
I was happy to see that the patient was finally able to know the complete truth of her situation.  The next morning the patient had decided to go home, and spend the remainder of her days with her family.  She was incredibly happy and at peace with her prognosis and her decision.  It made my day.