Informed Consent to Breaking Bad News

Abstract

Informed consent to breaking (or waiving) bad news is an important yet neglected topic. It is distinct from informed consent to diagnosis and to treatment, and may be logically and ethically sound, provided patients are competent and that no considerable harm may be caused to others by breaking or waiving bad news to patients. This requires a differential assessment procedure in order to balance patient autonomy, benefit and justice towards others, preferably exploring patients’ values, expectations and needs with them, so that an acceptable decision can be made on whether to act on their consent to breaking or waiving bad news, or to ignore it and act on informed consent by proxy. Future study should attempt to provide a detailed characterization of procedures for attaining informed consent to breaking or waiving bad news, and to test their success in establishing ethically sound health care.

Keywords

breaking (or waiving) bad news diagnosis informed consent

Get full access to this article

View all access options for this article.

References

Rudnick A , Ezra Y , Melamed E. Breaking bad news and personality assessment . Patient Educ Counsel 2000; 41: 157-160 .

Girgis A , Sanson-Fisher RW. Breaking bad news: consensus guidelines for medical practitioners . J Clin Oncol 1995; 13: 2449-2456 .

Seale C. Communication and awareness about death: a study of a random sample of dying people . Soc Sci Med 1991; 32: 943-952 .

Meininger V. Breaking bad news in amyotrophic lateral sclerosis . Palliat Med 1993; 7: 37-40 .

Grisso T , Appelbaum PS. Assessing competence to consent to treatment: a guide for physicians and other health professionals. New York: Oxford University Press , 1998.

Goldfield N , Rothman WA. Ethical considerations of informed consent: a case study . Soc Sci Med 1987; 24: 483-486 .

Laor N , Agassi J. Diagnosis: philosophical and medical perspectives. Dordrecht: Kluwer , 1990.

Beauchamp TL , Childress JF. Principles of biomedical ethics, fourth edition. Oxford: Oxford University Press , 1994.

Koehn D. Rethinking feminist ethics: care, trust and empathy. London: Routledge , 1998.

10.

Charles C , Gafni A , Whelan T. Decision-making in the physician-patient encounter: revisiting a shared treatment decision-making model . Soc Sci Med 1999; 49: 651-661 .