Breaking Bad News in Bioethics

Breaking Bad News

• Steps for breaking bad news are included in some bioethics stations.
• E.g., informing a mother about a serious birth defect or discussing termination of pregnancy.

Beginning the Station

• Introduce yourself and state your name and role.
• Ask the patient for their name and preferred name.
• Confirm the name is correct.
• E.g., "I understand your name is Lucy Smith, is that correct? Would it be alright if I call you Mrs. Smith?"
• Explain what you intend to do and obtain consent.
• Assure the patient of confidentiality.
• Inform the patient whether they can have someone with them.
• Give a warning shot if there is bad news to be delivered.
  • E.g., "I have your test results with me today, and I'm afraid they are not what we hoped for."

Throughout the Station

• Use appropriate verbal and nonverbal communication skills (like in a history taking session).
• Maintain a non-judgmental attitude.
• Demonstrate empathy.
• Try to understand the patient's perspective and fears.

Bioethical Principles/Health Laws

• Ethical considerations are relevant to bioethics OSCE stations.
• The decision is the patient's and the patient is supported in the decision.
• Respect patient autonomy.
• Provide options, pros, and cons of all possible alternatives.
• Explain available counseling and services.
• Don't try to convince a patient to do anything.
• Provide only basic, superficial clinical information.
• Excessive clinical information is inefficient.

Age of Consent

• Medical treatment: 12 years and maturity, assisted by parent/guardian.
• Surgical operation: 12 years and maturity, assisted by parent/guardian.
• HIV testing: 12 years
• Contraception: 12 years
• Termination of pregnancy: any age
• Male circumcision: 16 years

Informed Consent for HIV Test

• Pre-test counseling and post-test counseling are required.
• Information should cover test purpose, advantages, disadvantages, influence of result, and psychosocial impact.
• Proxy consent order of precedence: spouse, partner, parent, grandparent, adult child, sibling.

Children's Consent

• A child can consent at 12 or if mature.
• A mother of any age can consent for her child.
• Child under 12 requires mature consent, guardian (e.g., parent, caregiver), superintendent/person in charge.
• HIV status is confidential.
• Disclosure of HIV status requires consent or legal mandate.
• Disclosure is in the best interests of the child.

Ending the Station

• Refer appropriate support if needed (e.g., genetic counselors, social workers, psychologists).
• Reassure the patient they have time to consider the options and do not need to make a decision immediately.

HIV Testing of Children

• Only if in the child's best interest.
• If a child's healthcare provider has contact with the child's bodily fluid, then testing is necessary to determine if the child has HIV.

Additional Points

• In the case of HIV testing, if a patient doesn't want the test, tell them the test will remain available.
• If appropriate, use safety netting at the end of the consultation (e.g., an appointment date for follow up).
• Summarize the next steps.
• Ask if the patient has any further questions.

This quiz focuses on the crucial steps for delivering bad news to patients in a bioethics context. It covers the importance of communication skills, empathy, and obtaining consent when discussing sensitive information such as serious medical conditions or pregnancy termination.