Bioethics OSCE Station Guide PDF

NOTE: Although it is unlikely to form part of a bioethics station per se, the steps for the breaking of bad news are also included in the following breakdown, as appropriate, in case this comes up as a station / is combined with a bioethics station (e.g. breaking the bad news of a serious birth defe...

NOTE: Although it is unlikely to form part of a bioethics station per se, the steps for the breaking of bad news are also included in the following breakdown, as appropriate, in case this comes up as a station / is combined with a bioethics station (e.g. breaking the bad news of a serious birth defect to an expecting mother following prenatal screening and discussing the option of termination of pregnancy). GENERAL: Beginning the Station 1. Introduce yourself to the patient, stating your full name and role. 2. If not already given in the preparation station briefing, ask the patient for their name as well as what they would like you to call them. If their name has been given to you already, confirm with the patient that you have the correct name. E.g. “I understand your name is Lucy Smith, is that correct? Would it be alright if I call you Mrs. Smith? / May I call you Lucy?” 3. Explain what you would like to do and obtain consent from the patient before continuing. 4. Depending on the nature of the scenario given, it may be appropriate to assure the patient at the onset that anything you discuss with them during the consultation will remain confidential. 5. In the odd chance that breaking bad news is included as part of a bioethics station, this would also be an appropriate time to ask the patient if there is anyone they would like to have with them for the consultation. Additionally, a warning shot should be given before beginning. E.g. “I have your tests results with me today, and I’m afraid they are not what we hoped for.” / “Unfortunately, I have some bad news that I need to tell you about.” GENERAL: Throughout the station 1. Ensure that throughout the consultation you employ the same verbal and nonverbal communication skills that would be required in any history taking session. 2. Demonstrate a non-judgmental attitude at all times. 3. Demonstrate empathy. 4. Try to understand the patient’s perspectives and fears.  E.g. For a patient that does not wish to be tested for HIV, do not forget to ask why they do not wish to be tested. 5. Provide the patient with the options available to them as well as the pros and cons of all possible alternatives. 6. Respect patient autonomy. Assure the patient that the decision is his or her own and that you will support them in whatever course of action they choose. 7. Tell the patient about counseling and other services available. IMPORTANT NOTE: Never in any bioethics station are you required to convince the patient to do something. You are merely required to attempt to understand the patient and assist them in navigating the options available. There will never be a mark given for the patient agreeing to do what you ask. Additionally, bioethics stations are not designed to test your clinical knowledge. Give only basic, superficial clinical information required to give general pros and cons for the options available to the patient. Excessive clinical information will only waste time. SUMMARY OF BIOETHICAL PRINCIPLES / HEALTH LAWS The following table offers a brief summary of relevant facts that may be applicable to bioethics OSCE stations. Only bioethics lectures with facts pertinent to legal specifics are included in the table. This is by no means a complete summary. NOTE: You will not be required to cite laws / ethical theories during a station, but you should be aware of relevant laws. LECTURE SUMMARY OF IMPORTANT POINTS Intro to Health Age of Consent: Law BCM - Medical Treatment: 12 years and are ‘of sufficient maturity’ - Surgical Operation: 12 years and are ‘of sufficient maturity’ and are assisted by a parent / guardian - HIV testing: 12 years - Contraception: 12 years - Termination of pregnancy: any age - Male Circumcision: 16 years Ethical problems in Informed Consent for an HIV test requires pre-test HIV / AIDS counseling and post-test counseling. Information LOTS conveyed for any informed consent should cover: the purpose of the test, the advantages and disadvantages of having it done, why the health care practitioner wants it done, what influence the result will have on treatment, the psychosocial impact of a positive result. Proxy Consent: Order of precedence: spouse, partner, parent, grandparent, adult child, brother / sister of patient. Only 2 circumstances allow HIV Testing of Children: - Where it is in the best interests of the child to know the status and consent has been given - Where the test is necessary to establish the child’s HIV status because a HCW was in contact with a child’s bodily fluids. Children’s Consent: A child can consent at 12 years old to HIV testing, or under 12 where the child is mature enough to understand the implications. A mother of any age can consent to her baby being tested for HIV. - Child