Please also see “Breaking bad news” in the Communication Skills module.
Breaking — or not — bad news
Reflective exercise 5
In this encounter between Betsy and Dr. Riel, the oncologist, we revisit some of the issues around the consent process. In “Consent and confidentiality,” we saw the basics at work: voluntary, informed, and (not required here) capacity. We will now see that many of the issues that arise in the daily work of physicians are not quite so clear-cut. Being informed, understanding and appreciating consequences is just the beginning of a process called “shared decision-making.” This is an area of bioethics in which consent, paternalism and autonomy interact in an ongoing process.
Before considering further the situation of Betsy and the physicians, read the following articles:
- “Decision-making in the physician-patient encounter: Revisiting the shared treatment decision-making model” by C. Charles, A. Gafni and T. Whelan.
- “The Patient-Physician Partnership: Decision Making, Problem Solving and the Desire to Participate” by R.B. Deber.
- “Not All Patients Want to Participate in Decision-Making. A National Study in Public Preferences” by W. Levinson, A. Kao, A. Kuby and R.A. Thisted.
- “What do we mean by partnership in making decisions about treatment?” by C. Charles, T. Whelan and A. Gafni.
- “To care is to coprovide” by S.A. Buetow.
After reading the literature on decision-making, complete the following exercise. Remember that there are no right or wrong answers, but you should be able to support your responses with a reasoned argument. This is a good exercise for group discussion.