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Delivering 'Bad' News


It is the responsibility of the physician to deliver bad news about diagnosis and prognosis. It is the responsibility of the family to receive bad news about the patient’s diagnoses and prognosis; and to make decisions regarding care and treatment as well as what or whether the patient will be told. The family has an obligation to protect the patient from bad news, emotional distress or information that might affect the individual’s physical, psychological or spiritual well being. The shift of the burden of bad news to the family ensures that the patient will maintain hope; and not to give up.

The family member to deliver ‘bad news’ to the family may be a person other than the identified decision maker; there is a need to clarify with the key family members. Usually bad news is given to the decision maker; sometimes another member receives the patient information (such as a person with a medical background).


If the diagnosis or plan of care is likely to cause distress to the patient, the family may make a decision not to tell the patient about the care plan, procedure or operation to protect the patient from distress or burdens. In some cases, if the patient refuses to consent to the treatment plan, the family may still consent; with the intention of protecting the patient and ensuring that the treatment is provided. This situation may affect the ability of the health care team to fully prepare the patient for the procedure or operation and the physician should be contacted for further direction. This may create an ethical dilemma for the health care team, and requires ongoing discussion with the family as to the impact of their decision on the care of the patient.

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