Breaking Bad News to a Terminally-Diseased Physician in ICCU: A Case Study of Ethical and Cultural Dilemma
Abstract
Background: Breaking bad news is one of the most problematic tasks for physician. Moreover, local guidelines or recommendations about this is not well established in Indonesia and its practice still varies between physicians.
Case Illustration: This paper presents a case of a fellow physician admitted to ICCU with terminal cardiac condition whose family wished to keep the bad news away from the patient. The physician team were in a difficult situation when the patient asked about his condition, but they decided to respect and commit to the family’s decision to not giving information about his terminal state.
Conclusions: In performing such problematic task, balancing non-maleficence and autonomy principle is the key. Cultural background differences should also be considered when dealing with such cases. Other important factor that can affect this practice is lack of legal support in Indonesia. Combination of all those factors should always be considered for the best interest of both parties.
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References
2. Gold M. Is honesty always the best policy? Ethical aspects of truth telling. Intern Med J. 2004; 34(9-10): 578-80.
3. Shahidi J. Not telling the truth: circumstances leading to concealment of diagnosis and prognosis from cancer patients. Eur J Cancer Care. 2010; 19: 589-93.
4. Stone EG. Evidence-based medicine and bioethics: Implications for health care organizations, clinicians, and patients. Perm J. 2018; 22: 18-30.
5. Novack DH, Plumer R, Smith RL, Ochitill H, Morrow GR, Bennet JM. Changes in physician’s attitudes toward telling the cancer patient. JAMA. 1979; 241(9): 897-900.
6. Ruhnke GW, Wilson SR, Akamatsu T, Kinoue T, Takashima Y, Goldstein MK. Ethical decision making and patient autonomy: a comparison of physicians and patients in Japan and the United States. Chest. 2000; 118(4): 1172-82.
7. Xue D, Wheeler JL, Abernethy AP. Cultural differences in truth telling to cancer patients: Chinese and american approaches to the disclosure of bad news. Prog Paliat Care. 2011; 19(3): 125-31.
8. Tse CY, Chong A, Fok SY. Breaking bad news: A chinese perspective. Palliat Med. 2003; 17(4): 339-43.
9. Tavoli A, Montazeri A, Mohagheghi MA, Roshan R, Tavoli Z, Melyani M. Knowledge of cancer diagnosis and quality of life in patients with gastrointestinal cancer. Payesh. 2007; 6: 257-64.
10. Putranto R, Mudjaddid E, Shatri H, Adli M, Martina D. Development and challenges of palliative care in Indonesia: Role of psychosomatic medicine. Biopsychosoc Med. 2017; 11(29): 1-5.
11. Ferine M, Rahayu GR, Claramita M. Identifying doctors problems in breaking bad news: An initial step in developing recommendations for the curriculum. The Indonesian Journal of Medical Education. 2017; 6(2): 108-15.
12. Sobczak K, Leoniuk K, Janaszczyk A. Delivering bad news: patients perspective and opinions. Patient Prefer Aherence. 2018; 12: 2397-404.
13. Beauchamp TL, Childress JF. Principles of biomedical ethics. New York, NY: Oxford University Press; 1979.
14. Beauchamp TL, Childress JF. Principles of biomedical ethics: Making its fortieth anniversary. Am J Bioeth. 2019; 19(11): 9-12.
15. Rosenstein DL. Depression and end-of-life care for patients with cancer. Dialogues Clin Neurosci. 2011; 13(1): 101-8.
16. Ng CG, Dijkstra E, Smeetes H, Boks MPM, Wit NJD. Psychiatric comorbidity among terminally ill patients in general practice in the netherlands: A comparison between patients with cancer and heart failure. Br J Gen Pract. 2013; 63(606): e63-8.
17. Hebert PC, Hoffmaster B, Glass KC, Singer PA. Bioethics for clinicians: 7. Truth telling. CMAJ. 1997; 156(2): 225-8.
18. Barnett MM. Effect of breaking bad news on patients’ perceptions of doctors. J R Soc Med. 2002; 95(7): 343-7.
19. Farber NJ, Urban SY, Collier VU, Weiner J, Polite RG, Davis EB, et al. The good news about giving bad news to patients. J Gen Intern Med. 2002; 17(12): 914-22.
20. Okamura H, Uchitomi Y, Sasako M, Eguchi K, Kakizoe T. Guidelines for telling the truth to cancer patients: Japanese national cancer center. Jpn J Clin Oncol. 1998; 28(1): 1-4.
21. Naik SB. Death in the hospital: Breaking the bad news to the bereaved family. Indian J Crit Care Med. 2013; 17(3): 178-81.
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