1. The Art of Telling:
Revealing Bad News to
Hospice Patients
By: Andrea Phillips

2. The Dilemma:
• Occasionally, a family will ask
hospice staff not to reveal a
terminal diagnosis or a hospice
admission to the patient
• Is it ethical to comply?

3. The Dilemma
•The reasons for this request can be:
•To protect the patient from further distress
•The patient has expressed these wishes in the
past
•The family is uncomfortable telling the patient

4. The Dilemma
•What can we do to confirm that the patient wishes
not to hear the news?
•Just ask!
•Buckholz (2005) suggests that the medical
team asks the patient what s/he would like to
know about the diagnosis/prognosis

5. The Dilemma
•It is ideal to talk to the family prior to a
conversation with the patient in order to prepare
them
•Buckholz (2005) suggests that the best way to
avoid withholding information from the patient
and respecting the family’s wishes is to have an
open conversation about what the patient would
like to know (if anything at all!)

6. National Association
of Social Workers:
Code of Ethics

7. NASW Code of Ethics
• 1.01- Commitment to
Clients
• Social workers’ primary
responsibility is to promote the
well-being of clients. In general,
clients’ interests are primary.
However, social workers’
responsibility to the larger society
or specific legal obligations may
on limited occasions supersede
the loyalty owed clients, and
clients should be so advised

8. NASW Code of Ethics
•How does this ethical standard relate to the
dilemma?
•In hospice, the patient is our client, not the
family
•We are responsible for making sure that the
patient’s rights are respected
•If the patient elects not to have information
shared, it is his/her right
•If s/he wants to know, it is her right despire
the family’s wishes

9. Breaking Bad News to
Adults with Intellectual
Disabilities

10. Adults with
Intellectual Disabilities
Intellectual Disabilities
• Breaking bad news to
patients with intellectual
disabilities (IDs) must be
handled cautiously and
approached in a way that
ensures that the patient
understands the
diagnosis/prognosis

11. Adults with
Intellectual Disabilities
Intellectual Disabilities
•Tuffrey-Wijne (2013) concluded that there is no
correct way to address this issue with all adults
with intellectual disabilities
•Instead, it is best to tailor the delivery based on
the individual’s ability to understand and process
the information

12. Adults with
Intellectual Disabilities
Intellectual Disabilities• Tuffrey-Wijne (2013) found that, when faced with the
dilemma of disclosing a poor prognosis to a patient with
an ID:
• Some patients wanted to know while others were
unsure
• Family caregivers elected to be told privately prior
to the patient and almost all of them would opt to
lie to protect the patient
•Physicians determined that, ethically, the
patient must be told

13. Adults with
Intellectual Disabilities
Intellectual Disabilities
•If electing to disclose a poor prognosis to a patient
with IDs:
•The information must be given in a way that
the patient can easily process
•Usually in multiple steps to further
understanding
•There will be times that the patient does not
understand

14. So... To Tell or Not to
Tell?
•It is best to gauge what the patient wants to know
•Involve the family in determining the best way to
disclose bad news to the patient
•For those with IDs, it is imperative that they are
only given information that they can understand

15. Works Cited
• Buckholz, G. (2005). "Please don't tell her." Family opposition
to breaking bad news. San Diego Hospice & Palliative Care,
61(2), 61-62.
• Beckwith, S. K. (2005). When families disagree: Family
conflict and decisions. Ethical Dilemmas at the End of Life,
143-156.
• Tuffrey-Wijne, I. (2013). A new model for breaking bad news
to people with intellectual disabilities. Palliative Medicine,
27(5), 5-12.