Rudnick Abraham
Department of Behavioral Sciences, School of Medicine, Tel Aviv University, 69978 Tel Aviv, Israel.
Nurs Ethics. 2002 Jan;9(1):61-6. doi: 10.1191/0969733002ne481oa.
Informed consent to breaking (or waiving) bad news is an important yet neglected topic. It is distinct from informed consent to diagnosis and to treatment, and may be logically and ethically sound, provided patients are competent and that no considerable harm may be caused to others by breaking or waiving bad news to patients. This requires a differential assessment procedure in order to balance patient autonomy, benefit and justice towards others, preferably exploring patients' values, expectations and needs with them, so that an acceptable decision can be made on whether to act on their consent to breaking or waiving bad news, or to ignore it and act on informed consent by proxy. Future study should attempt to provide a detailed characterization of procedures for attaining informed consent to breaking or waiving bad news, and to test their success in establishing ethically sound health care.
关于披露（或放弃披露）坏消息的知情同意是一个重要但被忽视的话题。它与诊断和治疗的知情同意不同，并且在逻辑和伦理上可能是合理的，前提是患者有行为能力，并且向患者披露或放弃披露坏消息不会对他人造成重大伤害。这需要一个差异化的评估程序，以便在患者自主权、对他人的益处和公正性之间取得平衡，最好是与患者探讨他们的价值观、期望和需求，从而就是否根据他们对披露或放弃披露坏消息的同意采取行动，还是忽略该同意并根据代理知情同意采取行动做出可接受的决定。未来的研究应试图详细描述获得关于披露或放弃披露坏消息的知情同意的程序，并测试它们在建立符合伦理的医疗保健方面的成效。
