Awakening: Bad News and Good News
Orr, Robert D.
Journal of Clinical Ethics. 1992 Fall; 3(3): 204-205.
Most often, conflicts between the family and the treatment team that arise because of unrealistic hopes for recovery can be resolved by the treatment team after carefully reviewing objective clinical data and allowing the family adequate time to adjust to the unwelcome news. For instance, when a stroke is found to be caused by unsuspected cerebral metastases, review of the clinical findings and computed tomography results will usually lead the family to accept a change in treatment goals within a few days. In the newly diagnosed PVS patient, however, there are no objective data to show the family, and the clinical signs that have confirmed the diagnosis and prognosis for the neurologist have been interpreted differently by the family. The family very often will construe this discrepancy as either lack of caring or clinical incompetence on the part of the team.
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