Ethical persuasion: the rhetoric of communication in critical care

Abstract

This article reviews the ethics of rhetoric in critical care. Rational appeals in critical care fail to move patients or surrogates to a better course of action. Appeals to their emotions are considered illegitimate because they may preclude autonomous choice. This article discusses whether it is always unethical to change someone's beliefs, whether persuasive communication is inherently harmful and whether it leaves no space for voluntariness. To answer these questions, the article engages with Aristotle's work, Rhetoric. In considering whether there is a place for emotionally charged messages in a patient-provider relationship, the article intends to delineate the nature of this relationship and describe the duties this relationship implies. The article presents examples of persuasive communication used in critical care and discusses whether providers may have a duty to persuade patients. This duty is supported by the fact that doctors often influence patients' and families' choices by framing presented options. Doctors should assume responsibility in recognizing these personal and contextual influences that may influence the medical choices of their patients. They should attempt to modify these contextual factors and biases in a way that would assist patients and families in reaching the desired outcomes. The opening sections surveyed a number of definitions found in relevant literature and outlined some of the concepts included in the proposed definition. This definition helps to distinguish instances of persuasion from cases of manipulation, coercion and deception. Considering the fact that patients and families often make irrational decisions and the fact that doctors inadvertently influence their choices, the article suggested that persuasion can be a positive tool in medical communication. When patients or families clearly do not understand the risks or make decisions that contradict their long-term goals, persuasion can be used as a positive influence.

Diseases, patients and the epistemology of practice: mapping the borders of health, medicine and care

“…The issues at stake here are practical and cognitive, as well as ethical. Mahr's paper indirectly expands on several themes raised by Guidry‐Grimes and Dubov [34,35], both in terms of the relative weight given to patients’ subjective reports in assessment and decision‐making processes, but also the degree to which clinicians should feel ethically justified in rhetorically bolstering their clinical narrative.…”

“…The issues at stake here are practical and cognitive, as well as ethical. Mahr's paper indirectly expands on several themes raised by Guidry-Grimes and Dubov [34,35], both in terms of the relative weight given to patients' subjective reports in assessment and decision-making processes, but also the degree to which clinicians should feel ethically justified in rhetorically bolstering their clinical narrative. Anthony Fernandez and Sarah Wieten's paper 'Values-Based Practice and Phenomenological Psychopathology: Implications of Existential Changes in Depression' [37] argues that values-based practice (VBP) as currently understood does not adequately account for the subjective existential changes that take place in patients with certain severe psychiatric conditions, such as major depressive disorder.…”

“…Oleksandr Dubov looks at rhetorical strategies in the patient–physician interaction and examines the ethical issues at stake in expanding this communication beyond appeals to reason to encompass persuasive appeals to the emotions [35]. Although tracing this strategy back to Aristotle, Dubov's examination benefits from a more modern understanding of decision making as a process (contra Descartes) that always involves emotional processing.…”

Shared Decisionmaking in the Emergency Department: A Guiding Framework for Clinicians

“…Persuasion, in this case, is not coercion and is ethically justifiable. 24 Since refusing care would be not considered medically reasonable, this is not an exercise in SDM. However, patients may rationally choose to forgo medical care for valid, personal reasons.…”

Principles of Effective Communication and Persuasion in Business Negotiations

“…The use of rhetorical tools in bargaining process, the success of staying in contact with the other half of the negotiations is an important factor for effective negotiations (Mulken et al 2010;Salvi, Tanaka 2011;Schoop et al 2010;Shen et al 2015;Sparks et al 2013). If classical rhetoric focused attention on how to convince the other part, in modern rhetoric, focus is focused more to dialogue, to interaction between speakers, and harmonization of relations (Du et al 2010;Dubov 2015;Stanko, Dawson 2016;Toth 2013;Xie et al 2015;Turner 2007;Wyer, Shrum 2015).…”