What should we say?

Abstract

ethics mostly focuses on what we do. One form of action is a speech act. What we say can have profound effects. We can and should choose our words and how we speak wisely. When someone close to us suffers an injury or serious illness, a duty of beneficence requires that we support that person through beneficial words or actions. Though our intentions are most often benign, by what we say we often make the unfortunate person feel worse. Beginning with two personal accounts, this article explains what can go wrong in the compassionate speech of wellwishers, and uncovers some of the reasons why people say things that are hurtful or harmful. Despite a large body of clinical evidence, there is no perfect strategy for comforting a friend or relative who is ill, and sometimes even the best thing to say can still be perceived as insensitive and hurtful. In some cases, we may have good reason to knowingly say a hurtful or insensitive thing. Saying these 'wrong' things can sometimes be the best way to help a person in the long term. To complicate matters, there can be moral reasons for overriding what is good for the patient. What kind of admonishments should we make to a badly behaved patient? What is the value of authenticity in our communication with the people we love? These questions demand an ethical defence of those speech acts which are painful to hear but which need to be said, and of those which go wrong despite the best efforts of the wellwisher. We offer an ethical account, identifying permissible and impermissible justifications for the things we say to a person with a serious injury or illness.

Semi-Elective Cervical Disc Replacements for Cervical Myelopathy: A Qualitative Study

“…He stated: I was shocked at how many medics failed to distribute words of comfort in the rush to get on with the next case or whatever else might be exercising their minds. 4 …”

Nocebo Effects and Negative Suggestions in Daily Clinical Practice – Forms, Impact and Approaches to Avoid Them

“…In addition to comments from health care providers, expectations can also be influenced by fellow patients (observational learning) (Vögtle et al, 2016), media (Faasse et al, 2012), and visitors (“good willers”) (Savulescu et al, 2006). Words and situations in the waiting areas can predispose to bad experiences.…”

“…Relatives and friends with their strong impact can hurt by thoughtless comments (e.g., mother: “How could you do this to me!”), and even well-meaning comments (e.g., “You don‘t hurt, do you”) can set negative expectations with expressions of caring concerns (e.g., “Hopefully you don‘t catch a hospital-acquired infection!”) and weaken the patient (e.g., “Be happy that you haven‘t lost your leg. You must accept your disability!”) (Savulescu et al, 2006).…”

Negative und positive Suggestionen in der Anästhesie

“…können auf den Patienten verunsichernd wirken, in dem sie die Kompetenz des Arztes oder die Wirksamkeit des Eingriffs oder Medi kaments infrage stellen. "Versuchen Sie, die Medikamente regelmäßig einzuneh men", drückt aus, dass der Arzt nicht wirk lich mit einer Befolgung der Verordnung rechnet [53].…”