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Using motivational interviewing to facilitate death talk in end-of-life care: an ethical analysis

Black, Isra; Helgason, Ásgeir; (2018) Using motivational interviewing to facilitate death talk in end-of-life care: an ethical analysis. BMC Palliative Care , 17 , Article 51. 10.1186/s12904-018-0305-5. Green open access

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Abstract

Background: Morbidity arising from unprepared bereavement is a problem that affects close personal relations of individuals at the end-of-life. The bereavement studies literature demonstrates that a lack of preparedness for a loved one’s death is a risk factor for secondary psychological morbidity among survivors. Short awareness time of death negatively correlates to preparedness for bereavement. The absence of disclosure of end-of-life diagnosis and prognosis to close personal relations (‘death talk’) between patients and loved ones, or health professionals and loved ones, may contribute to short awareness time of death. To increase awareness time of death, we might attempt to increase patient first-personal disclosure of end-of-life diagnosis and prognosis to loved-ones, and/or patient consent to health professional disclosure of the same. Main text: Interventions based on motivational interviewing in end-of-life care whose aim is to facilitate death talk, either by the patient directly, or by a health professional with the patient’s consent, may offer a part solution to the problem of unprepared bereavement. This paper evaluates the ethical permissibility of such interventions. We consider two ethical objections to using motivational interviewing in this way: first, that it is inappropriate for practitioners to seek disclosure as an outcome in this setting; second, that aiming at disclosure risks manipulating individuals into death talk. While it need not be impermissible to direct individuals toward disclosure of end-of-life diagnosis/prognosis, the objection from manipulation implies that it is pro tanto ethically preferable to use motivational interviewing in a non-directive mode in death talk conversations. However, insofar as non-directive motivational interviewing requires more advanced skills, and thus may be more difficult to learn and to practise, we advance that it may be ethically permissible, all things considered, to employ directional, or specific outcome-oriented, motivational interviewing. Conclusion: Motivational interviewing interventions in end-of-life care whose aim is to facilitate death talk, either by the patient directly, or by a health professional with the patient’s consent may be ethically permissible, all things considered.

Type: Article
Title: Using motivational interviewing to facilitate death talk in end-of-life care: an ethical analysis
Location: England
Open access status: An open access version is available from UCL Discovery
DOI: 10.1186/s12904-018-0305-5
Publisher version: https://doi.org/10.1186/s12904-018-0305-5
Language: English
Additional information: This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Keywords: Science & Technology, Life Sciences & Biomedicine, Health Care Sciences & Services, Health Policy & Services, Palliative care, End-of-life, Motivational interviewing, Medical ethics, Death talk, Bereavement, Disclosure, FAMILY CAREGIVERS, LOW PREPAREDNESS, MENTAL-HEALTH, CANCER, METAANALYSIS, COMMUNICATION, DISCUSSIONS, DISCLOSURE, PATIENT, TRIAL
UCL classification: UCL > Provost and Vice Provost Offices > UCL SLASH > Faculty of Laws
UCL > Provost and Vice Provost Offices > UCL SLASH
UCL
URI: https://discovery.ucl.ac.uk/id/eprint/10158304
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