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

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


Title: Using motivational interviewing to facilitate death talk in end-of-life care: an ethical analysis
Author: Black, Isra   orcid.org/0000-0001-5324-7988
Helgason, Asgeir R.   orcid.org/0000-0002-0569-3067
Date: 2018-03-21
Language: English
Scope: 51
University/Institute: Reykjavík University (RU)
Háskólinn í Reykjavík (HR)
School: Viðskiptadeild (HR)
School of Business (RU)
Department: Psychology (RU)
Sálfræði (HR)
Series: BMC Palliative Care;17(1)
ISSN: 1472-684X
DOI: 10.1186/s12904-018-0305-5
Subject: General Medicine; Palliative care; End of life; Motivational interviewing; Medical ethics; Death talk; Bereavement; Disclosure; Sorg; Dauði; Líknarmeðferð; Siðferði
URI: https://hdl.handle.net/20.500.11815/1202

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Citation:

Black, I., & Helgason, A. R. (2018). Using motivational interviewing to facilitate death talk in end-of-life care: an ethical analysis. Bmc Palliative Care, 17, 51. https://doi.org/10.1186/s12904-018-0305-5

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.

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© The Author(s). 2018 Open Access 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.

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