Abstract

Communication is a key mediating variable in achieving the primary goal of palliative care: optimizing quality of life by reducing suffering in patients and families experiencing serious and life-limiting illness. Through analysis of its conceptual foundation and internal values, this chapter demonstrates that palliative care is an inherently moral practice, seeking to ameliorate suffering by restoring and supporting the moral agency of patients and families. Because therapeutic communication is a necessary condition for achieving this goal, it constitutes a core ethical obligation of palliative care providers and organizations. Ethical communication among healthcare providers, and between providers, patients, and family members, can be considered a form of care, subject to the same ethical norms that pertain to all clinical care: respect personhood, minimize harm, and maximize benefit. Using the concepts of sensitivity, truthfulness, confidentiality, and deliberation, a framework for ethical communication is presented. Because an excessive focus on communication outcomes often diverts attention away from the communication process itself, raising the risk for confrontation and stalemate, the ethical framework presented here emphasizes the importance of process, suggesting that communication processes are ethically significant apart from the outcomes they may produce.