Skip to main content
SpringerLink
Log in

Exploring Habermas’ theory of communicative ethics as an approach to physician communication training: the case of pediatric end-of-life care

  • Original Article
  • Published:
Social Theory & Health Aims and scope Submit manuscript

Abstract

In pediatric end-of-life (EOL) care, the partnership between physicians and parents is principally centered on communication and the parents’ decision-making role about the patient’s impending death. And, because parents are charged with EOL decision-making for their children, physicians are morally responsible to ensure that prognoses and treatment options are communicated to parents in a comprehendible way. Poor communication has been posited as a primary reason why the end-of-life (EOL) wishes of patients and surrogates are not implemented. This paper is based on findings from a qualitative study that utilized observation in a high-fidelity simulation and semi-structured interviews with physicians to explore narrative influences on pediatric EOL communication. The findings of this study, which revealed an inherent connection between communication, decision-making, and ethics, are reflected Habermas’ theory of Communicative Ethics (The theory of communicative action: reason and the rationalization of society, Beacon Press, Boston, 1984; The theory of communicative action: lifeworld and system: a critique of functionalist reason, Beacon Press, Boston, 1987). Therefore this paper proposes communicative ethics as an important model which, if utilized in physician education and training, could improve physician communication and in particular, physician–parent EOL communication.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  • Aschenbrenner, A.P., J.M. Winters, and R.A. Belknap. 2012. Integrative review: Parent perspectives on care of their child at the end of life. Journal of Pediatric Nursing 27 (5): 514–522.

    Article  Google Scholar 

  • Association of American Medical Colleges. 2011. Behavioral and social science foundations for future physicians. https://www.aamc.org/download/271020/data/behavioralandsocialsciencefoundationsforfuturephysicians.pdf. Accessed 6 Feb 2014.

  • Basu, R.K. 2013. End-of-life care in pediatrics: Ethics, controversies, and optimizing the quality of death. Pediatric Clinics of North America 60 (3): 725–739. doi:10.1016/j.pcl.2013.02.009.

    Article  Google Scholar 

  • Bateman, L.B., White, M.L., Tofil, N.M., Clair, J.M., and Needham, B.L. 2016a. A qualitative examination of physician gender and parental status in pediatric end-of-life communication. Health Communication. Published online ahead of print July 19, 2016.

  • Bateman, L.B., N.M. Tofil, M.L. White, L. Dure, J.M. Clair, and B.L. Needham. 2016b. Physician communication in pediatric end-of-life care: A simulation study. American Journal of Hospice and Palliative Care 33 (10): 935–941.

    Article  Google Scholar 

  • Bateman, L.B., and J.M. Clair. 2015. Physician religion and end-of-life pediatric care: A qualitative examination of physicians’ perspectives. Narrative Inquiry in Bioethics 5 (3): 251–269.

    Article  Google Scholar 

  • Beauchamp, T.L., and J.F. Childress. 2009. Priciples of biomedical ethics. New York: Oxford University Press.

    Google Scholar 

  • Bensing, J. 2000. Bridging the gap. The separate worlds of evidence-based medicine and patient-centered medicine. Patient Education and Counseling 39 (1): 17–25.

    Article  Google Scholar 

  • Berlinger, N., R. Barfield, and A.R. Fleischman. 2013. Facing persistent challenges in pediatric decision-making: New hastings center guidelines. Pediatrics 132 (5): 789–791. doi:10.1542/peds.2013-1378.

    Article  Google Scholar 

  • Bertakis, K.D. 1977. The communication of information from physician to patient: A method for increasing patient retention and satisfaction. Journal of Family Practice 5 (2): 217–222.

    Google Scholar 

  • Benhabib, S. 1992. Situating the self: Gender, community, and postmodernism in contemporary ethics. New York: Routledge.

    Google Scholar 

  • Burns, J.P., C. Mitchell, J.L. Griffith, and R.D. Truog. 2001. End-of-life care in the pediatric intensive care unit: Attitudes and practices of pediatric critical care physicians and nurses. Critical Care Medicine 29 (3): 658–664.

    Article  Google Scholar 

  • Burrell, D., and S. Hauerwas. 1977. From system to story. In H.T. Engelhardt, and D. Callahan (eds.) Knowledge, value and belief, pp. 111–152. Hastings-on-Hudson, New York: Institute of Society, Ethics and the Life Sciences.

  • Callahan, D. 1996. Can the moral commons survive autonomy? Hastings Center Report 26 (6): 41–42.

    Article  Google Scholar 

  • Chambers, T., and K.M. Hunter. 2002. Plot: Framing contingency and choice in bioethics. In The role of narrative in bioethics, ed. R. Charon, and M. Montello, 77–84. New York: Routledge.

    Google Scholar 

  • Cherlin, E., T. Fried, H.G. Prigerson, D. Schulman-Green, R. Johnson-Hurzeler, and D.H. Bradley. 2005. Communication between physicians and family caregivers about care at the end of life: When do discussions occur and what is said? Journal of Palliative Medicine 8 (6): 1176–1185. doi:10.1089/jpm.2005.8.1176.

    Article  Google Scholar 

  • Coyne, I., A. Amory, G. Kiernman, and F. Gibson. 2014. Children’s participation in shared decision-making: Children, adolescents, parents and healthcare professionals perspectives and experiences. European Journal of Oncology Nursing 18: 273–280.

    Article  Google Scholar 

  • De Graves, S., and S. Aranda. 2005. When a child cannot be cured—reflections of health professionals. European Journal of Cancer Care 14: 132–140.

    Article  Google Scholar 

  • Gatter, R. 1998. Communicative Ethics for Bioethics. Bioethics Examiner 1 (3): 4–5.

    Google Scholar 

  • Habermas, Jurgen. 1984. The theory of communicative action: Reason and the rationalization of society, Vol. 1. Translated by T. Mccarthy. Boston: Beacon Press.

  • Habermas, Jurgen. 1987. The theory of communicative action: Lifeworld and system: A critique of functionalist reason, Vol. 2. Translated by T. Mccarthy. Boston: Beacon Press.

  • Habermas, Jurgen. 1990. Moral consciousness and communicative action. Translated by C. A. N. Lenhardt, Shierry Weber. Cambridge, Massachusetts: MIT Press.

  • Hamric, A.B., and L.J. Blackhall. 2007. Nurse-physician perspectives on the care of dying patients in intensive care units: Collaboration, moral distress, and ethical climate. Critical Care Medicine 35 (2): 422–429. doi:10.1097/01.ccm.0000254722.50608.2d.

    Article  Google Scholar 

  • Institute of Medicine, Committee on Palliative and End-of-Life Care for Children and their Families: Institute of Medicine. 2003. When children die: Improving palliative and end-of-life care for children and their families, eds. M.J. Field and R.E. Behrman. Washington D.C.: The National Academy Press.

  • Institute of Medicine (IOM). 2004. Improving Medical Education: Enhancing the Behavioral and Social Science Content of Medical School Curricula. Washington DC: National Academy Press. http://www.ncbi.nlm.nih.gov/pubmed/20669422, accessed February 6, 2014.

  • Jonsen, A.R. 1999. The birth of bioethics. New York: Oxford University Press.

    Google Scholar 

  • Jurkovich, G.J., B. Pierce, L. Pananen, and F.P. Rivara. 2000. Giving bad news: The family perspective. Journal of Trauma 48 (5): 865–870.

    Article  Google Scholar 

  • Kochanek, K.D., S.E. Kirmeyer, J.A. Martin, D.M. Strobino, and B. Guyer. 2012. Annual summary of vital statistics: 2009. Pediatrics 129 (2): 338–348. doi:10.1542/peds.2011-3435.

    Article  Google Scholar 

  • Kolarik, R.C., G. Walker, and R.M. Arnold. 2006. Pediatric resident education in palliative care: A needs assessment. Pediatrics 117 (6): 1949–1954. doi:10.1542/peds.2005-1111.

    Article  Google Scholar 

  • Larcher, V., F. Craig, K. Bhogal, D. Wildinson, and J. Brierley. 2015. Making decisions to limit treatment in life-limiting and life-threatening conditions in children: A framework for practice. Archives of Disease in Childhood 100 (Supp 2): s1–s23.

    Article  Google Scholar 

  • Lee, K.J., and C.Y. Dupree. 2008. Staff experiences with end-of-life care in the pediatric intensive care unit. Journal of Palliative Medicine 11 (7): 986–990. doi:10.1089/jpm.2007.0283.

    Article  Google Scholar 

  • Levetown, M., and Bioethics American Academy of Pediatrics. 2008. Communicating with children and families: From everyday interactions to skill in conveying distressing information. Pediatrics 121 (5): e1441–e1460. doi:10.1542/peds.2008-0565.

    Article  Google Scholar 

  • Masera, G., J.J. Spinetta, M. Jankovic, A.R. Ablin, G.J. D’Angio, J. Van Dongen-Melman, T. Eden, A.G. Martins, R.K. Mulhern, D. Oppenheim, R. Topf, and M.A. Chesler. 1999. Guidelines for assistance to terminally Ill children with cancer: A report of the SIOP working committee on psychosocial issues in pediatric oncology. Medical and Pediatric Oncology 32 (1): 44–48.

    Article  Google Scholar 

  • May, W.F. 1994. The medical covenant: An ethics of obligation or virtue. In Theological analysis of the medical encounter, ed. G.P. McKenny, and J.R. Sande, 29–44. Boston: Kluwer Academic.

    Chapter  Google Scholar 

  • McCabe, M.E., Elizabeth A. Hunt, and Janet R. Serwint. 2008. Pediatric residents’ clinical and educational experiences with end-of-life care. Pedatrics 121 (4): e731–e737.

    Article  Google Scholar 

  • McKinlay, J.B., T. Lin, K. Freund, and M. Moskowitz. 2002. The unexpected influence of physician attributes on clinical decisions: Results of an experiment. Journal of Health and Social Behavior 43 (1):92

    Article  Google Scholar 

  • Michelson, K.N., T. Koogler, C. Sullivan, P. Ortega Mdel, E. Hall, and J. Frader. 2009. Parental views on withdrawing life-sustaining therapies in critically Ill children. Archives of Pediatrics and Adolescent Medicine 163: 986–992.

    Article  Google Scholar 

  • Moody, Harry R. 1996. Ethics in an aging society. Baltimore: Johns Hopkins University Press.

    Google Scholar 

  • Papadatou, D. 2000. A proposed model of health professionals’ grieving process. Omega 41 (1): 59–77.

    Google Scholar 

  • Papadatou, D., T. Bellali, I. Papazoglou, and D. Petraki. 2002. Greek nurse and physician grief as a result of caring for children dying of cancer. Pediatric Nursing 28 (4): 345–353.

    Google Scholar 

  • Rider, E.A., and C.H. Keefer. 2006. Communication skills competencies: Definitions and a teaching toolbox. Medical Education 40 (7): 624–629. doi:10.1111/j.1365-2929.2006.02500.x.

    Article  Google Scholar 

  • Roth, M., D. Wang, M. Kim, and K. Moody. 2009. An Assessment of the current state of palliative care education in pediatric hematology/oncology fellowship training. Pediatric Blood & Cancer 53 (4): 647–651. doi:10.1002/pbc.22110.

    Article  Google Scholar 

  • Salmon, P., and B. Young. 2009. Dependence and caring in clinical communication: The relevance of attachment and other theories. Patient Education and Counseling 74 (3): 331–338. doi:10.1016/j.pec.2008.12.011.

    Article  Google Scholar 

  • Sheetz, M.J., and M.A. Bowman. 2008. Pediatric palliative care: An assessment of physicians’ confidence in skills, desire for training, and willingness to refer for end-of-life care. American Journal of Hospice and Palliative Care 25 (2): 100–105. doi:10.1177/1049909107312592.

    Article  Google Scholar 

  • Smith, J.F. 1996. Communicative ethics in medicine: The physician-patient relationship, p. 398. New York: Oxford University Press.

    Google Scholar 

  • Wasserman, J.A., and S.L. Stevenson. 2013. Bioethics. In The Wiley-Blackwell encyclopedia of health, illness, behavior, and society, ed. W.C. Cockerham, R. Dingwall, and S. Quah. Blackwelll: Publishing Ltd.

    Google Scholar 

  • Widger, K., and C. Picot. 2008. Parents’ perceptions of the quality of pediatric and perinatal end-of-life care. Pediatric Nursing 34 (1): 53–58.

    Google Scholar 

  • Williams, J. 2010. Pediatric death: A focus on health care providers. Archives of Pediatrics and Adolescent Medicine 164 (4): 311–313. doi:10.1001/archpediatrics.2010.21.

    Article  Google Scholar 

  • Wittenberg-Lyles, E.M., J. Goldsmith, S. Sanchez-Reilly, and S.L. Ragan. 2008. Communicating a terminal prognosis in a palliative care setting: Deficiencies in current communication training protocols. Social Science and Medicine 66 (11): 2356–2365. doi:10.1016/j.socscimed.2008.01.042.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, 516P Medical Towers, Birmingham, AL, 35294-4410, USA

    Lori Brand Bateman

Authors
  1. Lori Brand Bateman
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Lori Brand Bateman.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bateman, L.B. Exploring Habermas’ theory of communicative ethics as an approach to physician communication training: the case of pediatric end-of-life care. Soc Theory Health 16, 60–76 (2018). https://doi.org/10.1057/s41285-017-0043-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1057/s41285-017-0043-4

Keywords

Search

Navigation