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Palliative care in Europe: ethics and communication



* Examine the importance of effective communication and the moral significance of truth telling in the palliative care setting within a European context.
* Seek an explanation of Europe wide differences by examining skill levels as well as looking at social. professional and cultural determinants.
* Produce a set of culturally sensitive teaching materials which would facilitate the development of communication skills across Europe whilst taking account of justifiable differences with respect to the core issue of truth-telling and disclosure.

This project addresses the ethical issues relating to communication within the context of European palliative care services. The project will analyse the moral arguments which ground a commitment to effective communication and truthfulness within health care more generally, and then consider why there might be particular reasons supporting a special commitment to each as they relate to the delivery of palliative care. Ethical analysis will be informed by a thorough survey of the empirical evidence relating to the effect of good or bad communication on patient and family well-being and staff performance. If it is thought appropriate the skills of the participants will be harnessed to complement existing research data. A small-scale qualitative study has been planned, and will be executed if the meta-analysis of existing studies suggests that it is required. Having investigated the basic issue of truthfulness, the analysis will them focus on the specific issue of disclosure of information? This analysis will be conducted against the backdrop of widely differing attitudes and practices within Europe, which exist despite the fundamental philosophy of care formulated by the founders of the palliative care movement. This philosophy would appear to endorse full and frank discussion with patients regarding diagnosis, prognosis and treatment. The question arises as to whether it is transferable across national, cultural and religious boundaries.

The fundamental ethical question is this: Are there reasons why non-disclosure can be justified in certain contexts despite a moral presumption in favour of truthfulness, and a commitment to the need for effective communication? In responding to this question the project will address four levels of communication as relevant to the enquiry- communication with patients, communication with families, communication between professionals, communication within society. The aim is to establish to what extent non-disclosure where it occurs is the justifiable response to relevant individual, cultural and societal factors. If this cannot be demonstrated one is forced to ask whether differences need to be explained in terms of a lack of commitment to effective communication as an element of appropriate care, or lack of skill in communicating on the part of the professionals involved. The project will not seek to enforce uniformity in practice across Europe; rather it will seek to distinguish between justifiable and unjustifiable differences. However, in the interests of developing Europe wide services and in order to contribute to the development of an appropriately European philosophy of palliative care, the project will produce materials to promote and facilitate the teaching of culturally sensitive communication skills. Having done this the project will have followed the issue through from its philosophical/theoretical beginnings to its practical service based end. As such it will have made a full contribution to the development of palliative care services within Europe.

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King's College London
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WC2R 2LS London

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