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Language with unintended consequences

  • Some commonly used phrases or statements may be counterproductive when discussing advance care planning and resuscitation status.

    Presenting advance care planning as a ‘choice’ for which families have sole responsibility may provoke great distress and guilt, and misrepresents the medical decision-making process.

    In their desire to be honest with families, clinicians may unconsciously present only information about what treatments they think should be withheld, not what active and engaged management will still be offered.

    Euphemisms may render the clinician’s intentions unclear to families and cause misunderstanding.

    Some commonly misunderstood phrases are listed below, with an explanation of the possible unintended consequences and an example of an alternative phrase that might be used (Stone 2001).


    Statement Problem Alternative

    ‘Do you want us to do everything possible?’

    or

    ‘What do you want us to do?’

    Shifts responsibility away from doctor and on to parents.

    Likely that parent will ‘want everything done’. What parent does not want ‘everything done’ to care for their child?

    Does not explain options or provide guidance; may include treatment choices that are futile or

    inappropriate to patient care.

    ‘There are many things we could do for your child,

    the question for us both is which of those things should we do.

    Everything we do has a benefit and a burden. We should only do those things that have an overall benefit for your child.’

    ‘Will you agree

    to discontinue care?’

    Implies dichotomous choice between treatment and abandonment by team.

    Implies child will not be cared for.

    Shifts responsibility away from doctor and on to parents.

    ‘I want to give (child) the best care possible. Their body is telling us it’s time for us to focus on you being with them and

    us making sure (child) is not suffering.’

    ‘There’s nothing left to be done.’ This is untrue and will provoke great distress. There may be no curative options, but other active treatment is always available. ‘I think we should focus on your child’s comfort and dignity as our top priority now. This is how ...’
    ‘I think we should stop aggressive therapy.’ Negative framing suggests abandonment of child by family. Unclear meaning. ‘I think we should focus on your child’s comfort and dignity as our top priority now. This is how...’
    ‘I’m going to make it so they won’t suffer.’ Implies euthanasia of child and assumes that suffering is inevitable in dying children. ‘I will focus my efforts on treating any symptoms your child might have.’

    ‘We could give more chemotherapy.

    Or we could stop and send you home with palliation, and the cancer would gradually get worse and ultimately they would die.’

    Portrays palliative care in a negative light.

    The term ‘palliative care’ already comes laden with negative connotations and mythology.

    ‘We could give more chemotherapy but I am worried that will mean they will need

    to stay in hospital and experience a lot of side effects with almost no chance of ever going home or being well again. We could instead, focus on helping them feel better and getting you all home. Palliative care can help us do that.’

     ‘I just need to go through this form with you to document what treatments we are and are not going to provide.’

    Confronting. Perceived as reducing child’s life down to a form.

    Perceived as a legal process.     		  

    After having discussion.

    ‘I am just going to write down what we have decided today so that if someone is called

    to assist you in an emergency, they can quickly see what we have been thinking. We have a special form that we keep

    in the medical record and send to the ambulance service.

    It is just a way of us communicating information quickly. Staff helping you at the time will always discuss this with you. Some parents like to have

    a copy of it. Others don’t.’

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