CLINICAL ETHICS

What should we say?

J Savulescu¹, B Foddy² and J Rogers³

¹ Uehiro Chair in Practical Ethics, Director, Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK
² Ethics Unit, Murdoch Childrens Research Institute, Royal Childrens Hospital Parkville, Victoria, Australia, Centre for Applied Philosophy and Public Ethics, University of Melbourne, Australia, Australian Stem Cell Centre, Clayton, Victoria, Australia
³ Senior Fellow, Genetic Health Services Victoria, Royal Children’s Hospital, Parkville, Victoria, Australia

Correspondence to:
Correspondence to:
B Foddy
Ethics Unit, Murdoch Childrens Research Institute, 9th Floor, Royal Childrens Hospital, Flemington Road, Parkville, Victoria, Australia, 3052; bennett{at}foddy.net

Abstract ethics mostly focuses on what we do. One form of action is a speech act. What we say can have profound effects. We can and should choose our words and how we speak wisely. When someone close to us suffers an injury or serious illness, a duty of beneficence requires that we support that person through beneficial words or actions. Though our intentions are most often benign, by what we say we often make the unfortunate person feel worse. Beginning with two personal accounts, this article explains what can go wrong in the compassionate speech of wellwishers, and uncovers some of the reasons why people say things that are hurtful or harmful. Despite a large body of clinical evidence, there is no perfect strategy for comforting a friend or relative who is ill, and sometimes even the best thing to say can still be perceived as insensitive and hurtful. In some cases, we may have good reason to knowingly say a hurtful or insensitive thing. Saying these ‘wrong’ things can sometimes be the best way to help a person in the long term. To complicate matters, there can be moral reasons for overriding what is good for the patient. What kind of admonishments should we make to a badly behaved patient? What is the value of authenticity in our communication with the people we love? These questions demand an ethical defence of those speech acts which are painful to hear but which need to be said, and of those which go wrong despite the best efforts of the wellwisher. We offer an ethical account, identifying permissible and impermissible justifications for the things we say to a person with a serious injury or illness.

Keywords: compassion; equity; misfortune; moral luck

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What you should have said

Odhran P Shelley

JME Online, 28 Feb 2006 [Full text]