Tell Parents the Truth, but Tell It Slant

This article draws on fiction, poetry, and memoir to suggest that for many people, tragic choices are best dealt with not through explicit conversations that directly confront difficult truths but, instead, through indirect and ambiguous conversations that only suggest what is most important. Telling the truth slant is not easier than telling it directly. It requires more imagination and perhaps more sensitivity to the parents' nonverbal cues. The underlying moral principles are the same in the 2 approaches. The values and preferences of the patient and the family should be given highest priority. But to respect those values and honor those preferences, doctors need to listen carefully to understand what parents are saying, what they are not saying, what they mean, and what they need. Sometimes they may be saying that there are things that they prefer not to discuss or decisions that would prefer not to affirm.