Silence and truth in death and dying

Area of Science:

• Medical Ethics
• Sociology of Medicine
• Thanatology

Background:

• A socio-medical discourse emerged around 1960 emphasizing truth-telling in patient-physician communication regarding end-of-life care.
• This discourse often condemns the prior practice of maintaining silence with dying patients.

Purpose of the Study:

• To challenge the notion that truth and silence are inherently opposed in end-of-life dialogues.
• To argue that the significant change since 1960 is not the possibility of speaking truth, but the evolving definition of truth itself.
• To analyze the shift in focus from post-mortem examination to the interrogation of the dying patient as a manifestation of this changing truth.

Main Methods:

• Literature review of socio-medical discourse on death and dying since 1960.
• Philosophical analysis of the concept of 'truth' in the context of medical ethics and patient communication.
• Historical analysis of communication practices surrounding death and dying.

Main Results:

• The paper refutes the simplistic dichotomy of truth versus silence in end-of-life care.
• It posits that the 'truth' concerning death has transformed, not merely become accessible.
• The shift from interrogating the corpse to interrogating the dying patient signifies this evolution in understanding truth.

Conclusions:

• The discourse on truth-telling in end-of-life care has evolved significantly since the 1960s.
• The opposition between truth and silence is a false dichotomy; the nature of truth itself has changed.
• The contemporary focus on the dying patient reflects a fundamental alteration in how truth about death is perceived and pursued.