clinical practice use‘ dead’ or‘ dying’. Another participant, who identified herself as a nurse, said‘ died’ was blunt and too direct and that‘ passed away’ was kinder.
clinical practice use‘ dead’ or‘ dying’. Another participant, who identified herself as a nurse, said‘ died’ was blunt and too direct and that‘ passed away’ was kinder.
One participant said that even after 20 years she still can’ t say that her husband had‘ died’. She can’ t use the word‘ died’. And yet another one said that when she did use the word‘ died’ when talking about her dad, she could almost see people wince as she said it. And that’ s the way it was received, I suppose.
The general message was that some euphemisms are okay such as‘ passed on’ or‘ passed away’, but it wasn’ t okay to use most of the terms they found, like‘ carked it’,‘ pushing up daisies’,‘ popped your clogs’ or‘ six feet under’.
On the other hand, some participants argued the opposite, saying:“ How could you soften death?” Another one said:“ Why would using different words lessen or soften the emotion?”
Someone, quite intuitively I thought, said that many people fear death and want to make it easier, I suppose, or sound nicer. I think it speaks to the way in which our language has changed over the years and our attitudes to death and dying.
More than two-thirds of participants were health professionals. How did they approach talking about death? This was interesting, as we specifically said when promoting the course that we were talking socially about death and dying and that it was for the general public. But lots of health professionals came in with their health professional hats on still not realising until the course actually started that we wouldn’ t be teaching them about palliative care. But in saying that, most of them had a great shift in their thinking and embraced what we were doing.
So rather than saying,‘ This isn’ t about palliative care, I’ m off’, they started to participate in the conversations. When they were doing that, they were mostly doing that as themselves as a person, as a nurse or as an occupational therapist. So there were occasions when they were relating experiences about caring for people who were dying at work, but they were just as likely to talk about their own personal experiences or express their own thoughts.
Interestingly, many said that they’ d learned a lot anyway, even if it wasn’ t the course they were expecting. That was a great outcome, and it speaks to the fact that even though we were thinking we can’ t hear the voice of consumers or the general public, there aren’ t that many forums where health professionals can have these sorts of conversations as well.
In an article for The Conversation, you discussed the complexities of talking about death and dying. What issues may arise if a health professional uses a euphemism in some of those conversations? I think that one of the big problems is when health professionals aren’ t clear in what they’ re saying to people at what can be a very difficult time, so when emotions are running high, for example. This is especially true when breaking bad news and when people are vulnerable. We know from the literature that in these situations people hear only a fraction of what is said to them. They often take away an entirely different message than the one that was given.
Now, when the public use euphemisms, it can cause confusion. For example, one participant spoke of an uncle in Tasmania who said his friend had gone over to the other side, and she just thought he’ d gone to the mainland. So there were examples like that.
However, when health professionals use euphemisms, it can cause a lot of upset and distress. One of the participants talked about an elderly woman who was waiting for news about which of two nursing homes her hospitalised husband was going to be transferred to. When the nurse rang her and said he’ d‘ gone’, the wife then said,“ Which one did you send him to?”, only to be told that he had died. That was an embarrassing misunderstanding that should have been avoided by using clear and direct language. I think that’ s something that health professionals need to be aware of.
When might a euphemism be an acceptable or better option? Despite the need to use plain language and be clear, it is important to be sensitive. As one participant said:“ It’ s about finding the words that people are comfortable with.”
Many of the health professionals said that while they’ re okay saying‘ dead’ or‘ died’ in general conversation to each other and quite often to some families, they would be guided by the person they were talking to, and that was a recurring theme. You have to judge the conversation that you’ re having and how it’ s being received, and what the language is that the person you’ re talking to is using.
This is particularly true with people from cultures where talking about death is taboo or you can only talk to a certain family member or an elder. This could also be true for people of different ages, so some participants talked about speaking to children or how they were spoken to as a child and / or people from another culture. So, for example, one participant said that after nursing in a multicultural area for years, she was aware of the cultural sensitivities that exist around death and dying, and certainly in talking to colleagues here who are working on other projects, many Aboriginal and Torres Strait Islander people prefer to use‘ finishing up’ rather than‘ dying’, and‘ passed away’ rather than‘ died’. So in some circumstances it’ s preferable to use euphemisms.
Why is it important that health professionals use the right language and, in particular, direct language when appropriate? While the language that we use is important, it is more about the message that is being given and whether it’ s been understood, and about the episode of communication as a whole. So it’ s okay to use‘ passed away’ if that’ s the language used by the person you’ re talking to and they fully understand what this means.
Though I did pause over the use of language when one nurse said:“ I was told to write‘ passed away’ in the case notes, so it made me wonder why it would be offensive or too harsh to state a fact like that in the medical record.” So not only is our language changing, much of our culture is as well.
The terms we found most likely to cause problems are‘ gone’ and‘ lost’, as they can cause a lot more misunderstanding and distress. Any health professionals saying these words need to consider the implications. For example, a few participants found it quite distressing when someone used the word‘ lost’ to them.
One example that was given, and a couple of people said something similar, was:“ The phrase‘ I’ m sorry you lost your son’ implies carelessness on my part. I didn’ t misplace him. I didn’ t lose him in the supermarket. He died.”
So you need to think about the words you’ re using. Just as we would avoid jargon or acronyms when talking to patients, you should avoid euphemisms whenever possible. ■
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