Exploring Habermas’ theory of communicative ethics as an approach to physician communication training: the case of pediatric end-of-life care

In pediatric end-of-life (EOL) care, the partnership between physicians and parents is principally centered on communication and the parents’ decision-making role about the patient’s impending death. And, because parents are charged with EOL decision-making for their children, physicians are morally responsible to ensure that prognoses and treatment options are communicated to parents in a comprehendible way. Poor communication has been posited as a primary reason why the end-of-life (EOL) wishes of patients and surrogates are not implemented. This paper is based on findings from a qualitative study that utilized observation in a high-fidelity simulation and semi-structured interviews with physicians to explore narrative influences on pediatric EOL communication. The findings of this study, which revealed an inherent connection between communication, decision-making, and ethics, are reflected Habermas’ theory of Communicative Ethics (The theory of communicative action: reason and the rationalization of society, Beacon Press, Boston, 1984; The theory of communicative action: lifeworld and system: a critique of functionalist reason, Beacon Press, Boston, 1987). Therefore this paper proposes communicative ethics as an important model which, if utilized in physician education and training, could improve physician communication and in particular, physician–parent EOL communication.