Bioethical communication: shared decision-making and relational empathy

ABSTRACT

Background: Theoretical tensions in shared decision-making (SDM) exist among bioethical principles, patient autonomy, and evidence-based medicine. Scholars in biomedicine have looked to empathy as a component of SDM that may assist in decreasing these conflicts.

Method: This article outlines a theoretical foundation for incorporating relational empathy in SDM. Informed by interpersonal communication theory and bioethics, relational empathy becomes an intrinsic component in the initial phase of SDM.

Results: Healthcare providers should consider developing relational empathy with their patients before they address treatment options. Relational empathy, especially in the context of values elicitation and clarification, may increase patient participation and provide more symmetrical communication opportunities. Relational empathy also assists in developing relational autonomy, which shifts the emphasis in SDM from the traditional bioethical view of the autonomous individual to a definition of autonomy that describes a person in relation with others.

Conclusion: Increased opportunities for relational empathy through interpersonal communication may provide a more ethical communication context for SDM.

KEYWORDS:

• Healthcare communication
• consultation
• bioethics
• shared decision-making
• relational empathy
• reciprocity
• autonomy
• social penetration theory

Disclosure statement

No potential conflict of interest was reported by the author.

Notes on contributor

Russell Kirkscey, Ph.D. is a Marion L. Brittain Postdoctoral Fellow in the Writing and Communication Program at the Georgia Institute of Technology. His research interests include health and medical rhetoric, communication ethics, rhetorical theory, and research methods.

Notes

1 Patients and HCPs who value SDM and find they cannot reach consensus may choose to find other HCPs who may better support the goals of SDM. However, situations become complicated by insurance, timeframe for treatment, geographical limiters, and other issues. A fuller treatment of this topic is beyond the scope of this article.

2 Other communication contexts and medical situations may demand different levels of patient and HCP communication and may be less conducive for SDM. See [72] for a full treatment of the topic.