title: "Nobody understands": on a cardinal phenomenon of palliative care.
abstract: In the clinical practice of palliative medicine, recommended communication models fail to approximate the truth of suffering associated with an impending death. I provide evidence from patients' stories and empiric research alike to support this observation. Rather than attributing this deficiency to inadequate training or communication skills, I examine the epistemological premises of the biomedical language governing the patient-physician communication. I demonstrate that the contemporary biomedicine faces a fundamental aporetic occlusion in attempting to examine death. This review asserts that the occlusion defines, rather than simply complicating, palliative care. Given the defining place of aporia in the care for the dying, I suggest that this finding shape the clinicians' responses to the needs of patients in clinical care and in designing palliative research. Lastly, I briefly signal that a genuinely apophatic voice construing the occlusion as a mystery rather than an aporia may be superior to the present communication and empathy models.
authors.affiliation: Marshfield Clinic, Marshfield, WI 54449, USA. okon.tomasz@marshfieldclinic.org
authors.forename: Tomasz R
authors.initials: TR
authors.lastname: Okon
mesh_terms: D001293:Attitude to Death; D003142:Communication; D032882:Comprehension; D004645:Empathy; D026690:Ethics, Clinical; D006801:Humans; D019359:Knowledge; D033262:Narration; D010166:Palliative Care / Q000941:ethics* / Q000523:psychology; D010817:Physician-Patient Relations; D019452:Terminally Ill / Q000523:psychology*