title: Death talk: Basic linguistic rules and communication in perinatal and paediatric end-of-life discussions.
abstract: OBJECTIVE
  This paper considers clinician/parent communication difficulties noted by parents involved in end-of-life decision-making in the light of linguistic theory.
  
  
  METHODS
  Grice's Cooperative Principle and associated maxims, which enable effective communication, are examined in relation to communication deficiencies that parents have identified when making end-of-life decisions for the child. Examples from the literature are provided to clarify the impact of failing to observe the maxims on parents and on clinician/parent communication.
  
  
  RESULTS
  Linguistic theory applied to the literature on parental concerns about clinician/parent communication shows that the violation of the maxims of quantity, quality, relation, and manner as well as the stance that some clinicians adopt during discussions with parents impact on clinician/parent communication and lead to distrust, anger, sadness, and long-term difficulties coping with the experience of losing one's child.
  
  
  CONCLUSIONS
  Parents have identified communication deficiencies in end-of-life discussions. Relating these communication deficiencies to linguistic theory provides insight into communication difficulties but also solutions.
  
  
  CONCLUSIONS
  Gaining an understanding of basic linguistic theory that underlies human interactions, gaining insight into the communication deficiencies that parents have identified, and modifying some communication behaviours in light of these with the suggestions made in this article may lead to improved clinician/parent communication.
authors.affiliation: Discipline of Obstetrics and Gynaecology, The University of Adelaide, Adelaide, Australia. Electronic address: vicki.xafis@adelaide.edu.au.
authors.forename: Vicki
authors.initials: V
authors.lastname: Xafis
authors.affiliation: Mercy Hospital for Women, Melbourne, Australia. Electronic address: watkina@mac.com.
authors.forename: Andrew
authors.initials: A
authors.lastname: Watkins
authors.affiliation: Discipline of Obstetrics and Gynaecology, Women's and Children's Hospital, The University of Adelaide, Adelaide, Australia; Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK. Electronic address: dominic.wilkinson@philosophy.ox.ac.uk.
authors.forename: Dominic
authors.initials: D
authors.lastname: Wilkinson
mesh_terms: D003142:Communication; D003643:Death; D003657:Decision Making; D005260:Female; D006801:Humans; D008037:Linguistics; D008297:Male; D010290:Parents / Q000523:psychology*; D010372:Pediatrics; D066087:Perinatal Death; D011247:Pregnancy; D011368:Professional-Family Relations; D013727:Terminal Care / Q000379:methods*; D019452:Terminally Ill
keywords: Consumer health information; Decision making; End of life care; Health communication