It is good to talk. This expression has adorned countless appeals, advertisements, posters, podcasts and inspirational GIFs, all aiming to sell an idea, product, or service, build connections, boost confidence, raise campaign awareness or inspire changes in attitudes, beliefs, behaviours and understanding. The dictum seems inherently sensible and is borne out by other proverbial idioms that identify with the idea of communication making life easier, such as ‘a problem shared is a problem halved’.
For many years, policies and practices for improving the provision of palliative and end-of-life care have been predicated on the need to promote ‘death talk’ to and among a population that might otherwise have been (sometimes and often erroneously) considered unwilling to engage or feel prohibited from actively contributing to the debate or discussion (Wilson et al, 2022). In recent times, Marie Curie (2021) identified that, while people may convey the impression that they feel comfortable talking about death and dying, few actually do so in terms of formally planning end-of-life preferences and arrangements. This may be, in part, because people lack the knowledge of services or linguistic or interpersonal communication skills to have such conversations (Graham-Wisener et al, 2022).
Healthcare practitioners may also have reservations or communicative limitations when it comes to addressing certain challenging aspects of palliative and end-of-life care, such as emotional concerns (Ellington et al, 2012) or prognoses (McLennon et al, 2013). They may avoid or otherwise miss opportunities for engaging with such dialogue (Knutzen et al, 2021). And yet, the professional's role and responsibility for initiating and enabling such conversations is an expectation of patients and their families (Bergenholtz et al, 2020). However, the moral weight of the term, along with its emotional and ethical significance, complicates its use in contemporary and historical contexts. The associations with assisted suicide or assisted dying make discussions around it invariably challenging. Nonetheless, after a period of nine years or so since the last parliamentary and public debate on the topic, the House of Commons has published the Private Members Terminally Ill Adults (End of life Bill) (House of Commons, 2024). This bill proposes that eligible adults be allowed assisted death. The eligibility criteria specifies that the person should be a resident of England and Wales, registered with a GP for at least 12 months, living with a terminal illness and expected to die within six months. The person must have the mental capacity to make a clear and fully informed choice about the end of their life, free from coercion or pressure. The bill excludes disability and mental illness as eligibility criteria. While it is without the scope of this article to deliberate further on the scope of the bill, it will be debated and scrutinised and receive much media coverage, representing and reflecting the mores, morals and messages of a modern UK.
As such, it is widely acknowledged that palliative and community care staff play a fundamental role in facilitating effective and supportive communication, which enables and empowers better co-ordination of services and shared decision-making (Ferguson et al, 2023). Practitioners might still need to consider how they will address the general and specific questions and concerns that such contemporary conversation topics can engender in a way that is open, honest and empathetic, let alone conversant of all the legal and professional considerations. The Arabic axiom ‘speech is silver, silence is golden’ may not be an option or opportune but talk is cheap, and actions may speak louder than words.