Helping Patients Improve Their Quality of Life as They Face Death

By Michael A. Harvey and John Greer Clark

This article is a part of the May/June 2021, Volume 33, Number 3, Audiology Today issue.

In an article titled “The Final Frontier: Heightening Our Vigilance to the Taboo of Discussing Death During Patient Encounters,” published in the March/April 2021 issue of Audiology Today, we urged audiologists to be ready to address mortality issues that patients may have and to engage supportively (Clark and Harvey, 2021). Here, in this article, we kick our recommendation up a notch.

We consider that it might even be appropriate and helpful to not only respond supportively when patients broach the topic of death, but sometimes even for audiologists to initiate discussions about death. This may include taboo questions, such as asking terminally ill patients when they predict they may die, why they may not want to die, and what they wish they could do differently during their remaining time.

Many audiologists may immediately deem these kinds of discussions as extremely inappropriate and well beyond ethical practice parameters. Indeed, we are not mental health therapists. Our scope of practice is to help patients cope with, and adjust to, hearing loss—certainly not to terminal illness. Moreover, it is our ethical responsibility to remain vigilant for such issues that may arise in clinical encounters that are beyond professional boundaries and to establish appropriate referral procedures.

But bear with us! We must also recognize that there are gray areas in our discussions with patients that may present a challenge to professional boundaries, rather than a breach of those boundaries (Clark and English, 2019). Admittedly, if done thoughtlessly, it is clearly inappropriate to ask these questions about dying, but, as we will illustrate, if done judiciously, those very questions may indeed prove to be quite supportive to patients and helpful for their audiological care.

Of course, appropriate timing and a respectful approach are everything. It is important to ask a patient for permission to discuss that taboo topic. We may use humor by assuring patients that there is no implied time commitment to when they may die. We might even reference the book, Tuesdays with Morrie (Albom, 1997).