When It Hurts to Ask: Avoiding Moral Injury in Requests to Forgo Treatment

Clinicians commonly believe that "there is no harm in asking" patients with life-threatening illnesses if they would like to forgo aggressive therapy. In fact, many clinicians believe that the question is not only appropriate, but obligatory on grounds of patient empowerment and autonomy: Patients should be given all options, including the option to stop treatment. But in this piece, I argue that there is, indeed, serious -- and even traumatic -- harm in asking patients to forgo treatment if that request is perceived by the patient as evidence that the clinician devalues or questions the integrity of that patient's life. When such requests are perceived to imply: "Your life is not worth saving," the effect of the "ask" is insult and offense, not empowerment. I then argue how clinicians can avoid moral injury in conversations about withholding or withdrawing treatment.