At the International Congress of Palliative Care in 2010 an international authority made a bold, yet accurate, conclusion that the domain of Palliative Care has not made meaningful progress in the past decade. I was in the minority of attendees who complimented him on his courage to arrive at such a cogent conclusion. As I reflect on the status quo, I believe that the main reason relates to linguistic problems, specifically related to the misuse, overuse, and euphemistic use of the word “palliative”. This stunted growth, and potential regression, is largely linked to linguistic confusion generated through the use of “mitigated speech”. By definition, “mitigated speech” refers to any attempt to downplay or sugarcoat the meaning of what is being stated. During the 1980’s, the airline industry experienced an epidemic of airline crashes that were ultimately attributed to the use of “mitigated speech” between pilots and air traffic controllers. With the exception of bonafide experts in Palliative Medicine/Palliative Care, the majority of physicians lack a complete understanding of the term “palliative”. Therefore, how can we possibly expect that patients and their family member understand what it implies? The first step in improving the unacceptable status quo is to employ the word palliative ONLY to describe the philosophy of care that the PATIENT has decided to adopt. In a truly patient-centered/patient empowered model, it is the PATIENT, NOT THE DOCTOR, that deems themselves palliative. Instead of terming a “palliative patient”, we should instead state, for instance, “the patient with an advanced illness, namely, stage IV cancer, is terminally ill (incurable), manifests a PPS of 40%, and has elected for a completely “palliative” mode of care (ie, pain & symptom management to enhance comfort, dignity, quality of life, and quality of death). In summary, if we wish to avoid “crashes” by our patients and their families we MUST clarify and standardize our linguistics, thus avoiding the currently unmitigated use of “mitigated speech” in the management of patients with advanced illness. Finally, let’s “call a spade a spade” and exercise linguitic purity when using the word “palliative“.
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