Laughing at the dark: Tactical humor for autonomous decision making in serious illness

摘要

Seriously ill persons often avoid challenging the doctors' perspectives about treatment decisions because they fear that doing so might compromise the quality of their care. This barrier to self-expression presents a major threat to modern concepts of autonomy. In this brief essay we describe a real clinical interaction that exemplifies one common strategy that patients and their families use to navigate this terrain-humor-and how doctors can respond to promote respectful decision making. Based in recent work on humor and humiliation, we cite a direct observation of one recent palliative care consultation, in order to highlight how patients and families use unexpected, unpredictable means to establish autonomy and make communal decisions amid suffering and serious illness.