The Value of Implicitness: An Empirical Ethics Analysis of Indonesian Everyday Family Involvement in a Palliative Care Setting

The lack of professional support for patients needing palliative care in Indonesia leads to a heavier reliance on family members for care. However, family tensions often arise from unmet expectations about support from other family members. This study explores implicitness, which we describe as the use of indirect or unspoken methods to communicate messages. We argue that the value of implicitness strongly influences the communication of these expectations and affects family caregiving dynamics. This paper aims to discuss the hidden expectations shaped by implicitness, what makes it an important value in family care, its ethical implications, and strategies for resolving the problems that arise from it. We conducted ethnographic fieldwork in Banyumas, Indonesia, involving in-depth interviews, home observations, and focus group discussions with patients, families, and health professionals. Data were analyzed through an empirical ethics approach. Our findings indicate that implicitness shapes family expectations regarding involvement of other family members in daily caring activities and financial support. Implicitness serves as an important value as it seeks to preserve sincerity and also maintain harmony, by not directly asking for help. However, implicitness can also lead to underlying family tensions that hinder proper care and reduce the well-being of patients and families. Families were able to resolve problems by accepting difficult circumstances or sharing them with health professionals. We suggest that health professionals should acknowledge the role of implicitness and use active listening skills to identify potential problems. If appropriate, they could help persuade family members to be more actively involved in caregiving through indirect communication. By doing so, they may enhance the well-being of both patients and families without needing every expectation to be directly and explicitly articulated.