75 Ethics of ACP dialogue: a consideration of the timing of dialogues by care providers

<h3>Background</h3> In the practice of ACP, care providers face challenges, such as determining the appropriate timing to initiate conversations about the future, understanding how to conduct these dialogues effectively, and assessing the patient’s readiness for such discussions. These challenges highlight the difficulty in preparing for meaningful patient dialogue and underscore the importance of further research in ‘clinical dialogue.’ <h3>Aim</h3> This presentation aims to deepen the exploration of clinical dialogue by focusing on the concept of ‘time’ within such interactions as a key perspective for examination. <h3>Methods</h3> The examination will utilize literature focusing on ‘time’ or ‘timing’ within clinical dialogue to deepen the analysis. <h3>Results and Discussion</h3> Japanese bioethicist, Kaoruko Aita, emphasizes that, in providing decision-making support, care providers engage in a ‘continuous and collaborative process’ through repeated dialogue with patients which aligns with the principle of respecting patients individually and ensures the ethical validity of such dialogues. Based on this, Japanese philosopher, Seisuke Hayakawa, argues that care providers must respect ‘the patient’s sense of time as experienced amidst illness’ with ethically appropriate dialogue. Hayakawa also identifies the concept of ‘stagnant sense of present time’; referring to a closed perception of time patients may experience when illness prevents them from moving forward into the future, leaving them anchored in a difficult present. This ‘stagnant sense of present time,’ characteristic of the experience of suffering, represents an ‘isolated present,’ resulting from discrepancies between the patient’s sense of time and those around them. These discrepancies can heighten patient anxiety, leading to deeper suffering. To break this negative cycle, Hayakawa insists that care providers and others in the patient’s environment must work to correct these temporal discrepancies. Regarding temporal discrepancy correction, Thomas Fuchs’ concept of ‘intersubjective synchronization’ is instructive. In a phenomenological study on depression, Fuchs highlights the importance of supporting patients in regaining synchronization, or ‘resynchronization’, with those around them and the broader world, as the breakdown of synchronization exacerbates feelings of alienation and isolation. According to Fredrik Svenaeus, the isolated sense of present time is not limited to psychiatric patients but can also be found in many experiencing illness-related suffering. Thus, Hayakawa advocates incorporating the perspective of ‘synchronization’ to address discrepancies in the sense of time between patients and care providers. This perspective can help resolve issues in clinical dialogues, such as the appropriate timing of discussions. In this presentation, I will show some examples of correction of discrepancies in clinical dialogue.