Truth-indifferent communication in healthcare: a functional analysis of bullshit

Debates in bioethics and healthcare governance repeatedly confront communicative practices that smooth over uncertainty, ritualise consent or protect institutions more than they inform patients and professionals. These practices can be labelled 'bullshit', but the term is morally charged and analytically imprecise. This paper develops a diagnostic for truth-indifferent communication in healthcare that does not depend on inferring inner motives. By juxtaposing Frankfurt-style, Cohen-style and a Luhmannian approach, it shows how a systems-theoretical lens is especially useful for thinking through 'bullshit' as a structural and organisational phenomenon rather than an individual moral failure. Drawing on this perspective, the analysis focuses on observable proxies for truth-indifference: verification latency, incentive alignment, format and placement (eg, slogans or ritual reassurances), and the strength of sanction coupling. Informed consent serves as the central case for demonstrating how formalisation and nudging can both discipline and foster truth-indifferent communication. The result is a second-order, non-moralising framework that distinguishes functional from dysfunctional truth-indifferent communication and translates this distinction into concrete design and governance levers for bioethics and clinical practice.