The findings of this qualitative, exploratory study suggest that ethical concepts and analyses of double pressure situations should have an important role in education and training designed to prepare emergency personnel for difficult life and death choices. More research is needed to shed light on how ethical dilemmas arise in prehospital work.

The article presents a study of the interaction between paramedics and parents in cases of Sudden Infant Death Syndrome (SIDS). We have sought to understand how the parents perceived the paramedics ability to communicate as well as empathise and deal with practical aspects of the situation. We have also sought to understand how the paramedics view their role as professional health workers, and how they think they should interact with persons in crisis. The method used in this study is qualitative and involves semi-structured interview schemes. We conducted twelve interviews -six with parents and six with paramedics. One of our primary findings is that many of the parents interviewed were not satisfied with the paramedics' communication, empathy and ability to take care of the practical aspects of the situation. The interviews have also revealed that there is significant disagreement among paramedics about the interpersonal role of health workers in situations involving people in crisis. The final part of this article includes a discussion of these and other findings. We argue that guidelines that specify threshold conditions for communication and care should be implemented in education and training. The aim of such guidelines should be to make sure that parents of lifeless children are secured a minimum of relevant explanations, information and care. BackgroundThis article presents results from a qualitative research project designed to study and understand interpersonal relations in an emergency setting involving persons in crisis. The study has focused on the interaction between paramedics and parents of children whose deaths were later attributed to Sudden Infant Death Syndrome (SIDS). This interaction is very dramatic and difficult. The paramedics normally encounter the parents with the knowledge that they have a lifeless child, and they also know that the parents are undergoing extreme emotional and cognitive stress. Before the arrival of the paramedics and medical doctors, the parents' only contact with the health system is interactive, by way of medical emergency telephone.The aim of our research has been to understand how challenges related to communication, care and empathy are experienced in the interaction between paramedics and parents. The next section clarifies this aim of the project and its wider significance to studies of communication in emergency situations. Section three presents relevant theoretical assumptions and the qualitative method used in the semi-structured interviews with paramedics and parents. Section four presents the main results of the study,

Hilary Putnam's influential analysis of the 'division of linguistic labour' has a striking application in the area of doctor-patient interaction: patients typically think of themselves as consumers of technical medical terms in the sense that they normally defer to health professionals' explanations of meaning. It is at the same time well documented that patients tend to think they are entitled to understand lay health terms like 'sickness' and 'illness' in ways that do not necessarily correspond to health professionals' understanding. Drawing on recent philosophical theories of concept possession, the article argues that this disparity between medical and lay vocabulary implies that it is, in an important range of cases, easier for doctors to create a communicative platform of shared concepts by using and explaining special medical expressions than by using common lay expressions. This conclusion is contrasted with the view that doctors and patients typically understand each other when they use lay vocabulary. Obviously, use of expressions like 'sickness' or 'illness' does not necessarily lead to poor communication, but it is important that doctors have an awareness of how patients interpret such terms.

It is a fundamental assumption in nursing theory that it is important for nurses to understand how patients think about themselves and the contexts they are in. According to modern theories of hermeneutics, a nurse and a patient must share the same concepts in order to communicate beliefs with the same content. But nurses and patients seldom understand medical concepts in exactly the same way, so how can this communicative aim be achieved in interaction involving medical concepts? The article uses a theory of concepts from recent cognitive science and philosophy of mind to argue that nurses and patients can share medical concepts despite the diversity of understanding. According to this theory, two persons who understand medical language in different ways will nevertheless possess the same medical concepts if they agree about the normative standards for the applications of the concepts. This entails that nurses and patients normally share medical concepts even though patients' conceptions of disease and illness are formed in idiosyncratic ways by their social and cultural contexts. Several practical implications of this argument are discussed and linked to case studies. One especially important point is that nurses should seek to make patients feel comfortable with deferring to a medical understanding. In many cases, an adequate understanding of patients presupposes that nurses manage to do this. Another implication is that deference-willingness to normative meaning is not equivalent to the actual application of concepts. Deference-willingness should rather be thought of as a pre-communicative attitude that it is possible for patients who are not fully able to communicate to possess. What is important is that nurses and patients have the intention of conforming to the same meaning.

The paper explores consequences of applying the view that illness is negative first-person experience in caring practice. The main reason this is an important issue is that it is empirically documented that patients conceive of illness in different ways. Communicating about illness in caring practice can therefore involve difficulties. I argue that many of these difficulties can be avoided if nurses focus directly on the extension of the concept of illness--patients' experiences like the state of being in pain--and not on how this extension is represented as (the intension) illness. This argument is compatible with different views on the nurse-patient relationship as a communicative process. All it requires is the acceptance of minimal assumptions about concepts and concept possession. The argument has a descriptive and a normative dimension. It is descriptive in the sense that it seeks to use concepts from philosophy of mind to explain how many nurses succeed in talking about illness without applying the concept of illness. It is normative in the sense that it provides a philosophical justification for this practice.