The multicultural stigmatization of death and dying has sparked an ethical controversy surrounding the use of humor in end-of-life care by medical providers. Humor is a crucial mode to connect with patients undergoing a challenging experience. Yet, balancing the line between comedy and sensitivity regarding such a serious subject poses a difficult challenge for medical professionals. Determining the clinical significance and cultural acceptance of humor may offer insights into how comedy can be utilized as a vital asset in healthcare.
Humor has made a noticeable impact on wellbeing. Several studies have shown that humor in medical settings has enhanced patients’ pain tolerance, as demonstrated through a cold pressor test (1). Moreover, humor has enabled patients to alleviate stress and mitigate agitation towards specific procedures or practices. Krotos et al. illustrated this by introducing clowns and jesters at elder care homes, resulting in decreased doses of psychotropic medications throughout their stay (2). Medical professionals practice beneficence or the act of working for the patient’s well-being. The studies prove that humor actively works to improve the mental state of terminally ill patients and thus should be adopted into standard practices. Comedy helps patients feel more secure and relaxed about their situation, easing tension. However, these studies have limitations, as many experiments employing humor in palliative care lack a longitudinal nature, making it challenging to deduce all trends in humor’s impact on patient health (3).
The cultural perspective of humor must be considered when evaluating if comedy is a viable treatment method for end-of-life care. Maintaining a sense of humor was rated as highly important in a Western/European cultural setting of patients (3). When dealing with a heavy subject such as death, the type of humor employed can have a significant impact. The balance between discussing the course of action and humor is essential for medical professionals as it could disrupt patient autonomy or the principle on individual choice of treatment. Humor in this setting could skew patients to opt for procedures or therapies that they wouldn’t regularly do, violating this fundamental principle.
Moreover, the delivery of humor has an impact on patient health. Research has indicated that cynicism or sarcasm can harm patient health and morale, although the extent of this disruption is still being explored (5). Studies have shown that appropriate forms of humor that validate patients’ experiences can enable them to distance themselves from death and feel less isolated during their stay at palliative care homes. Yet, the most challenging limitation in studying cross-cultural humor responses is the variety of definitions that define humor, limiting the ability to compare many humor studies on patient health (4). Overall, medical professionals who incorporate humor into their practice were able to significantly assist their patients in understanding their conditions and ultimately improve their quality of life.
Humor is widely recognized as an effective coping mechanism for stressors, and its utilization in medical settings aims to provide a better quality of life to terminally ill patients. (6) However, how doctors and nurses employ humor can have diverse positive effects on the patient, from enhancing pain tolerance to reducing medication dosage levels. One thing is clear: death and dying are morose subjects to discuss, but humor might be the best way to reflect, cherish, and acknowledge the natural end of life.
Reviewed by Kiara Lavana
Graphic by Eugene Cho
Sources
(1) : Weisenberg M., Tepper I., Schwarzwald J. (1995). Humor as a cognitive technique for increasing pain tolerance. Pain 63, 207–212. 10.1016/0304-3959(95)00046-U
(2): Kontos P., Miller K.-L., Mitchell G., Stirling-Twist J. (2015). Presence redefined: the reciprocal nature of engagement between elder-clowns and persons with dementia. Dementia 16, 46–66. 10.1177/1471301215580895
(3) Linge-Dahl LM, Heintz S, Ruch W, Radbruch L. Humor Assessment and Interventions in Palliative Care: A Systematic Review. Front Psychol. 2018 June 19;9:890. doi: 10.3389/fpsyg.2018.00890. PMID: 29973892; PMCID: PMC6020769.
(4) Bag, B. (n.d.). JOURNAL OF PSYCHIATRIC NURSING. The use of humor in palliative care services. https://jag.journalagent.com/phd/pdfs/PHD_12_2_173_179%5BA%5D.pdf
(5) Ruch W., Heintz S., Platt T., Wagner L., Proyer R. T. (2018). Broadening humor: comic styles differentially tap into temperament, character, and ability. Front. Psychol. 9:6. 10.3389/fpsyg.2018.00006
(6) Lee, E. J. (2020, July 1). Humor in health care. Journal of Ethics | American Medical Association. https://journalofethics.ama-assn.org/article/humor-health-care/2020-07
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