“There is nothing more we can do.”
Words That Close the Door
I walked into the doorway to ICU bed 3 when I heard the dreaded phrase.
“There is nothing more we can do.”
The attending, trying to introduce me as the palliative consultant, intended to help. But his words sparked fear in the patient.
The room was quiet and reflective, but tension immediately rose. I watched the patient’s daughter glance down, hands clenched, bracing for impact. That one sentence changed the energy in the room. An emotional door closed—and I hadn’t even sat down yet.
Not only was that phrase untrue—it caused harm. Postulating the answer as “nothing” closes the door and locks it, isolating the patient and family from hope, connection, and choice.
Language Isn’t Neutral: It Builds Trust or It Breaks It
Clinicians face one of the highest-stakes conversations in medicine when sitting with someone who is seriously ill. In hospice, these conversations often happen in an ICU or a living room, where you’re not just discussing medical options. You are honoring hopes and dreams that may be about to be cut short.
Too often, we mean to comfort or clarify but do the opposite. Never-Words, as defined by Awdish, Grafton, and Berry in their 2024 Mayo Clinic Proceedings [1] paper, are phrases that take away choice, frighten, or unintentionally sever connection. They are not just poor phrasing. They are missed opportunities for trust, clarity, and dignity.
This post reviews the seminal article by Awdish et al., adds hospice-specific insights, and offers practical replacements for common Never-Words. It builds on Think with the End in Mind to support Clarity First dialogue.
What Are Never-Words?
“Never-Words” are phrases that clinicians should avoid in serious illness conversations.
They often:
- Shut down dialogue
- Impose authority over patient agency with declarative communication
- Sound reductive or dismissive
Examples include:
- “There is nothing more we can do.”
- “You failed treatment.”
- “We will withdraw care.”
- “He needs a transplant.”
Why They Harm
Never-Words reinforce power imbalances in emotionally charged moments. They suggest judgment, finality, or abandonment. Take the question: “Do you want us to do everything?”
It sounds like collaboration—but it conceals a failure to lead. In asking it, we dodge our duty to name prognosis and give informed consent. It’s moral abdication, disguised as respect.
In busy hospital settings with fragmented care, harmful phrases persist because no one owns the language. EMRs default to jargon. New clinicians receive little coaching on how to speak at the bedside.
We need to normalize communication training. We need to model better language.
Patients hear more than words. They hear tone. They feel intention. And when the words land poorly, they linger. They echo. “Patient failed treatment” might land in the chart, but it isn’t respectful to the patient or family.
The profession needs to own the language and cannot allow a prognostic burden shift. We need to own the lack of role modeling, poor EMR defaults, and poor word choices.
There is a chance to do better in the moment and implement clear teaching moving forward.
Practical Alternatives
| Never-Word | Alternative Phrase | Why It Works |
| “There’s nothing we can do.” | “We can shift our focus to comfort and quality of life.” | Conveys continued presence and care |
| “She failed treatment.” | “The treatment hasn’t had the effect we hoped for.” | Removes blame from the patient |
| “Withdrawing care” | “We’re continuing care that aligns with what matters to them.” | Reframes as a shift, not a stop |
| “Do you want everything done?” | “Let’s talk through what care would be most meaningful.” | Avoids false binaries; invites shared decisions |
| “He needs a transplant.” | “His heart is worsening. May we talk about what that means?” | Shares concern and invites exploration |
Print this table for your next IDG meeting or keep it handy to guide your language.
Hospice Perspective
Far too often in the ER and even in hospice IDG meetings—I hear the phrase “He is a DNR.” It always stops me cold. No one is a code status. Reducing a person’s full narrative to a three-letter shorthand flattens nuance, erases deliberation, and risks signaling finality. It is also dehumanizing.
A better option? “Mr. Smith has chosen a DNR order to prioritize comfort. It is noted on file.” That framing reflects a choice made with thought, intention, and context. In hospice, where identity and dignity reign, this isn’t a matter of semantics. It’s a matter of respect.
The Never Words article struck a nerve for me. Families often remark, “Those words still haunt us.” Language lingers. Your choices can echo and impact grief long after you leave the room. It creates moral residue for clinicians too. There are many reasons why language matters.
I’ve seen how phrases like “comfort only” or “withdraw care” can send families into emotional free fall. I’ve also seen language bring calm, restore clarity, and invite collaboration. Words shape tone. Tone shapes trust. And we need more trust in medicine. Trust that we will work together and never abandon the patient. Trust that there is a doctor, a nurse, a social worker, a chaplain, an aide, a volunteer, and more. Trust that there is a whole team available.
When we say, “Let’s talk through this together and consider all options” it shifts the dynamic from detachment to solidarity. That’s the essence of hospice. We comfort. We show up—deliberately and consistently.
Vision That Lights the Way
If we want families to see the paths ahead, we have to illuminate them. That means guiding families through goals-of-care discussions with empathy to ensure they feel supported. We have to help them understand why hospice may be the best option—not the last option.
In our prior post, Hospice is not a Place, It’s a Promise, we discussed how hospice prioritizes showing up for patients. Avoiding Never-Words builds on that foundation by ensuring our language honors choices and uplifts patients.
Hospice is about showing up. It’s understanding the patient’s voice—and honoring their decisions. Now is the right time.
To avoid Never-Words, training programs should include role-playing serious illness conversations and reviewing phrases like those in the table above. New providers can practice these during on-boarding to build confidence.
It all begins with recognition—and learning to carefully craft powerfully positive words.
Three Key Insights
- Never-Words are rarely intentional—but they still cause harm.
- Better phrases build trust, agency, and clarity.
- Communication training should be standard in serious illness care.
One Actionable Ideas
- Review your own scripts and swap out one habitual Never-Word this week and seek out other resources like VitalTalk or the REDE Model.
- Practice walking back a phrase that didn’t land well: “That came out wrong. Can I say that another way?”
One Actionable Item
Speak as though your words will echo—because for many families, they do. Share Never-Words with your team at IDG. Bring up this topic at your next staff meeting. Link to this Blog. Let’s learn together!
Glossary
- Never-Words (new): Harmful phrases that sever connection in serious illness conversations, often unintentionally.
- Language Shift (new): The practice of replacing default or harmful clinical phrases with language that builds trust, clarity, and compassion.
- Words That Heal (new): A Hospice Synopsis communication principle promoting language that honors patient dignity and supports informed, shared decisions.
- IDG (existing): Interdisciplinary Group – the full hospice team that includes physicians, nurses, social workers, chaplains, aides, and others.
- DNR (existing): Do Not Resuscitate – a medical order indicating no CPR or advanced cardiac life support if breathing or heartbeat stops.
Quote
“Speak as though your words will echo, because for many families they will.” — Brian H. Black, D.O.
Bibliography
- [1] Awdish RL, Grafton G, Berry LL. (2024). Never-Words: What Not to Say to Patients With Serious Illness. Mayo Clinic Proceedings, 99(10): 1553–1557. https://doi.org/10.1016/j.mayocp.2024.05.011
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