THE DEATH AVOIDANCE PARADOX IN PSYCHIATRIC END-OF-LIFE CARE: A MULTIDIMENSIONAL CONCEPTUAL FRAMEWORK OF CLINICIAN AVOIDANCE

Abstract

Background
Patients with severe mental illness (SMI) experience high physical morbidity and reduced life expectancy yet remain underrepresented in palliative and end-of-life care. Clinicians working in psychiatric settings face complex clinical, ethical, and organizational challenges, contributing to disparities in care.

Aim
This paper develops a conceptual framework to explain how avoidance behaviors emerge and persist among healthcare professionals in psychiatric end-of-life care.

Conceptual approach
The framework is based on a conceptual synthesis of literature from palliative care, psychiatry, Terror Management Theory, experiential avoidance research, and organizational behavior. It integrates psychological and systemic perspectives to develop a multidimensional explanatory model.

Proposed framework
The Death Avoidance Paradox is introduced as a five-dimensional model comprising existential, emotional, cognitive, organizational, and cultural avoidance. These interrelated domains interact recursively, transforming mortality-related anxiety and clinical uncertainty into sustained patterns of professional and institutional avoidance, ultimately shaping communication and care delivery.

Conclusions
The framework provides a comprehensive explanation for persistent disparities in psychiatric palliative care by conceptualizing avoidance as a multilevel and dynamic process. It offers a theoretical foundation for future empirical research, clinical training, and organizational interventions aimed at improving end-of-life care for patients with SMI.