How Psychology Can Ease End-of-Life Challenges: Modifying Social Norms Around Death and Dying in the US

In the context of life-limiting illness, spending more on healthcare and prescribing more invasive disease-directed treatments often leads to worse quality-of-life outcomes for patients and caregivers while increasing medical debt. Current approaches to mitigating these harms are inadequate, necessitating new conceptual frameworks to guide research, interventions, and policy. The Transtheoretical Model of Irrational Biomedical Exuberance (TRIBE) leverages psychological research and theory to explain how moral emotions (e.g., compassion, pride, shame) experienced by clinicians, patients, and their families lead to the prescription of disease-directed interventions (e.g., chemotherapy, dialysis) that often cause more harm than benefit. In this extension of the TRIBE model to the broader US health policy context, we posit that moral emotional processes also influence healthcare policy and commercialized healthcare delivery. Specifically, we posit that death decorum norms and corresponding moral emotions (e.g., compassion) motivate harmful end-of-life interventions by eroding death literacy and stoking death anxiety. Similarly, commercialization norms and corresponding moral emotions (e.g., pride) motivate the overuse of biomedical interventions and lead clinicians, patients, policymakers, and the public to place undue faith in biotechnology. Socioemotional processes obscure financial motives that incentivize disease-directed treatments while disincentivizing psychological interventions and the development of community-based interventions and systems of care. Given psychologists’ expertise in behavior, emotions, and systems-level culture change, they are uniquely positioned to mitigate the harms of disease-directed treatments at the end-of-life. Opportunities abound for psychologists to contribute to transdisciplinary research, interventions, policy, and culture change initiatives aimed at easing the challenges associated with end-of-life transitions and promoting higher quality care.