Why the Concept of "Critical Abilities" is Misguided: Lessons Learned from the Updated Serious Illness Conversation Guide

Abstract: In 2021, Ariadne Labs’ Serious Illness Care team began a two-year effort to revisit the Guide language to "ensure that conversations are accessible for everyone, regardless of race, culture, physical abilities, gender identity, or other personal factors." One result of that effort was the removal of the question, "What abilities are so critical to your life that you can’t imagine living without them?" In this paper, we analyze data on the relationship between disability and quality of life both in general and also in end-of-life contexts more specifically. We argue that this research indeed supports the idea that the theoretical construct of "critical abilities" is likely to at best misrepresent the dynamic and complex nature of the relationship between people's abilities and their overall wellbeing and at worst reinforce ableist assumptions about living with disability. Especially given the fact that palliative care has historically paid too little attention to the needs of disabled people nearing the end of life, the removal of constructs such as "critical abilities" from deliberations over end-of-life care is a step in the right direction. We conclude with implications of this argument for non-palliative domains of care.

Michael Pottash, MD, MPH – Associate Professor, Clinical Medicine, Georgetown School of Medicine