Challenging Face-to-Face Communication in Clinical Ethics: Autism as an Illustrative Case.

Abstract

This paper examines the ethical status of face-to-face communication in clinical practice, using autism as an illustrative case. Drawing on phenomenological accounts of embodiment and first-person descriptions of autistic experience, it argues that face-to-face interaction-characterized by immediacy, multimodality, and unpredictability-can impose significant perceptual and cognitive burdens on autistic patients. Digitally mediated communication, by contrast, provides greater temporal flexibility, semiotic stability, and user control, thereby reducing communicative pressure and supporting more accessible participation. Reframing communication through the principles of autonomy, non-maleficence, and relational care, the paper argues that communicative practices should be understood as context-sensitive and responsive to patients' perceptual conditions rather than governed by a default preference for face-to-face interaction. It concludes that presence should be reconceptualized as a relational achievement grounded in responsiveness rather than physical co-presence alone, with implications for how ethical communication in clinical care is understood.