It’s Time She Stopped Torturing Herself: Hospital Culture and Medical Paternalism in End-Of-Life Care

• In Event: 161 - Section on Organizations, Occupation and Work Roundtable Session (one-hour).
  In Refereed Roundtable: Table 23. Research on Work

Abstract

Notions of a ‘good’ and ‘bad’ death abound in society, forming part of a biomedical culture surrounding death. Little is known, however, about how physicians’ collective understandings about death influence their decision-making in end-of-life care. Drawing on over two years of ethnographic observation with 20 teams of internal medicine residents, this article: (1) explores the existence of a hospital culture (specifically, shared understandings among physicians) regarding the ‘right time’ to die, and (2) illustrates how this culture impacts medical practice. The results reveal that when residents’ views clash with patients’ wishes about end-of-life care, they face an ethical quandary that pits the medical ethical imperative of non-maleficence against the legally-enshrined doctrine of patient self-determination. Residents, who are less empowered than senior physicians to invoke futility processes for example, reconcile this quandary by becoming moral entrepreneurs, pursuing what they feel is in their patients’ best interest, even if this violates patient autonomy. The findings adumbrate why paternalism persists in end-of-life care, despite legal doctrines to the contrary.

Author

• Tania M. Jenkins, Brown University