Bioethics-In-Action: Transforming Resistance into Acceptance through Persuasion

• In Event: Ethical Issues in Biomedical Research, Health Policy, and Clinical Practice – I

Abstract

In clinical consultations patient and physicians are sometimes at odds over how to treat. In pediatric epilepsy, seizure control for children is critical to brain development. However, parents are often concerned about the side effects of giving seizure treatment. If parents resist clinicians’ recommendations for epilepsy treatment does this create an intractable ethical problem? And if so, in what way? In an era of shared decision-making, should physicians take cues from parents even if it leads to undertreatment, or should clinicians stand their ground when they believe it is in the child’s best interests? At the same time, professional medical authority rests partly on patients’ voluntary compliance with physicians’ directives. Parents’ resistance to treatment recommendations and physicians’ ability to convert resistance into acceptance indexes the strength of contemporary professional authority and the potential of contemporary clinical encounters to morph into ethical dilemmas. Using conversation analytic methods to analyze 149 video-recordings of patient-clinician encounters involving pediatric epilepsy patients, we identify three distinct grounds for resistance: preference-, fear-, and evidence-based resistance. Clinicians meet these grounds with three corresponding persuasion strategies ranging from pressuring, to coaxing, to accommodating. We show that clinicians discriminate between resistance that contests their ability to medically direct the treatment course versus challenges to the epistemic basis of the directive. Even when physicians increasingly rely on persuasion to achieve patient buy-in, they preserve professional authority. However, this professional achievement may come at the cost of the parents’ preferences. We then study the health, professional, and social tradeoffs of bioethics-in-action.

Authors

• Stefan Timmermans

• Tanya Stivers, UCLA