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‘It's time she stopped torturing herself’: Structural constraints to decision-making about life-sustaining treatment by medical trainees

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  • Jenkins, Tania M.

Abstract

This article explores how structural factors associated with the profession and organization of medicine can constrain internal medicine residents, leading them to sometimes limit or terminate treatment in end-of-life care in ways that do not always embrace patient autonomy. Specifically, it examines the opportunities and motivations that explain why residents sometimes arrogate decision-making for themselves about life-sustaining treatment. Using ethnographic data drawn from over two years at an American community hospital, I contend that unlike previous studies which aggregate junior and senior physicians' perspectives, medical trainees face unique constraints that can lead them to intentionally or unintentionally overlook patient preferences. This is especially salient in cases where they misunderstand their patients' wishes, disagree about what is in their best interest, and/or lack the standing to pursue alternative ethical approaches to resolving these tensions. The study concludes with recommendations that take into account the structural underpinnings of arrogance in decision-making about life-sustaining treatment.

Suggested Citation

  • Jenkins, Tania M., 2015. "‘It's time she stopped torturing herself’: Structural constraints to decision-making about life-sustaining treatment by medical trainees," Social Science & Medicine, Elsevier, vol. 132(C), pages 132-140.
    • Handle: RePEc:eee:socmed:v:132:y:2015:i:c:p:132-140
    DOI: 10.1016/j.socscimed.2015.03.039
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    References listed on IDEAS

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    1. Muller, Jessica H., 1992. "Shades of blue: The negotiation of limited codes by medical residents," Social Science & Medicine, Elsevier, vol. 34(8), pages 885-898, April.
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