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Negotiating palliative care expertise in the medical world

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  • Hibbert, Derek
  • Hanratty, Barbara
  • May, Carl
  • Mair, Frances
  • Litva, Andrea
  • Capewell, Simon

Abstract

This paper explores the relationship between palliative medicine and the wider medical world. It draws on data from a focus group study in which doctors from a range of specialties talked about developing palliative care for patients with heart failure. In outlining views of the organisation of care, participants engaged in a process of negotiation about the roles and expertise of their own, and other, specialties. Our analysis considers the expertise of palliative medicine with reference to its technical and indeterminate components. It shows how these are used to promote and challenge boundaries between medical specialities and with nursing. The boundaries constructed on palliative medicine's technical contribution to care are regarded as particularly coherent within orthodox medicine. In contrast, its indeterminate expertise, represented by the 'holistic' and 'psychosocial' agendas, is potentially compromising in a medical world that prizes science and rationality. We show how the coherence of both kinds of expertise is contested by moves to extend palliative care beyond its traditional temporal (end-of-life) and pathological (cancer) fields of practice.

Suggested Citation

  • Hibbert, Derek & Hanratty, Barbara & May, Carl & Mair, Frances & Litva, Andrea & Capewell, Simon, 2003. "Negotiating palliative care expertise in the medical world," Social Science & Medicine, Elsevier, vol. 57(2), pages 277-288, July.
  • Handle: RePEc:eee:socmed:v:57:y:2003:i:2:p:277-288
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    Cited by:

    1. Peretti-Watel, P. & Bendiane, M.K. & Moatti, J.P., 2005. "Attitudes toward palliative care, conceptions of euthanasia and opinions about its legalization among French physicians," Social Science & Medicine, Elsevier, vol. 60(8), pages 1781-1793, April.
    2. Broom, Alex & Kirby, Emma & Good, Phillip & Wootton, Julia & Adams, Jon, 2013. "The art of letting go: Referral to palliative care and its discontents," Social Science & Medicine, Elsevier, vol. 78(C), pages 9-16.
    3. Martin, Graham P. & Currie, Graeme & Finn, Rachael, 2009. "Reconfiguring or reproducing intra-professional boundaries? Specialist expertise, generalist knowledge and the 'modernization' of the medical workforce," Social Science & Medicine, Elsevier, vol. 68(7), pages 1191-1198, April.
    4. Chattoo, Sangeeta & Atkin, Karl M., 2009. "Extending specialist palliative care to people with heart failure: Semantic, historical and practical limitations to policy guidelines," Social Science & Medicine, Elsevier, vol. 69(2), pages 147-153, July.

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