A new publication from Tania Jenkins that may be of interest to OOW members.
Jenkins, T. M. (2015). ‘It’s time she stopped torturing herself’: Structural constraints to decision-making about life-sustaining treatment by medical trainees. Social Science & Medicine, 132, 132-140. doi:http://dx.doi.org/10.1016/j.socscimed.2015.03.039
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.
Organizations, Occupations and Work 