Medical Discourse in Oral Contexts
ELLEN BARTON Trajectories of Alignment and the Situated Ethics of End-of-Life Discussions in American Medicine 1. Introduction Sarangi and Roberts set an interdisciplinary goal of developing “an ethics of practical relevance” (1999: 2) for joint work in applied linguistics and medical communication. Such an ethics would focus on communicative situations and events that involve medical decision- making with ethical dimensions through the discourse analysis of naturally-occurring instances of these interactions. In contrast to research on ethics that sets out a normative (that is, prescriptive) decision-making procedure that physicians and patients or surrogates ought to follow (Beauchamp / Childress 2001), a discourse analysis describes the interplay of ethical issues and concerns in decision- making as it actually happens in and across encounters between physicians, patients, and families (Solomon 2005). This kind of discourse analysis offers a descriptive approach to ethics by showing how ethical issues emerge in decision-making as situated in the discourse of particular communicative events (Barton / Sarangi 2005). Following this approach, the research reported here looks at one particular communicative event in end-of-life care in American medicine – the end-of-life (EOL) discussion between physicians and families of terminally ill patients in intensive care.1 In American hospitals, one of every five patients dies in an ICU (intensive care 1 Although a study of EOL care and communication across languages and cultures would be fascinating and important, that would be far beyond the scope of a single chapter. I limit myself to American medicine in this chapter because my data come...
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