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Advances in Medical Discourse Analysis: Oral and Written Contexts

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Maurizio Gotti and Françoise Salager-Meyer

The focus of this volume is on medical discourse, a domain of language which deserves closer scrutiny by academics as well as practitioners, due to its increasing relevance and pervasiveness in modern society. Despite the wealth of publications dealing with specialized or academic discourse and its rhetoric, few of these are devoted specifically to medical discourse. This book seeks to redress the balance by bringing together a number of studies that bear witness to the widespread interest in medical texts shown by linguists and professional communities around the world. The volume is divided into two main parts: the first targets medical discourse in its spoken dimension, while the second contains various analyses of written texts. The theoretical perspectives and individual case studies presented here reflect the wide range of methodological approaches and theoretical issues that characterise current research in the field.

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Medical Discourse in Oral Contexts

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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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