Browsing by Author "Buscariolli, André"

Advance healthcare directives (AD) are written documents in which patients can express their preferences regarding the provision of specific medical treatments, providing future instructions in case they become unable to communicate and make the decisions for themselves. Whereas these documents are praised for promoting patient’s autonomy, recent research has shown that patients often fail to predict what kind of treatment they would like to receive. This leads to an apparent contradiction: on which grounds can patient’s autonomy be regarded as the positive feature of AD if patients themselves are not likely to anticipate future preferences? This thesis draws on different agency theories to further elaborate on this contradiction while exploring taken for granted assumptions about patient’s autonomy. Relying on the premises of symbolic interactionism and social constructionism, it argues that goals are construed during emerging social interactions, subjected thus to constant reevaluation and reinterpretation. Methodologically, I used Goffmanian frame analysis to analyze semi-structured interviews of six Finnish physicians, elaborating on how they frame end-of-life treatment discussions, how they constructed the agency of different actors, how they approach patient’s autonomy, and what are the implications for the use of advance directives. From the data five frames were identified: medical knowledge frame, patient’s autonomy frame, negotiation frame, ethical frame, and legal frame. During the interviews physicians used these frames to discuss and negotiate the nature and meanings of advance directives, as well the agency and interests of different actors involved in end-of-life decision-making. Two meanings of patient’s autonomy have emerged from analysis: as the patients’ souvereign right to express his/her will of end-of-life treatment; and as the patients’ capacity to choose between different treatments . Whereas physicians often praise the first meaning, the second becomes problematic to the extent that patients’ capacity for decision-making can be compromised. Thus, physicians reframe the notion of patient’s autonomy in relational terms constructing themselves as agents for the patients’ interests. In conclusion, I propose that instead of trying to improve advance directives reliability; their situational component should be incorporated into the very principle that establishes their use, accounting for a holistic process in end-of-life care decision-making.