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Cited by 21Palliative Care and End-of-Life IssuesEthics and bioethics in healthcareEthics in medical practice

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‘It's time she stopped torturing herself’: Structural constraints to decision-making about life-sustaining treatment by medical trainees

Jenkins, Tania M.·2015·Social Science & Medicine
DOI 10.1016/j.socscimed.2015.03.039
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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.

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Metadata

Authors
Jenkins, T. M.
Affiliations
Brown University (US)
Corresponding author
Jenkins, Tania M.
ORCID
Jenkins, Tania M.
Venue
Social Science & Medicine
Publisher
Elsevier BV
Published
2015-05
Volume
132
Pages
132-140
ISSN
0277-9536 (ISSN-L)
DOI
10.1016/j.socscimed.2015.03.039
OpenAlex
W1984441503
Cited by
21
References
1
Citations by year
2026: 1 · 2025: 1 · 2024: 2 · 2023: 4 · 2022: 3 · 2021: 3 · 2020: 2 · 2018: 1 · 2017: 3 · 2016: 1
FWCI
1.79
Type
journal article
Language
en
Open access
closed
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Social Science & Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • RePEc: Research Papers in Economics (submittedVersion)
Funders
  • National Science Foundation Dissertation Improvement (1303276)
  • Brown University Beatrice
  • Joseph Feinberg Memorial Fund
  • Social Sciences and Humanities Research Council of Canada (752-2010-0219)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics and bioethics in healthcare
  • Health Sciences › Health Professions › General Health Professions › Ethics in medical practice
Keywords
life-sustaining treatment, end-of-life care, medical residents, internal medicine residency, patient autonomy, patient preferences, clinical decision-making, hospital ethics, physician-patient relationship
MeSH terms
Anthropology, Cultural, Decision Making, Female, Humans, Internal Medicine, Internship and Residency, Life Support Care, Male, Power, Psychological, Social Environment, Terminal Care, United States, Personal Autonomy, Beneficence, Withholding Treatment, Patient Preference

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