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Managing death: navigating divergent logics in end‐of‐life care
Author(s) -
Bailey Simon,
Hodgson Damian,
Lennie SarahJane,
Bresnen Mike,
Hyde Paula
Publication year - 2020
Publication title -
sociology of health and illness
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.146
H-Index - 97
eISSN - 1467-9566
pISSN - 0141-9889
DOI - 10.1111/1467-9566.13095
Subject(s) - meaning (existential) , order (exchange) , health professionals , sociology , public relations , health care , psychology , political science , business , law , finance , psychotherapist
Delivery of end‐of‐life care has gained prominence in the UK, driven by a focus upon the importance of patient choice. In practice choice is influenced by several factors, including the guidance and conduct of healthcare professionals, their different understandings of what constitutes ‘a good death’, and contested ideas of who is best placed to deliver this. We argue that the attempt to elicit and respond to patient choice is shaped in practice by a struggle between distinct ‘institutional logics’. Drawing on qualitative data from a two‐part study, we examine the tensions between different professional and organisational logics in the delivery of end‐of‐life care. Three broad clusters of logics are identified: finance, patient choice and professional authority. We find that the logic of finance shapes the meaning and practice of ‘choice’, intersecting with the logic of professional authority in order to shape choices that are in the ‘best interest’ of the patient. Different groups might be able to draw upon alternative forms of professionalism, and through these enact different versions of choice. However, this can resemble a struggle for ownership of patients at the end of life, and therefore, reinforce a conventional script of professional authority.