Whose decision? Negotiating epistemic and deontic rights in medical treatment decisions
Journal article by Anne Marie Dalby Landmark, Pål Gulbrandsen and Jan Svennevig in Journal of Pragmatics Special Issue: Epistemics and Deontics in Conversational Directives, volume 78, 2015.
Shared decision making has become an ideal in contemporary clinical practice, and guidelines recommend exploring patients’ preferences and providing them with options so they can make informed decisions. This paper examines how the ideal of sharedness is maintained and negotiated through epistemic and deontic resources in secondary care consultations where patients are given a choice between invasive and non-invasive treatment options. The analysis suggests that the physician's presentation of treatment options is often tilted in favor of one proposal over the other, yet giving the patient the right to make the final decision. The patients on the other hand regularly resist this responsibility by claiming lack of epistemic authority (e.g. I know nothing about it) or by making the decision contingent on the physician taking a stronger deontic stance (e.g. if you think so). This may be characterized as an inverted use of deontic authority from both parties: Physicians give patients deontic rights in their pursuit of independent commitment to their preferred option, while patients orient to physicians’ epistemic and deontic rights as a way to resist committing to the physicians’ propositions. These conflicting orientations to epistemic and deontic authority counteract the ideal of shared decision making.