Managing death: navigating divergent logics in end-of-life care.

Area of Science:

• Sociology of Health and Illness
• Healthcare Management
• Medical Ethics

Background:

• End-of-life care delivery in the UK emphasizes patient choice.
• Healthcare professionals' understanding of 'a good death' and their role influences patient choice.
• Contested ideas exist regarding who is best positioned to provide end-of-life care.

Purpose of the Study:

• To examine the influence of distinct 'institutional logics' on the delivery of end-of-life care.
• To analyze the tensions between professional and organizational logics in shaping patient choice.
• To understand how financial and professional authority logics interact to define patient interests.

Main Methods:

• Qualitative data from a two-part study.
• Examination of tensions between different professional and organizational logics.
• Identification of three broad clusters of logics: finance, patient choice, and professional authority.

Main Results:

• The logic of finance significantly shapes the meaning and practice of 'choice' in end-of-life care.
• Finance and professional authority logics intersect to guide choices deemed in the patient's 'best interest'.
• Alternative professionalism can enact different versions of choice but may reinforce professional authority.

Conclusions:

• The delivery of end-of-life care is characterized by a struggle between institutional logics, primarily finance and professional authority.
• Patient choice is not autonomous but is constructed within these competing logics.
• The dominance of certain logics may reinforce conventional professional control over end-of-life decision-making.