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Managing death: Navigating divergent logics in end-of-life care

Bailey, Simon, Hodgson, Damian, Lennie, Sarah-Jane, Bresnen, Mike, Hyde, Paula (2020) Managing death: Navigating divergent logics in end-of-life care. Sociology of Health and Illness, . ISSN 0141-9889. E-ISSN 1467-9566. (doi:10.1111/1467-9566.13095) (KAR id:80562)


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 health care 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.

Item Type: Article
DOI/Identification number: 10.1111/1467-9566.13095
Uncontrolled keywords: end-of-life care; institutional logics; patient choice; professional conflict; bureaucracy; informal work
Subjects: H Social Sciences > H Social Sciences (General)
Divisions: Divisions > Division for the Study of Law, Society and Social Justice > School of Social Policy, Sociology and Social Research > Centre for Health Services Studies
Depositing User: Simon Bailey
Date Deposited: 20 Mar 2020 11:15 UTC
Last Modified: 14 Jan 2024 06:10 UTC
Resource URI: (The current URI for this page, for reference purposes)

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