Can promoting patient decision making be exclusionary? Moral expectations and cultural difference in the narratives of UK maternity clinicians

Authors

  • Myfanwy Davies Cardiff University, Cardiff, UK
  • Glyn Elwyn Cardiff University, Cardiff, UK
  • Irena Papadopoulos Middlesex University, London, UK
  • Lon Fleming Middlesex University, London, UK
  • Gareth Williams Cardiff University, Cardiff, UK

DOI:

https://doi.org/10.1558/cam.v6i1.39

Keywords:

Autonomy, virtue, decision making, cultural difference, Arab Muslim, ethnic minority groups

Abstract

Patient autonomy in health care decision making is increasingly advocated as a means of promoting patients’ ‘responsibilities’ for treatments and costs. However, little is known with regard to clinicians’ understanding of patients’ potential responsibilities in decision making. We explore how clinicians may view decision making as a ‘moral’ obligation and examine how moral virtue is discursively constructed in this context and in the face of ethnic and social difference. Data reported are derived from an interview study that examined perceptions of maternity decision making among Arab Muslim women and clinicians. Results reported here are from the clinician sample which includes obstetricians, general practitioners (GPs) and midwives. Clinicians perceived that a key element of their role involved imparting relevant information to their clients and, increasingly, involving them in making autonomous decisions about their care. However, by analysing and assessing the attribution of specific cultural differences in clinicians’ discussion of decision making processes with minority group women, we demonstrate how some clinicians justified their failure to promote autonomy through shared decision making with women from these groups. We will demonstrate these attributes to be those of passivity and non-rationality which entail some negative moral judgements and which have a complex relationship to gender and power.

Author Biographies

Myfanwy Davies, Cardiff University, Cardiff, UK

Cardiff University, Cardiff, UK

Glyn Elwyn, Cardiff University, Cardiff, UK

Cardiff University, Cardiff, UK

Irena Papadopoulos, Middlesex University, London, UK

Middlesex University, London, UK

Lon Fleming, Middlesex University, London, UK

Middlesex University, London, UK

Gareth Williams, Cardiff University, Cardiff, UK

Cardiff University, Cardiff, UK

Published

2009-07-13

How to Cite

Davies, M., Elwyn, G., Papadopoulos, I., Fleming, L., & Williams, G. (2009). Can promoting patient decision making be exclusionary? Moral expectations and cultural difference in the narratives of UK maternity clinicians. Communication and Medicine, 6(1), 39–48. https://doi.org/10.1558/cam.v6i1.39

Issue

Section

Articles