The goal of the proposed training program is to broaden understanding of the varying languages of death and dying that influence the process of decision-making by people at the end of their lives. The bioethics community has effectively advocated for a model of decision-making in clinical practice that emphasizes autonomy. This view is based on liberal political theory and assumes a rational individual with a right and capacity for self-determination over bodily integrity. Many important protections for patients have been developed from the model and it has achieved support from organizational and legal structures. However, growing empirical evidence suggests that this model is insufficient to meet the needs of people in our pluralistic society. Dissent is particularly clear in minority communities and among people with more orthodox religious beliefs. Additionally, the autonomy model fails to account for the diversity of values expressed regarding the commitments of families and communities to participate in decision-making. The methodology of discourse analysis will be used in this study to analyze interview data with the goal of exploring two related aims. They are: 1) to identify how people from diverse communities talk about and frame discussions of dying and death and 2) to map overlapping and distinct uses of the circulating discourses of death (including the language of the bioethics literature) that might influence negotiation and decision-making around dying. Knowledge generated from this study will inform communication with people who are dying and will be instrumental in guiding the development of new models of decision-making in the bioethics community to better represent the pluralistic values and needs present in American society.
| Shirley, Jamie L (2007) Limits of autonomy in nursing's moral discourse. ANS Adv Nurs Sci 30:14-25 |
