Transformability of Doctors

From Narratives of Home Care Physicians on Drip Infusion at the End of Life

Abstract

Home care medicine has been widely promoted as the purpose of healthcare has shifted from the treatment of diseases toward the overall improvement of patientsʼ quality of life. This study focuses on the emotional conflicts of home care physicians, especially when they have to decide whether to administer intravenous infusions to patients who are no longer able to take oral fluids in order to consider the roles of physicians in the age of community-based care. The use of intravenous infusions at the end of life is not medically recommended. However, people have different expectations regarding intravenous infusions. Talcott Parsons describes the roles of physicians as “limited” and “emotionally neutral.” However, home care medicine is a field where these roles cannot easily be accomplished. Further, physicians are under the pressure of instrumental activism and thus struggle with multiple norms in decision-making concerning end-of-life intravenous infusions. Through interviews with two home care physicians, this study finds that they deal with these conflicts by exchanging narratives with patients and families and engaging in the practice of “acting with hesitance,” extending their options for decision-making both cross-sectionally and longitudinally. This study calls their role recognition “transformability.” Physicians tended to avoid emotional conflicts over handling patientsʼ lives by adhering to their “limited” roles. The practice of “acting with hesitance” may provide a potential pathway to overcome such limitations, and “transformability” may become a new role recognition of the physician in this era of community-based care.