Communication & Medicine, Vol 6, No 1 (2009)

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

Myfanwy Davies, Glyn Elwyn, Irena Papadopoulos, Lon Fleming, Gareth Williams
Issued Date: 13 Jul 2009


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
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.

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DOI: 10.1558/cam.v6i1.39


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