Treatment that will not provide significant net benefit at the end of a person’s life (called futile treatment) is considered by many people to represent a major problem in the health sector, as it can waste resources and raise significant ethical issues. Medical treatment at the end of life involves a complex negotiation that implicates intergroup communication between health professionals, patients, and families, as well as between groups of health professionals. This study, framed by intergroup language theory, analyzed data from a larger project on futile treatment, in order to examine the intergroup language associated with futile treatment. Hospital doctors (N = 96) were interviewed about their understanding of treatment given to adult patients at the end of life that they considered futile. We conducted a discourse analysis on doctors’ descriptions of futile treatment provided by themselves and their in-group and out-group colleagues. Results pointed to an intergroup context, with patients, families, and colleagues as out-groups. In their descriptions, doctors justified their own decisions using the language of logic, ethics, and respect. Patients and families, however, were characterized in terms of wishing and wanting, as were out-group colleagues. In addition, out-group doctors were described in strongly negative intergroup language.
Australian Commission on Safety and Quality in Health Care. (2013). Safety and quality of end-of-life care in acute hospitals: A background paper. Sydney, New South Wales, Australia: Author.
BerwickD. M.FinkelsteinJ. M. (2010). Preparing medical students for the continual improvement of health and health care: Abraham Flexner and the new “public interest.”Academic Medicine, 85, S56-S65.
4.
CandrianC. (2013). Taming death and the consequences of discourse. Human Relations, 67, 53-69.
5.
ClaytonJ. M.HancockK. M.ButowP. N.TattersallM. H. N.CurrowD. C. (2007). Clinical practice guidelines for communicating prognosis and end-of-life issues with adults in the advanced stages of a life-limiting illness, and their caregivers. Medical Journal of Australia, 186(12), 77.
6.
DriedgerS. M.GalloisC.SandersB. C.SantessoN. (2006). Finding common ground in team-based qualitative research using the convergent interviewing method. Qualitative Health Research, 16, 1145-1157.
7.
FleckL. M. (2011). Just caring: Health care rationing, terminal illness, and the medically least well off. Journal of Law, Medicine and Ethics, 39, 156-171.
8.
GalloisC.OgayT.GilesH. (2005). Communication accommodation theory: A look back and a look ahead. In GudykunstW. (Ed.), Theorizing about intercultural communication (pp. 121-148). Thousand Oaks, CA: Sage.
9.
GasiorekJ.van de PoelK. (2012). Divergent perspectives on language-discordant mobile medical professionals’ communication with colleagues: An exploratory study. Journal of Applied Communication Research, 40, 368-383.
10.
GilesH. (Ed., 2012). The handbook of intergroup communication. New York, NY: Routledge.
11.
HewettD. G.WatsonB. M.GalloisC. (2013). Trust, distrust, and communication accommodation among hospital doctors. In CrichtonJ.CandlinC. (Eds.), Discourses of trust (pp. 36-51). Basingstoke, England: Palgrave Macmillan.
12.
HewettD. G.WatsonB. M.GalloisC.WardM.LeggettB. A. (2009a). Intergroup communication between hospital doctors: Implications for quality of patient care. Social Science & Medicine, 69, 1732-1740.
13.
HewettD. G.WatsonB. M.GalloisC.WardM.LeggettB. A. (2009b). Communication in medical records: Intergroup language and patient care. Journal of Language and Social Psychology, 28, 119-138.
14.
Institute of Medicine. (2014). Dying in America: Improving quality and honoring individual preferences near the end of life. Washington, DC: National Academies Press.
15.
LeuthnerS. R. (2008). Futility: Interpretation and usefulness in clinical practice. Health Matrix Cleveland, 18, 245-259.
16.
LingardL. (2009). Productive complications: Emergent ideas in team communication and patient safety. Healthcare Quarterly, 15, 18-23.
17.
MaassA.ArcuriL. (1992). The role of language in the persistence of stereotypes. In SeminG. R.FiedlerK. (Eds.), Language, interaction and social cognition (pp. 129-143). Newbury Park, CA: Sage.
18.
MaassA.SalviD.ArcuriL.SeminG. (1989). Language use in intergroup contexts: The linguistic intergroup bias. Journal of Personality and Social Psychology, 57, 981-993.
19.
MarckC. H.WeilJ.LaneHWeilandJ.PhilipJ.BougheyM.JelinekG. A. (2014). Care of the dying cancer patient in the emergency department: Findings from a national survey of Australian emergency department clinicians. Internal Medicine Journal, 44, 362-368.
20.
McDougallR. J.GillamL. (2014). Doctors’ “judgements” and parents’ “wishes”: Ethical implications in conflict situations. Medical Journal of Australia, 200, 372.
21.
MohammedS.PeterE. (2009). Rituals, death, and the moral practice of medical futility. Nursing Ethics, 16, 292-302.
22.
National Health and Medical Research Council. (2011). An ethical framework for integrating palliative care principles into the management of advanced chronic or terminal conditions. Canberra, Australia: Author.
23.
NussbaumJ. F.FisherC. L. (2009). A communication model for the competent delivery of geriatric medicine. Journal of Language and Social Psychology, 28, 190-208.
RitchieJ.SpencerL. (1994). Qualitative data analysis for applied policy research. In BrymanA.BurgessR. G. (Eds.), Analyzing qualitative data (pp. 173-194). London, England: Routledge.
26.
SavulescuJ. (2013). Just dying: The futility of futility. Journal of Medical Ethics, 39, 583-584.
27.
SchneidermanL. J.JeckerN. S.JonsenA. R. (1993). Medical futility: Its meaning and ethical implications. Annals of Internal Medicine, 112, 949-954.
28.
SeminG.FiedlerK. (1992). Properties of interpersonal language and attribution. In SeminG.FiedlerK. (Eds.), Language, interaction and social cognition (pp. 58-77). Newbury Park, CA: Sage.
29.
SlomkaJ. (1992). The negotiation of death: Clinical decision making at the end of life. Social Science & Medicine, 35, 251-259.
30.
SolomonM. (1993). How physicians talk about futility: Making words mean too many things. Journal of Law and Medical Ethics, 21, 231-237.
31.
ThompsonT. (2011). Hope and the act of informed dialogue: A delicate balance at end of life. Journal of Language and Social Psychology, 30, 177-192.
32.
WatsonB. M.GalloisC.HewettD.JonesE. (2012). Culture and health care: Intergroup communication and its consequences. In JacksonJ. (Ed.), The Routledge handbook of intercultural communication (pp. 512-524). London, England: Routledge.
33.
WhiteB.WillmottL.WinchS.ParkerM.GalloisC.GravesN.CloseE.ShepherdN. (2015). What does “futility” mean? An empirical study of doctors’ perceptions and practice.
34.
WilkinsonD. J. C. (2013). Futile treatment: The ethicist’s perspective. Medical Journal of Australia, 198, 223-224.
