UCSF

Though much has been written about death and dying in medical settings, there is little literature that discusses the phenomenon of talking with patients about the end of life from the physician's perspective.This dissertation uses interpretive phenomenology to understand the challenges physicians face in talking with patients with life-threatening diseases about dying and death. 14 physicians were interviewed, and the interviews themselves used open-ended questioning to elicit stories of physicians' experiences talking with their patients about the end of life. The use of interpretive phenomenology to analyze the narratives necessarily incorporates issues of situated context, embodiment and finitude to examine how we as patients and physicians deal with how relational spaces are constitutive, and the difficulty of confronting finitude given the human condition of not ever being able to get out of and beyond finitude in the face of our dying. Four major themes, of connectedness, presence, rupture, and vulnerability arose in the analysis, demonstrating how physicians, despite their scientific stance, are as caught up as their patients in the situatedness of their experiences and their biography. Framing these narrative themes around larger issues of experience, understanding, habitus, and climate of the medical scene provided a larger view of the challenges physicians and patients face in discussing end-of-life issues. How physicians are able to go beyond the narrow scientific paradigm of their medical world is demonstrated in their stories that illustrate the vulnerable and situated nature of caring for the seriously ill and dying.