'It's time she stopped torturing herself': structural constraints to decision-making about life-sustaining treatment by medical trainees.

摘要: This article explores how structural factors associated with the profession and organization of medicine can constrain internal residents, leading them to sometimes limit or terminate treatment in end-of-life care ways that do not always embrace patient autonomy. Specifically, it examines opportunities motivations explain why residents arrogate decision-making for themselves about life-sustaining treatment. Using ethnographic data drawn from over two years at an American community hospital, I contend unlike previous studies which aggregate junior senior physicians' perspectives, medical trainees face unique constraints lead intentionally unintentionally overlook preferences. is especially salient cases where they misunderstand their patients' wishes, disagree what best interest, and/or lack standing pursue alternative ethical approaches resolving these tensions. The study concludes recommendations take into account underpinnings arrogance