BUT IF YOU LOOK AT THE CORONARY ANATOMY.. - RISK AND RATIONING IN CARDIAC-SURGERY

Recently there has been wide public debate in Britain about the denial of cardiac surgery to smokers and other patients possessing negative risk factors. While some senior medical practitioners have insisted th at such decisions are based on objective clinical grounds linked to pr ognosis and effective use of resources, other commentators argue that doctors are policing lifestyle and making judgements about deservingne ss. One way of shedding light on this controversy is to examine how me dical practitioners themselves talk about cases when consequential dec isions must be made. This paper presents tape-recorded data from cardi ac catheterisation conferences in which cardiologists present cases to a cardiac surgeon, who must decide whether to accept them for surgery , For much of the time, decisions are linked to the technical feasibil ity of surgery and the details of coronary anatomy. However, in many c onferences age, lifestyle, and wider social structural factors figure centrally in discussions and appear to influence outcomes. The analysi s explores some of the tensions that occur as doctors move between 'te chnical' and 'social' discourse frames to make sense of patient histor ies. Far from remaining exclusively within a neutral medico-technical discourse, doctors construct arguments and counter-arguments that clos ely resemble the standpoints in the wider public debate on rationing a nd deservingness.