DECISION-MAKING, RESPONSIBILITY, AND ADVOCACY IN GERIATRIC-MEDICINE -PHYSICIAN DILEMMAS WITH ELDERLY IN THE COMMUNITY

This descriptive anthropological study explores the nature of physicia n decision making in the case of old people who reside in the communit y. Focusing on physician narratives of actual dilemmas, this article c ontributes toward a phenomenology of clinical medicine and provides ex amples of how decisions in geriatrics are influenced by professional v alues, institutional constraints, and cultural forms. In-depth intervi ews with 40 physicians revealed dilemmas to have three sources: (1) un resolved questions about how much to intervene in patients' lives to r educe risk; (2) structural, moral, and medical limits to patient advoc acy; and (3) the problem of assessing vulnerability and quality of lif e when pondering placement.