Negotiating Medical Authority: Shared Decision-Making in the ICU

Hospitalized individuals who are unable to communicate have the right to an empowered surrogate who participates in shared decision-making. Based on 300 hours of participant observation in an intensive care unit (ICU) and 35 interviews with staff, this article examines shared decision-making as a negotiated social process of aligning frames of understanding. Drawing from Erving Goffman's concepts of frames (1974) and performance teams (1959), this article shows the interactional strategies ICU clinicians as a team used to bring family surrogates' frame of understanding into alignment with their own assessment that the patient was unlikely to survive. Findings show clinicians maintained authority over end-of-life care while also maintaining a process recognized as shared decision-making.