Resisting responsibility for decision-making during medical consultation: A conversation analytic study in Singapore

Shared decision-making (SDM) has long been advocated in healthcare. However, the view of medical decision-making as having a paternalistic orientation remains entrenched in clinical practice. Interestingly, such an orientation may also be held by a patient, which may potentially derail the SDM process. Crucially, the SDM process must be jointly negotiated and accomplished by both the patient and the doctor based on a clear division of epistemic and deontic responsibilities. Our analysis reveals a singular practice that is used by elderly Mandarin-speaking patients to deflect responsibility for medical decisions to the doctors. Understandably, the doctors also interactionally demonstrate a reluctance to accept such a responsibility. This discussion brings to light how healthcare ideals may be at odds with the epistemic status and stance of elderly patients in a globalised but culturally rooted Asian country like Singapore.