Talking About Advance Directives: A Discourse Analysis of Clinical Encounters in Hong Kong

Advance directives are written statements outlining patients’ preferences regarding life-sustaining treatments at the end of their lives. These statements are brought about through discussions between patients, family, and clinicians. We take an interactional perspective on advance directives and focus on how they are talked about during clinical encounters in Hong Kong. The findings are based on a discourse analysis of 27 consultations. Clinicians talked about advance directives in three ways. First, clinicians talked about life-sustaining treatment when introducing advance directives as a topic. Second, clinicians emphasized principles of advance directives. Third, clinicians described what other patients had done with their advance directives. Our findings reveal that clinicians are oriented towards a potentially preferred outcome in these consultations: guiding patients towards signing advance directives. We discuss the findings with reference to a trend towards an interactional preference, and with regards to culture and clinical practice.