Prof. Dr. Daniel Ochieng Orwenjo
Discursive Constructions of Competing Moralities in End- of- Life Care Contexts in Kenya
Prof. Dr. Daniel Ochieng Orwenjo
Abstract
One of the most salient ways through which thoughts about death are repressed is through the language used to talk about it, especially when it is imminent, as in the case of End-of-life Care. The objective of this study was to unravel the moralities behind the inherently 'heteroglossic' EOL discourses and how these moralities are discursively embodied and enacted, in a bid to understand the various socio-political forces shaping EOL conversations between clinicians, medically frail patients under EOL care, and their caregivers. We conducted a 6-month critical ethnography involving observations and interviews of clinicians, caregivers and patients (n=16) in four EOL care facilities in western Kenya. Analysis of data for discourse and power-knowledge systems revealed competing moralities of care vs choice discursively constructed by discourses of frailty and more life. Further analysis revealed that these moralities were characterized by moral fallacies, discursive converges, and Dialectical Tensions. The study underscores the need for future research to focus on improving EOL conversations and co-creating approaches to care that can better accommodate the various competing dialectical dilemmas by emphasizing on moralities that create a balance between care and choice.
Key Words: End- of- Life Care, Discursive Construction of Illness, Health Communication, Competing Moralities