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. [ABSTRACT FROM AUTHOR]