TGIF SEASON 17 - Death as Laughing Matter: Patients talking about Dying in Advance Care Planning Sessions
Prominent in the growing literature on End-of-Life (EoL) conversations are studies of doctors breaking bad news to patients, broaching the topic of death and dying, or giving advice on how best to conduct EoL conversations. In contrast, less work has been done from the patients’ perspective as they engage in EoL conversations with clinicians; for example, how patients respond to clinicians’ questions about EoL decisions. Two notable exceptions are Holt (2016), which looks into a patient’s articulation of his plans as he approaches end-of-life, and Pino & Parry (2019) which details patients’ practices in seeking life expectancy estimates from their clinicians. Useful work has also been done on parents talking about issues relating to their children’s end-of-life, where death and dying are naturally discussed ‘in the third person’. Using Conversation Analysis, we explore the question what interactional goals are achieved through patients’ direct reference to death and why laughter is built into these turns-at-talk. Drawing on the literature on conversational laughter inspired by Jefferson (1979), we examine the use of laughter in our data as a feature of recipient design. By packaging the talk of death with laughter, patients are able to demonstrate to clinicians their awareness of the awkward nature of the subject matter, to propose the manner in which the subject (of death) can be approached, but at the same time to indicate their readiness to face up to, and come to terms with their end-of-life. We will further explore possible cultural and religious underpinnings of these episodes in the context of previous studies.
K.K. Luke is President’s Chair of Linguistics at Nanyang Technological University, Singapore. His research is in the fields of Conversation Analysis and Ethnomethodology. He has done work on collaborative turn production, the use of gestures in turn-taking, storytelling, and the role of grammar in interaction. His more recent work focuses on doctor-patient interaction in a number of clinics in Singapore, where issues of empathy, multi-party consultations, and patient-centred care are explored.