Moral negotiations in the clinic: Navigating the purgatorial pressure in prophylactic implantable cardioverter defibrillator therapy

Julie Christina Grew*, Mette Nordahl Svendsen

*Corresponding author for this work

    Abstract

    Who should be offered prophylactic implantable cardioverter defibrillator (ICD) therapy, which is lifesaving but costly, has side effects and only benefits some of the patients treated with the therapy? In Denmark, cardiologists play key roles in making decisions about who to include in the target group for prophylactic ICD therapy. In this paper, we explore what is at stake for Danish cardiologists making these decisions in a welfare state context. Based on fieldwork in ICD clinics and the device industry, we identify three different imperatives that cardiologists juggle in the process of identifying the target group. We conceptualise the cardiologists’ negotiations as ways of groping through a moral landscape and illuminate how cardiologists walk the path of including as many people as possible in the target group for ICD therapy, thereby also supporting the elite clinic. However, in expanding the target group, the cardiologists experience ‘purgatorial pressure’ and seek indulgence for placing the future of the welfare society at risk by implanting more ICDs than is financially sustainable.

    Original languageEnglish
    JournalBioSocieties
    Volume13
    Issue number3
    Pages (from-to)640-655
    Number of pages16
    ISSN1745-8552
    DOIs
    Publication statusPublished - 1 Sep 2018

    Keywords

    • clinical decision-making
    • imperatives
    • moral pathfinding, moral landscapes
    • prophylactic ICD therapy
    • science and technology studies

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