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Journal of Health Psychology
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When Technical Rationality Fails

Thinking about Terminally Ill Patients

Arthur Still

University of Durham, UK

Chris Todd

University of Cambridge, UK

The theory that thinking is modelled on the social activity of argument is investigated through the views of general practitioners about terminally ill patients. The social activity of general practice centres on the consultation, which the doctor manages by 'technical rationality'. But this is difficult when the patient is terminally ill. In that case technical rationality is seen to fail and rhetorical skills are invoked. GPs' thinking about such consultations can be described using an agonistic model based on a hierarchy of objectives, strategies and tactics. The objective of keeping patients comfortable and dignified is aimed at through three strategies, and a variety of rhetorical tactics is drawn on in thinking about these strategies.

Key Words: death and dying • general practice • rhetoric • terminal care • thinking

Journal of Health Psychology, Vol. 3, No. 1, 137-148 (1998)
DOI: 10.1177/135910539800300111
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