Dartmouth Events

This talk explores how end-of-life care exposes the limits of medicine’s outcome-focused model. Drawing on new concepts of clinical ambiguity and hewing, it shows how Hospice and Palliative Medicine clinicians reshape decision-making by aligning patients, families, and specialists around shared, achievable goals. The session highlights implications for medical ethics, including autonomy, collaboration, and professional responsibility when cure is no longer possible.

In contemporary hospitals, medical specialization has transformed care into a fragmented enterprise, with each specialty pursuing narrow technical goals. Nowhere are the limits of this model more apparent than in the care of the seriously and terminally ill, where standard protocols fail to provide clear guidance. Drawing on interviews and ethnographic fieldwork, this work examines how Hospice and Palliative Medicine (HPM) clinicians navigate these breakdowns in routine medical reasoning. The concepts of clinical ambiguity and hewing are introduced to describe how HPM clinicians construct shared goals from patients’ idiosyncratic preferences, align diverse specialists, and reorient decision-making from a fixation on outcomes (cure, longevity) to processes that respect patients’ identities and values. For medical ethics, these practices highlight the moral labor required when “what can be done” no longer indicates “what ought to be done,” inviting a reexamination of autonomy, collaboration, and professional responsibility at the end of life.