Ethics-in-interaction examines how the ethical dimensions of medical decision-making emerge in real-time interactions among real people, through (semi-)ordinary language that is often more indirect than direct, and in complex contexts that are both institutional and asymmetrical. It is a bottom-up process of studying how ethical issues are raised, explored, negotiated, justified, and settled (or not) in medical interactions. By analyzing the discourse of end-of-life discussions and offers to participate in cancer clinical trials, this chapter illustrates five emerging themes of ethics-in-interaction. First, discussions of ethical concerns are often distributed across communicative events rather than concentrated in specific decision-making sequences. Second, patients, their family members, and physicians all index the medical and ethical bases for their decisions, sometimes mirroring each other’s reasoning, and at other times offering significant reformulations. Third, medical decision-making often takes place as an implicit trajectory of interactional alignment or nonalignment between participants rather than through an explicit decision-making sequence. Fourth, the use of persuasion is a key ethical issue for physicians, sometimes reflecting tensions between bioethics and traditional medical ethics. Finally, research on ethics-in-interaction can disseminate information that points to both ethical and unethical ways of managing medical decision-making. The chapter closes with recommendations for expanding the focus of future studies of ethics-in-interaction to better attend to the wide range of ethical standards, health care practitioners, and medical contexts.
