Hospitalized individuals who are unable to communicate have the right to an empowered surrogate who participates in shared decision-making. Based on 300 hours of participant observation in an intensive care unit (ICU) and 35 interviews with staff, this article examines shared decision-making as a negotiated social process of aligning frames of understanding. Drawing from Erving Goffman's concepts of frames (1974) and performance teams (1959), this article shows the interactional strategies ICU clinicians as a team used to bring family surrogates' frame of understanding into alignment with their own assessment that the patient was unlikely to survive. Findings show clinicians maintained authority over end-of-life care while also maintaining a process recognized as shared decision-making.

中文翻译：

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协商医疗权威：ICU 中的共同决策

无法沟通的住院个人有权获得参与共同决策的授权代理人。基于在重症监护室 (ICU) 进行的 300 小时参与观察和对工作人员的 35 次访谈，本文将共同决策作为协调理解框架的协商社会过程进行了研究。本文借鉴 Erving Goffman 的框架 (1974) 和绩效团队 (1959) 的概念，展示了 ICU 临床医生作为一个团队用来使家庭代理人的理解框架与他们自己的评估一致的互动策略，即患者不太可能存活. 调查结果表明，临床医生保持对临终关怀的权威，同时也保持一个公认的共同决策过程。