Difficult dialogues about death: applying risk orders theory to analyse chaplains’ provision of end-of-life care

Understandings of risk permeate end-of-life (EOL) care contexts. In addition to the risk of bodily death, patients, family and healthcare providers face spiritual and communication risks during EOL care. The Western biomedical healthcare model is an objectivist, curative framework focusing on fixing the body; this cultural notion limits communication regarding physical illness. Existing work argues that Americans’ reticence to discuss EOL can be considered a public health issue, due to high financial and relational costs, lack of education about treatment options, and avoidance of EOL discussions until decisions must be made during health crises. The current study applied risk orders theory in analysing chaplains’ experiences of EOL care in the US, where medical practice is dominated by biomedical health models. Risk orders theory is used to examine risk discourses from a social constructionist perspective in response to dominant objectivist approaches to risk. The current study expands conceptions of third-order risks through exploration of the chaplaincy profession. Analysis of chaplain qualitative interviews and focus groups, totalling 48 participants across the US, suggest chaplains possess the potential to reframe cultural discourses about death and reinvigorate cultural imagination surrounding EOL care.