“It’s your choice to make”: Deontic inversion as a practice for handling conflicting grounds for decision-making

Landmark et al (2015) found that, when clinicians and patients discussed a potentially invasive treatment recommendation, on some occasions each party renounced the right to decide, seeking to confer it on the other. They called this “an inverted use of deontic authority”. I confirm this practice in a British neurology data set, and take it further, under the more general term “deontic inversion”. I find that clinicians use it in the service of a variety of actions, including: pursuit of a recommended option, enabling the patient to make a choice that might be deemed sub-optimal, and demarcating a decision as ‘non-medical’. I argue that what unites my collection and that of Landmark et al is not a battle over who gets to decide, or even a battle over a biomedical vs. lifeworld basis for deciding. Rather, the practice is used to navigate the quite general problem of there being more than one accountable basis for deciding. As such, it should extend well beyond the medical and into any site of dispute and decision-making. Data are in British English.