How companions speak on patients’ behalf without undermining their autonomy: Findings from a conversation analytic study of palliative care consultations

Companions are individuals who support patients and attend healthcare appointments with them. Several studies characterised companions’ participation in broad terms, glossing over the details of how they time and design their actions, and how patients and healthcare practitioners (HCPs) respond to them. This paper aims to examine these aspects in detail by using conversation analysis, focusing on actions whereby companions speak on patients’ behalf—mentioning delicate aspects of patients’ experience (specifically, by alluding to patients’ thoughts or feelings about dying). Some studies suggest that these actions undermine patients’ autonomy. By contrast, through examination of palliative care consultations in a UK hospice, we found that these interventions are warranted by contextual circumstances: they are either invited by patients or HCPs (through questions or gaze) or volunteered to help with the progression of an activity (e.g., when a patient does not answer an HCP’s question). Additionally, all parties collaborate in constructing these companion interventions as temporary departures from an otherwise prevailing normative orientation to patients’ right to speak for themselves. The study contributes to the sociology of health an illness by characterising how companions contribute to the ways in participant coordinate their relative rights and responsibilities, and ultimately their relationships, within healthcare interactions.