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Morality and expert systems: problem solving in medical team meetings

The article derives from a study of inter-professional and collaborative medical problem solving, an activity in which moral issues are invariably implied, if not explicitly stated. Data come from fieldwork in the thoracic ward of a Norwegian hospital. Focus is on a regular inter-professional meeting called ‘the thoracic meeting’. This meeting functions as an expert system characterised by socially distributed cognition. The work of the expert system is communicatively accomplished and moral dimensions appear as characteristics of the problem-solving talk. Three cases or sequences of talk from institutionalised collaborative medical problem-solving work are presented. Each of them displays moral aspects of medical practice. The first case concerns the question of in whose interest decisions are made. Are they made in the patient's best interest, the institution's best interest or in the professional practitioners' best interest? The second case regards the interaction order, which is seen as a normative or moral order that characterise sequences of collaborative problem-solving talk. It has to do with discursive dominance, discursive tactics and adherence to the norms of interaction order. The third case shows that turning medical problems into moral problems may be used as a discursive tactic to manage professional and institutional problems. The cases show the comprehensiveness of moral issues in medical problem solving in such expert systems as the thoracic meeting.