HERMES - Journal of Language and Communication in Business

El consentimiento informado en la comunicación médico-paciente: análisis crítico del marco legislativo

Robert Martinez-Carrasco, Pilar Ordóñez-López — Fri, 27 Oct 2023 00:00:00 +0200

Abstract

The paradigm shift in doctor-patient communication patterns that has taken place in recent decades has led to more engaging and empowering communicative models that highlight the importance of clinical communication. In this context, informed consent (IC) plays a fundamental role as it helps democratize clinical communication and ensures the patient’s autonomy and right to information. This article examines the communicative process associated with IC by means of a critical analysis of the Spanish legislative framework, both at national and regional level, to determine to what extent current legal provisions regulate the complex communication process involved in giving consent. Based on a corpus of all Spanish legal provisions regulating patient autonomy and the rights and obligations of patients regarding clinical information and documentation, this article analyzes IC as an act of communication on the one hand, and as a document proving the patient's consent on the other. The results indicate that, although they are complementary processes, Spanish legislation devotes more attention to IC as a communicative process than to the document itself, thus failing to address fundamental aspects related to its content and form. It is also observed that the patient's voice tends to be somewhat neglected (consultation of doubts, expression of concerns, etc.). Together with the challenge posed by the need for adequacy and personalization of the information, the legibility and comprehensibility of the IC forms as well as aspects related to its delivery protocol, this casts some doubt on the efficacy of IC as a tool for clinical communication.

Resumen

El cambio de paradigma en los patrones de comunicación médico-paciente que se ha producido en las últimas décadas ha dado paso a un modelo más dialéctico y participativo que no ha hecho sino poner de relieve la importancia de la comunicación clínica durante el proceso asistencial. En este contexto, el consentimiento informado (CI), objeto de estudio del presente trabajo, desempeña un papel fundamental en tanto que elemento democratizador de la comunicación clínica y garante del principio de autonomía y derecho a la información del paciente. El artículo que presentamos profundiza en el acto comunicativo que subyace al otorgamiento del CI mediante un análisis crítico del marco legislativo español, tanto estatal como autonómico, para determinar hasta qué punto las disposiciones legales actuales regulan el acto complejo de comunicación que supone el otorgamiento de consentimiento. Partiendo de un corpus formado por todas aquellas disposiciones legales que regulan la autonomía y los derechos y obligaciones del paciente en materia de información y documentación clínica, el artículo analiza el CI en tanto que acto de comunicación prolongado en el tiempo y documento que materializa el consentimiento del paciente. Los resultados indican que, pese a tratarse de procesos complementarios, la legislación dedica más atención al proceso comunicativo que al producto, pues deja sin regular aspectos fundamentales relacionados con el contenido y la forma del mismo. Se observa, además, que se da poco espacio a la voz del paciente (consulta de dudas, expresión de inquietudes, preocupaciones, etc.) lo que, unido al desafío que supone la adecuación y personalización de la información, la legibilidad y comprensibilidad del documento CI (DCI) e incluso aspectos relacionados con el protocolo de entrega del mismo, arrojan ciertas dudas sobre la eficacia del CI en su vertiente comunicativa.

Under Pressure? A Study of Heart Rate and Heart-Rate Variability Using SmarTerp

Christian Olalla-Soler, Nicoletta Spinolo, Ricardo Muñoz Martín — Sun, 19 Nov 2023 00:00:00 +0100

The results of a quasi-experimental, intra-subject study are reported on the effects of the use of SmarTerp on physiological stress levels of twelve second-year students of the MA in Interpreting at the University of Bologna during a simultaneous interpreting task. The study, part of a broader project, explores the rendition of terminological units, proper names, and numbers and its correlation with stress levels, to provide insights into SmarTerp’s practical usefulness in the field. Physiological stress levels were measured through heart rate and heart-rate variability indicators with Empatica E4 wristbands. Participants took part in three data-collection sessions over a month. In sessions 1 and 3 the participants interpreted two speeches, one with SmarTerp and another one without it. Descriptive findings hinted at a potential stress-alleviating effect of interpreting with SmarTerp, especially when interpreting into a second language. However, all inferential statistical results consistently revealed non-significant outcomes. Furthermore, stress levels did not decrease significantly over time when using SmarTerp. While the non-significant reduction in stress may cast doubt on the tool’s efficacy, the complexity and multiple variables influencing stress in interpreting tasks should be factored in. SmarTerp may serve its primary purpose in aiding accurate rendition of terminological units, proper names, and numbers.

Introduction: Evaluation, Argumentation and Narrative(s) in Conflicting Contexts

Polina Shvanyukova, Nickolas Komninos — Fri, 27 Oct 2023 00:00:00 +0200

Strategies of Justification in Resolving Conflicts of Values and Interests. A Comparative Analysis of Constitutional Argumentation in Cases of Animal Sacrifice

Stanisław Goźdź-Roszkowski — Fri, 27 Oct 2023 00:00:00 +0200

Understood as reasons and rationale given by courts in rendering their decisions (DiMatteo 2015; Gudowski 2015), justification is of great importance when resolving morally sensitive issues. In such cases, judges are tasked with finding solutions to fundamental conflicts of incommensurable constitutional principles, which are inherently open-ended, general and in need of interpretation. Constitutional courts rely on different models of constitutional review depending on a given legal system and culture. However, their overarching goal is to consider ways of resolving conflicts and their justifications arising from a clash between constitutionally protected rights and interests and other values deemed worthy of protection by legislatures. The question addressed in this paper is how a constitutional court can resolve conflicts and communicate motives behind its decision in morally sensitive issues and how evaluative language is instrumental in achieving this strategic goal. Two cases are compared in which judges resolve a conflict between freedom to exercise religion and the animal welfare. In Church of the Lukumi Babalu Aye v. City of Hialeah, the US Supreme Court addressed the constitutionality of animal sacrifice for religious purposes. In Poland, the Constitutional Tribunal in its decision (K52/13) ruled for the admissibility of ritual slaughter. Adopting the methodology of Corpus-Assisted Discourse Studies (CADS), this paper demonstrates that while the argumentation in the Polish decision is heavily axiological, with Polish judges using value-based language to engage in fundamental values and principles, the US Supreme Court judges avoid broad, abstract reasoning by resting the argumentation on low-level and medium-level principles (Sunstein 2018) translated into concrete rules and standards.

Writing History in a Supreme Court Ruling: Evaluative language in the majority opinion concerning Dobbs vs. Jackson

Polina Shvanyukova — Fri, 27 Oct 2023 00:00:00 +0200

This paper conducts an exploratory investigation into the use of evaluative language in the historical section of the majority opinion in Dobbs v. Jackson Women’s Health Organization, 597 U.S. (2022). The investigation employs Martin & White’s (2005) Appraisal Theory, adapted specifically for the analysis of the particular evaluative features of historical discourse as elaborated on, for example, by Myskow (2018a) and Oteíza & Pinuer (2013). The findings confirm that a revised version of the Appraisal framework can be fruitfully applied to systematically account for the complex interplay between, on the one hand, the various sources of evaluation, and, on the other hand, the specific attitudinal resources, employed by the authorial voice in an attempt to construe and advance a particular view of the past. This particular ideological view is ultimately leveraged to produce a convincing justificatory argument for the overruling of the two previous landmark Supreme Court decisions that had, respectively, granted and confirmed abortion as a constitutional right in the United States of America.

Legal and Political Framing of Homophobia in two Namibian Newspapers since Independence: An Appraisal Theoretic Analytical Approach

Collen Sabao — Fri, 27 Oct 2023 00:00:00 +0200

The most abhorred population group in Africa (and by extension in Namibia) is the LGBTQI community. Non-heterosexuality is largely condemned in most African countries for political, religious, cultural and legal reasons. Couched within Appraisal Theory, the paper examines how linguistic resources are exploited in manners that evince how homophobia is politically and legally framed in two Namibian daily newspapers – The Namibian and New Era. For example, while the world has reacted to the realities of the departure from the traditional binary definitional parameters of sexualities and sexual identities, Namibia still remains largely homophobic, together with at least 47 other African countries still criminalising homosexuality. In 2001, for example, a video documentary quotes the then President of Namibia, Dr Sam Nujoma, expressing the sentiments that “Lesbians and homosexualism, these we condemn – we reject them. In Namibia there will be no lesbian, no homosexualism” (Blecher, 2001). In August 2005, Minister of Home Affairs, Theopolina Mushelenga, publicly denounced the human rights of Namibian gays and lesbians and also asserted that “homosexuals were responsible for the HIV and AIDS pandemic” (Lorway, 2006, p. 436). Homosexuality has generally, thus, been regarded as an uncultural, unAfrican, uncommon and unacceptable phenomenon in Africa, including Namibia. In Namibia, as in other African countries, the penalty for homosexual behaviour is imprisonment. Many Namibian political leaders have publicly expressed that homosexual rights go against the legal, religious and cultural values of the country. There are political and legal imports to the rejection of homosexual behaviour patterns in Namibia as evinced in news reporting cultures. Homosexuality in Namibian political and legal discourses is largely imagined as either an ‘unAfrican’ behaviour or attributed to western influences on Africa. Linguistic expression by many Namibian politicians also evince a revulsion of homosexuality.

Master Narratives in US Contemporary War Discourse: Situating and Constructing Identities of Self and Other

Nicoletta Vasta — Fri, 27 Oct 2023 00:00:00 +0200

The present paper aims to discuss the discursive strategies of otherization, legitimation, and normalization typically found in extracts from the author’s video corpus of US Presidents’ selected official statements at the height of actual or potential armed conflicts between the First Gulf War (1990-1991) and the end of the Obama Administration (2016). The underlying working assumption is that, to consolidate asymmetrical power relationships and monitor dissent and/or win domestic consent about the use of force, the US Administration systematically resorts to a relatively restricted inventory of political myths and cultural constructs sustained by strategic storytelling and powerful master narratives, or Intertextual Thematic Formations. The qualitative analysis, informed by a systemic functional, critical discourse approach, is undertaken at both the macro- and micro-levels, with a view to highlighting how master narratives project distinct/conflicting standpoints and socio-institutional roles and identities (e.g. the-President-as-Father-of-the-Nation; the-Community-as-Protector-of-its-Members'-Interests; the-West-as-Civilizer), while feeding the myth of a ‘super-empowered’ President and ultimately sustaining the ideological square. The final contention is that awareness-raising pedagogical models are needed which work upwards from the bottom of the hierarchical narrative structure, contextualizing the master narrative and linking it to the audience’s individual narratives, so that discourse can fulfil its critical function of dismantling potentially manipulative and/or normalizing discourse practices and foster civil society-led, personal counter-narratives that remove stereotyping and oversimplification.

Hate speech or legitimate satire? Drawing the line in cartoons

Elizabeth Swain — Fri, 27 Oct 2023 00:00:00 +0200

Controversial cartoons appearing in contemporary news and social media are periodically denounced by consumers for hate speech, and argued over in blogs, reader comments and news articles. Visual and verbal discourse analysts could contribute useful insights to such debates and to awareness raising programmes for addressing hate speech issues in cartoons, but to date have produced little work on the topic. This paper addresses the difficult question of how we distinguish between legitimate satire and hate speech in controversial cartoons about real events featuring public figures belonging to groups with a history of discrimination. The paper proposes that key considerations in this endeavour are the distinction between conceptual and narrative representations and the relevant participant role(s) assigned to the public figure in question (Kress & Van Leeuwen, 2006). The latter’s construal as being, doing or undergoing in the visual structure constrains the options for their evaluation. The evaluations are analysed using visual analogues of the verbal appraisal framework (Martin & White, 2005; Economou, 2009; Swain 2012; White, 2014). It is argued that negative evaluations based on representations of the public figure’s real-life behaviour may more plausibly pass for legitimate satire, whereas those based on the public figure’s appearance alone may be more susceptible to a hate speech interpretation.

Discourse Analysis of the 2022 Australian Tennis Open: A Multimodal Appraisal Perspective

Nickolas Komninos — Fri, 27 Oct 2023 00:00:00 +0200

This article presents a preliminary analysis of a corpus of texts relating to the 2022 Australian Tennis Open using a multimodal appraisal framework. The study utilises quantitative and qualitative content analysis to examine media reports, official statements, and public reactions to the incident, which centred around Novak Djokovic's vaccination status. The analysis focusses on assessing how evaluative language contributes to community-building and identifies the underlying values, beliefs, and evaluations that shape stakeholders' emotional, cognitive, and behavioural responses.
The appraisal framework, encompassing attitude, engagement, and graduation, serves as a comprehensive tool for categorising resources that express evaluation. Furthermore, the article delves into the application of appraisal analysis within the context of multimodal and online discourse, encompassing various platforms such as newspapers, television, radio, YouTube, Twitter, Instagram, blogs, official political statements, and court rulings. By examining these diverse media, the study seeks to investigate the dynamic discourse interplay surrounding the 2022 Australian Open, highlighting the pivotal role of evaluative communication in fostering alignment among readers through shared values and attitudes.
The preliminary findings suggest that access to greater semiotic recourses increases consensus. The gains from using this interpretative framework are an asset, facilitating the coding of a large data set and attending the different manifestations of discourses around the player’s participation. As discourse continues to shape societal narratives, this multimodal appraisal investigation contributes to our understanding of the complex dynamics inherent in discourse construction and the influence of evaluative language in shaping collective perception.