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.

对风险的理解渗透到临终 (EOL) 护理环境中。除了身体死亡的风险外，患者、家庭和医疗保健提供者在 EOL 护理期间还面临精神和沟通风险。西方的生物医学保健模式是一个客观的、治疗性的框架，专注于修复身体；这种文化观念限制了有关身体疾病的交流。现有工作认为，美国人对讨论 EOL 的沉默可以被视为一个公共卫生问题，这是由于高昂的财务和相关成本、缺乏关于治疗方案的教育以及在健康危机期间必须做出决定之前避免讨论 EOL。目前的研究应用风险命令理论来分析牧师在美国的 EOL 护理经验，美国的医疗实践以生物医学健康模型为主。风险秩序理论被用来从社会建构主义的角度审视风险话语，以回应主流的客观主义风险方法。目前的研究通过对牧师职业的探索扩展了三阶风险的概念。对全美 48 名参与者的牧师定性访谈和焦点小组的分析表明，牧师有可能重新构建关于死亡的文化话语，并重振围绕 EOL 护理的文化想象力。