This study explores the phenomenon of dilemma in paediatric practice. Using a hermeneutic phenomenological method informed by the writings of Heidegger [1889-1976] and Gadamer [1900 -2002] this study provides an understanding of the meaning of ‘being in dilemma’ from the perspective of predominantly paediatric health care professionals but also families in New Zealand. Study participants include four families who had a child requiring health care and fifteen health care practitioners from the disciplines of medicine, nursing, physiotherapy, play specialist and occupational therapy who work with families and children requiring health care. Participants’ narratives of their experiences of ‘being in dilemma’ were captured via audio taped interviewing. These stories uncover the everyday realities facing health professionals and families and provide an ontological understanding for the notion of dilemma. The findings of this study suggest that experience of dilemma for health professionals reveals a world that is uncertain and questionable where they are thrown into having to make uncomfortable choices and must live with the painful consequences of their actions. The consequences of being in such dilemma have to find ways of living with the angst, or risk becoming too sensitive or desensitizing. For families the experience of dilemma reveals a similar phenomenon most evident in circumstances where they feel totalized by the impact of heath care encounters. This study has uncovered that the perspectives that health professionals and families bring to the experience of dilemma reveal different concerns and commitments and may be hidden from each other. This thesis proposes that health professionals and families need support in living with their own personal encounters of enduring experiences of dilemma.

This study explores the phenomenon of dilemma in paediatric practice. Using a hermeneutic phenomenological method informed by the writings of Heidegger [1889-1976] and Gadamer [1900 -2002] this study provides an understanding of the meaning of ‘being in dilemma’ from the perspective of predominantly paediatric health care professionals but also families in New Zealand. Study participants include four families who had a child requiring health care and fifteen health care practitioners from the disciplines of medicine, nursing, physiotherapy, play specialist and occupational therapy who work with families and children requiring health care. Participants’ narratives of their experiences of ‘being in dilemma’ were captured via audio taped interviewing. These stories uncover the everyday realities facing health professionals and families and provide an ontological understanding for the notion of dilemma. The findings of this study suggest that experience of dilemma for health professionals reveals a world that is uncertain and questionable where they are thrown into having to make uncomfortable choices and must live with the painful consequences of their actions. The consequences of being in such dilemma have to find ways of living with the angst, or risk becoming too sensitive or desensitizing. For families the experience of dilemma reveals a similar phenomenon most evident in circumstances where they feel totalized by the impact of heath care encounters. This study has uncovered that the perspectives that health professionals and families bring to the experience of dilemma reveal different concerns and commitments and may be hidden from each other. This thesis proposes that health professionals and families need support in living with their own personal encounters of enduring experiences of dilemma.

Il presente lavoro si è proposto di indagare il concetto di razionalità limitata nel contesto delle scelte mediche. Sono stati reclutati 80 adulti, senza una storia clinica particolare a cui è stato dapprima somministrato un test virtuale che richiedeva di prendere delle decisioni su alcuni trattamenti e, successivamente, è stata somministrata una intervista semi-strutturata per approfondire il tema della scelta. I principali risultati: in primis, le persone adottano l’uso di euristiche veloci e frugali. In particolare, le persone adottano l’euristica del “Prendi il meglio” considerando, per ogni scelta, un numero limitato di caratteristiche. In secondo luogo, l'uso di euristiche è legato a una razionalità ecologica che adatta le strategie decisionali alla struttura delle informazioni disponibili del contesto ambientale. In questo contesto, se il consiglio del o le informazioni rispetto ai rischi/effetti indesiderati sono disponibili allora essi saranno sempre valutati perché sono caratteristiche fondamentali del processo di scelta. Il consiglio del medico è espressione della fiducia tra medico e paziente. La fiducia è rappresentata da segnali semplici e onesti che il medico è capace di trasmettere e questi segnali formano un canale di comunicazione tra le persone. Infine un altro risultato riguarda la comprensione del rischio associato al consumo di un farmaco che è risultato di difficile comprensione e rappresentazione. / This research aimed at applying the concept of bounded rationality in common medical choices in order to analyse the process by which laypersons make decisions in the field of health. Eighty adults, without a particular disease history were recruited and they were asked to manage both some virtual situations of medical choices and to discuss face to face about their past experiences in medical choices.Three major findings emerged. Firstly, people often use fast and frugal heuristics. In particular, people adopt the rule of the ‘take the best” considering, for each choice, a very limited number of elements to make their decisions. Secondly, the use of heuristics is related with the principle of ecological rationality in which strategies are chosen in connection with the available information of the environmental context. In this context, if “doctor’s advice” as well as “side effects information” are available, they will be always considered because they represent fundamental features of the decision making process. Doctor’s advice is expression of the trust between patient-doctor relationship. Trust is represented by simple and honest signals that the doctor communicates and these signals form an unconscious channel of communication between people. Thirdly, we found that risks associated with treatments are not easy to be conceived by laypersons. It was that people have not in mind a clear definition of the risk implied by medicines and treatment and they show, in average, a scarce interest in risk comprehension.