In this case of Complex Ethics Consultations: Cases that Haunt Us, the author recounts an ethics consultation involving a 70-year-old Roman Catholic nun in the cardiac ICU after emergency bypass and mitral valve replacement. As difficult postoperative complications began to resolve, including her respiratory function, the patient indicated that she wanted all treatments stopped, but in the past she had accepted treatments after initial reluctance. She pointed to her trach, saying she wanted it to be removed. Upon questioning by the ethics consultant, her discomfort was with the tube, not the ventilator per se. Reducing the diameter of the trach tube eased her comfort and she consented to a two-day trial. She was subsequently weaned from the vent. The author reflects on professional boundaries in ethics consultations and the risk that ethics consultants can inadvertently become stewards of the "culture of death" when they make premature assumptions.

This chapter discusses different types of evidence that conversation analysts use to ground their claims about social action. We begin by reviewing the epistemological perspective of CA, which demands that evidence reflect participants’ orientations; as a critical part of understanding the terms ‘participant orientation’ and ‘relevance,’ here we also discuss two ways in which CA’s position and emphasis on them are commonly misunderstood. The bulk of this chapter then reviews and illustrates a range of types of participant-orientation evidence. We organize our presentation of types of evidence roughly by sequential position vis-à-vis the focal action about which the analyst is making claims, including evidence to be found in: (i) next-turn, (ii) same-turn (e.g., same-TCU self-repair, accounts), (iii) prior turn or sequence, (iv) third turn/position (e.g., repair after next turn, courses of action/activity), (v) fourth turn/position, and (vi) more distal positions. We also discuss other forms of evidence that are not necessarily defined by sequential position, including: (i) third-party conduct, (ii) reported conduct, (iii) deviant cases, and (iv) distributional evidence. We conclude by offering some brief reflections on bringing different types and positions of evidence together toward the construction of an argument.

Intercultural interactions in English as a Lingua Franca (ELF) are increasingly becoming the norm as speakers of diverse first languages and cultures find themselves needing to communicate in both personal and professional domains for any number of reasons. The chapter provides an overview of ELF pragmatics research that is focused on how multilingual, multicultural speakers in real-world settings achieve mutual understanding through the effective use of ELF. Specifically, the chapter examines the pragmatic strategies that speakers deploy to preempt misunderstanding as they conjointly negotiate and construct shared meaning. Practices that enhance explicitness and clarity, such as repetition, rephrasing, topic negotiation, and the insertion of a parenthetical remark that provides additional information, reveal how speakers who anticipate difficulty in understanding, possibly arising from linguistic variability and cultural difference, increase efforts to minimize mis/non-understanding. Using data extracts from relevant ELF studies, the chapter illustrates how speakers in these intercultural interactions accommodate their interlocutors and the context of communication to arrive at shared understanding.