Negotiating the 'buffet' of choice: advances in technology and end-of-life decision-making in the intensive care unit setting.

Sociology of Health & Illness
Julia I Bandini

Abstract

In recent years, increases in medical technologies in the critical care setting have advanced the practice of medicine, enabling patients to live longer while also creating dilemmas for end-of-life decision-making. Clinicians have increasingly been called on to involve patients and family members in decision-making through a process of shared decision-making (SDM), yet less is known about how SDM plays out in the critical care setting and the ways in which clinicians engage in SDM. Using observational data from 14 months of ethnographic fieldwork in two intensive care units and interviews with 33 family members of 25 critically ill patients and 51 clinicians, I explore how clinicians refer to the choices available in medical decision-making paradoxically as a 'buffet' of choice while they simultaneously recognise that such rhetoric is misaligned with complex and emotional decision-making, often involving pain and suffering. Lastly, this paper considers the role of SDM and the ways in which clinicians push back on the 'buffet' rhetoric and engage in practices to guide families in end-of-life decision-making by granting permission for families to make decisions and validating their decisions to decline treatment when there is an ...Continue Reading

References

May 29, 2003·Critical Care Medicine·Daniel Callahan
Nov 30, 2005·Sociology of Health & Illness·Stefan Timmermans
Dec 22, 2010·Journal of Health and Social Behavior·Monica J Casper, Daniel R Morrison
Mar 2, 2012·The New England Journal of Medicine·Michael J Barry, Susan Edgman-Levitan
May 24, 2012·Journal of General Internal Medicine·Glyn ElwynMichael Barry
May 3, 2015·Trends in Cardiovascular Medicine·Shannon M Dunlay, Jacob J Strand
Oct 29, 2015·Critical Care Medicine·Alexander A KonUNKNOWN American Thoracic Society

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Citations

Jun 6, 2021·Social Science & Medicine·Sophie LewisFrances Boyle
Aug 27, 2021·Sociology of Health & Illness·Hyeyoung Oh Nelson, Karen Lutfey Spencer

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