The Karamazov complex: Dostoevsky and DNR orders

Perspectives in Biology and Medicine
Martha M Montello, John D Lantos

Abstract

Families making difficult end-of-life decisions in the intensive care unit often do not exercise their autonomy in accord with the individualistic philosophic and legal models that currently prevail. Instead, they try to avoid responsibility and deny complicity, even for decisions that they ultimately approve. This paper examines two novels and a recent case from a neonatal intensive care unit that reveal how people actually make tragic decisions for family members. Dostoevsky's The Brothers Karamazov and Kenzaburo Oe's A Personal Matter explore the patterns of communication by which people in such situations test complicity and share or submerge accountability. The psychological similarities between the novelists' portrayals and the actual processes that families undergo in the ICU have practical clinical implications for the ways physicians approach discussions about do not resuscitate (DNR) orders with patients' family members.

Citations

May 12, 2006·Journal of Perinatology : Official Journal of the California Perinatal Association·J J ParisM Goodwin
Jan 14, 2016·Tidsskrift for den Norske lægeforening : tidsskrift for praktisk medicin, ny række·Thor Willy Ruud Hansen, Reidun Førde
Sep 6, 2011·Clinics in Perinatology·Marlyse F HawardDeborah E Campbell
Dec 19, 2006·Journal of Critical Care·Hsiu-Fang HsiehJ Randall Curtis
Apr 13, 2011·Acta Paediatrica·William Meadow, John Lantos
Mar 4, 2006·Epilepsy Research·Pedro M Gonçalves PereiraPedro Rosado
Nov 4, 2011·The American Journal of Bioethics : AJOB·John J Paris, Michael Patrick Moore
Nov 4, 2011·The American Journal of Bioethics : AJOB·John D Lantos, William L Meadow
Apr 28, 2006·HEC Forum : an Interdisciplinary Journal on Hospitals' Ethical and Legal Issues·Lisa Anderson-ShawJohn J Lantos
Mar 18, 2021·Patient Education and Counseling·Brownsyne Tucker EdmondsMiriam Kuppermann
Nov 6, 2018·Pediatrics·John D Lantos
Sep 30, 2015·Pediatrics·Brownsyne Tucker EdmondsLucia D Wocial

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