End-of-Life Decision-Making

2017 ◽  
Author(s):  
Chad D. Kollas ◽  
Beth Boyer Kollas
Keyword(s):  
Decision Making ◽  
Elderly Patients ◽  
End Of Life ◽  
Planning Process ◽  
Legal Reasoning ◽  
The United States ◽  
Medical Decision ◽  
The Right ◽  
End Of Life Decision ◽  
Life Decision

Growth in the size and wealth of the United States’ elderly population, coupled with a trend toward increasing patient autonomy, has created an environment for increased conflict in end-of-life decision-making. This chapter explores the required elements for making decisions at the end of life, including determination of medical decision-making capacity. Also discussed is the development of the legal reasoning that governs situations involving elderly patients who lack the capacity, but retain the right, to make medical decisions. The chapter describes the utility of the advance care planning process, by which elderly patients can make their preferences for medical treatment known in advance of conditions or illness that could result in cognitive impairment that would otherwise hamper their ability to participate personally in end-of-life decisions. Finally, a variety of forms of advance directives are described, critical tools in honoring the medical autonomy of elderly patients.

Preferences for autonomy in end-of-life decision making in modern Korean society

2014 ◽  
Vol 22 (2) ◽  
pp. 228-236 ◽  
Author(s):  
Su Hyun Kim
Keyword(s):  
Decision Making ◽  
Family Functioning ◽  
End Of Life ◽  
Low Income ◽  
Financial Burden ◽  
Medical Decision ◽  
Korean People ◽  
End Of Life Decision ◽  
Life Decision ◽  
End Of Life Treatment

Background: The demand for autonomy in medical decision making is increasing among Korean people, but it is not well known why some people prefer autonomy in decision making but others do not. Research objectives: The aim of this study was to determine the extent to which Korean adults wished to exercise autonomy in the process of decision making regarding end-of-life treatment and to determine whether economic issues and family functioning, in particular, were associated with preferences for participation in decision making in Korean people. Research design: This study was a cross-sectional correlational study using a survey. Participants and research context: Data were collected using structured questionnaires from 354 patients or their families who visited ambulatory departments at two general hospitals in South Korea, recruited by the proportionate quota sampling method. Data analysis was performed using multinomial logistic regression analyses. Ethical considerations: The study was approved by the hospitals’ directors and the ethics committee of Kyungpook National University Hospital. Written informed consent was given by all participants. Findings: A majority of Korean people wanted to make autonomous decisions regarding treatment at the end of life. Preferences for autonomous decision making regarding end-of-life treatment, rather than relying on family, showed a significant increase in association with poor family functioning and low income. Discussion: Results of this study suggested the necessity for development of alternatives to a dominant traditional “family-centered” approach in Korean people, in order to enhance end-of-life decision making for people who wish to take an active role in the decision-making process. Conclusion: Healthcare providers need to examine not only patients’ preferred decision-making style but also any reasons for their choice, in particular, family conflict and financial burden.

End-of-Life Decision Making across Cultures

2011 ◽  
Vol 39 (2) ◽  
pp. 201-214 ◽  
Author(s):  
Robert H. Blank
Keyword(s):  
Decision Making ◽  
End Of Life ◽  
Ethical Issues ◽  
The United States ◽  
Special Issue ◽  
The Past ◽  
Life Saving ◽  
Demographic Patterns ◽  
End Of Life Decision ◽  
Life Decision

As is evident from the other articles in this special issue, end-of-life treatment has engendered a vigorous dialogue in the United States over the past few decades because decision making at the end of life raises broad and difficult ethical issues that touch on health professionals, patients, and their families. This concern is exacerbated by the high cost related to the end of life in the U.S. Moreover, in light of demographic patterns, progressively scarce health care resources, and an expanding array of life-saving technologies, decisions at the end of life are becoming problematic matters of public and, thus, scholarly concern in most countries. Issues at the end of life are central not only to bioethics but also raise important ancillary policy dimensions.

Moral Distress: Inability to Act or Discomfort with Moral Subjectivity?

2009 ◽  
Vol 16 (6) ◽  
pp. 734-742 ◽  
Author(s):  
Mark Repenshek
Keyword(s):  
Decision Making ◽  
End Of Life ◽  
Moral Distress ◽  
Ethical Framework ◽  
Critical Examination ◽  
Course Of Action ◽  
Starting Point ◽  
The Right ◽  
End Of Life Decision ◽  
Life Decision

Amidst the wealth of literature on the topic of moral distress in nursing, a single citation is ubiquitous, Andrew Jameton’s 1984 book Nursing practice. The definition Jameton formulated reads ‘... moral distress arises when one knows the right thing to do, but institutional constraints make it nearly impossible to pursue the right course of action’. Unfortunately, it appears that, despite the frequent use of Jameton’s definition of moral distress, the definition itself remains uncritically examined. It seems as if the context of how moral distress arises (i.e. anger, frustration etc.) has been co-opted as its definition. This current work suggests that the current definition is not moral distress as defined by Jameton, but rather, in large part, nursing’s discomfort with moral subjectivity in end-of-life decision making. A critical examination of how the Catholic tradition’s normative ethical framework accounts for moral subjectivity in end-of-life decision making serves to aid nursing’s discomfort and as a starting point to recontextualize moral distress.

Bereaved families’ experiences of end-of-life decision making for general medicine patients

2021 ◽  
pp. bmjspcare-2020-002743
Author(s):  
Felicity Moon ◽  
Christine Mooney ◽  
Fiona McDermott ◽  
Alistair Miller ◽  
Peter Poon
Keyword(s):  
Decision Making ◽  
End Of Life ◽  
Patient Preferences ◽  
End Of Life Care ◽  
General Medicine ◽  
Medical Decision ◽  
Life Care ◽  
Hospitalised Patients ◽  
End Of Life Decision ◽  
Life Decision

BackgroundFamily involvement in decision making for hospitalised patients is associated with improved end-of-life care. Yet, these discussions can be challenging for physicians and families and associated with distress, confusion and conflict. There is a need to understand how best to support families involved in decisions regarding the transition from active to palliative treatment in hospital settings.AimTo explore bereaved families’ experiences of end-of-life decision making for general medicine patients.DesignA qualitative exploratory study framed by social constructionism using semistructured interviews and thematic analysis.Setting and participantsThe general medicine units of one large public hospital in Melbourne, Australia. We recruited 28 bereaved family members of patients who had received end-of-life care.FindingsPatients and families depended on physicians to explain clinical complexity and treatment beneficence; however, trust in medical judgement was mediated by participant’s own interpretations of clinical progress. Families sought to be respected as advocates and experienced distress if physicians disregarded their perspectives and insight concerning patient preferences. Ideally, families supported patients to express their preferences to physicians. Otherwise, families contextualised treatment decisions through their knowledge of patient’s values and quality of life. Families often felt burdened by or excluded from medical decision making and experienced distress and confusion regarding their rights to request or refuse treatment.ConclusionOur study highlights how families contribute to decision making to ensure end-of-life care treatments reflect patient preferences. Physicians can ease families’ distress around treatment withdrawal by providing a meaningful explanation of complex clinical issues, clarifying decision-making roles and acknowledge families’ desire to protect and advocate for their loved one.

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