scholarly journals Rethinking the withholding/withdrawing distinction: the cultural construction of “life-support” and the framing of end-of-life decisions

2015 ◽  
Vol 10 ◽  
Author(s):  
Yechiel M. Barilan
Keyword(s):  
Mechanical Ventilation ◽  
End Of Life ◽  
Moral Psychology ◽  
Life Support ◽  
Legal Regulation ◽  
Cultural Construction ◽  
End Of Life Decisions ◽  
Novel Approach ◽  
Division Line ◽  
History Of

This paper is a theoretical and empirically informed examination of the naturalist distinction between withholding and withdrawing life-support. Drawing on the history of mechanical ventilation and on a recent Israeli law containing a novel approach to disconnecting life-support at the end of life, it is argued that the design of machines predicates the division line between “active” and “passive” interventions, and that the distinction itself might be morally self-defeating. Informed by insights from moral psychology, behavioral economics and philosophies of technology, the paper warns against the placement of this old distinction at the heart of the moral and legal regulation of life-support at the end of life.

Waiting for a miracle or best medical practice? End-of-life medical ethical dilemmas in Bahrain

2019 ◽  
Vol 45 (6) ◽  
pp. 367-372 ◽  
Author(s):  
Sayed Alwadaei ◽  
Barrak Almoosawi ◽  
Hani Humaidan ◽  
Susan Dovey
Keyword(s):  
Decision Making ◽  
End Of Life ◽  
Medical Practice ◽  
Life Support ◽  
Cultural Dimensions ◽  
End Of Life Decisions ◽  
Brain Dead ◽  
Life Decisions ◽  
End Of Life Decision ◽  
Life Decision

Background and objectivesIn Bahrain, maintaining life support at all costs is a cultural value considered to be embedded in the Islamic religion. We explore end-of-life decision making for brain dead patients in an Arab country where medical cultures are dominated by Western ideas and the lay culture is Eastern.MethodsIn-depth interviews were conducted from February to April 2018 with 12 Western-educated Bahraini doctors whose medical practice often included end-of-life decision making. Discussions were about who should make withdrawal of life support decisions, how decisions are made and the context for decision making. To develop results, we used the inductive method of thematic analysis.ResultsInformants considered it difficult to engage non-medical people in end-of-life decisions because of people’s reluctance to talk about death and no legal clarity about medical responsibilities. There was disagreement about doctors’ roles with some saying that end-of-life decisions were purely medical or purely religious but most maintaining that such decisions need to be collectively owned by medicine, patients, families, religious advisors and society. Informants practised in a legal vacuum that made their ethics interpretations and clinical decision making idiosyncratic regarding end-of-life care for brain dead patients. Participants referred to contrasts between their current practice and previous work in other countries, recognising the influences of religious and cultural dimensions on their practice in Bahrain.ConclusionsEnd-of-life decisions challenge Western-trained doctors in Bahrain as they grapple with aligning respect for local culture with their training in the ethical practice of Western medicine.

End-of-life decisions and appropriateness of care in intensive care: a cross-sectional, pilot study

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
F Cescon ◽  
E Monaco ◽  
D Gregori ◽  
M Martinato
Keyword(s):  
Intensive Care ◽  
Pilot Study ◽  
End Of Life ◽  
Life Support ◽  
High Rate ◽  
Cross Sectional ◽  
End Of Life Decisions ◽  
Inappropriate Care ◽  
Organ Failures ◽  
Life Decisions

Abstract In Intensive Care Units (ICUs) patients can experience severe organ failures. In several cases, failures can be incurable, making many of the treatments inappropriate, according to ethical principles. Based on the current legislation, in ICUs, clinicians proceed to limit life support care in most of the cases described. Despite this, some studies report that in many cases the care provided is inappropriate for the prognosis. The study aims at investigating the type and frequency of healthcare personnel's End of Life Decisions (DEL) and the point of view of patients' family, contributing to the debate. A non-interventional cross-sectional pilot study was conducted in 3 ICUs in North-Eastern Italy. Two questionnaires were administered: the first investigates DEL and the perception of nurses and physicians regarding the inadequacy of care provided to patients (from the ELDY study), the second focuses on the family's opinions. Data are expressed by frequencies, percentages, means and standard deviations. In line with most of previous studies, cases identified as DEL are all related to non-treatment decisions (n = 20, 74%), 44% of these are related to having stopped or not started treatments already knowing the possibility of anticipating the end of life of the patient, while 27% had the precise intention of shortening life. The situation has been discussed with patient's relatives only in two cases. The cause of increased inappropriateness (87%) was the perception that other patients would benefit more from intensive care than the patient in charge, and 40% of the healthcare personnel reported that similar situations occur very frequently. The restriction of treatment has been confirmed as the most frequent DEL, and interruption being more frequent than non-implementation. Given the high rate of inappropriate care, it could be effective to follow adequate guidelines in the management of the DEL and discuss strategies within the team and with patients' family. Key messages When severe organ failures are incurable, in ICUs clinicians proceed to limit life support to the patient in charge. Despite this, in many cases the care provided is inappropriate for the prognosis. Given the high rate of inappropriate care, it could be effective to follow adequate guidelines in the management of the DEL and discuss strategies within the team and with patients’ family.

scholarly journals ECCO2R as a bridge to a decision in type II respiratory failure

2019 ◽  
Vol 26 (1) ◽  
pp. 101-106
Author(s):  
Lina Grauslytė ◽  
Gonzalo De La Cerda ◽  
Tomas Jovaiša
Keyword(s):  
Decision Making ◽  
Case Report ◽  
Respiratory Failure ◽  
End Of Life ◽  
Lung Transplant ◽  
Life Support ◽  
Support Systems ◽  
Extracorporeal Life Support ◽  
Life Support Systems ◽  
End Of Life Decisions

Introduction. End-of-life decisions are often time consuming and difficult for everyone involved. In some of these cases extracorporeal life support systems could potentially be used not only as a bridge to treatment but as a tool to buy time to allow patient’s participation in decision making and to avoid further futile invasive procedures. Case report. A previously healthy 53-year-old female patient presented with respiratory failure of unknown cause. In the course of treatment her condition was deemed irreversible and the only option for any chance of long-term survival was a lung transplant. During this whole time the patient’s condition was managed with extracorporeal carbon dioxide removal system (ECCO2R). She remained compos mentis and expressed the wish to stop all the treatment as the option of lung transplant was not acceptable to her. Treatment was withdrawn and she passed away. Discussion. In cases of end-of-life decisions, time can play an essential role. Even though extracorporeal life support systems have been conceptualised to be a bridge to treatment, they could be beneficial in a situation when time is needed to make a decision. ECCO2R has been used as a treatment method in different settings, however, in this case it served as a tool to maintain the patient alive and conscious for a sufficient time for her to participate in decision making. Conclusions. Our case report demonstrated that ECCO2R could serve as a bridge to decision in situations when time is limited and the decisions that need to be made are difficult.

The Evolution of Moral Progress

2018 ◽  
Author(s):  
Allen Buchanan ◽  
Russell Powell
Keyword(s):  
Moral Psychology ◽  
Cultural Construction ◽  
Moral Progress ◽  
Moral Norms ◽  
Moral Thought ◽  
The Enlightenment ◽  
The Social ◽  
History Of ◽  
And Behavior ◽  
First Time

The idea of moral progress played a central role in liberal political thought from the Enlightenment through the nineteenth century but is rarely encountered in moral and political philosophical discourse today. One reason for this is that traditional liberal theorists of moral progress, like their conservative detractors, tended to rely on underevidenced assumptions about human psychology and society. For the first time in history, we are developing robust scientific knowledge about human nature, especially through empirical psychological theories of morality and culture that are informed by evolutionary theory. In addition, the social sciences now provide better information about which social arrangements are feasible and sustainable and about how social norms arise, change, and come to shape moral thought and behavior. Accordingly, it is time to revisit the question of moral progress. On the surface, evolutionary accounts of morality paint a pessimistic picture, suggesting that certain types of moral progress are unrealistic or inappropriate for beings like us. In brief, humans are said to be “hard-wired” for rather limited moral capacities. However, such a view overlooks the great plasticity of human morality as evidenced by our history of social and political moral achievements. To account for these changes while giving evolved moral psychology its due, we develop a dynamic, biocultural theory of moral progress that highlights the interaction between adaptive components of moral psychology and the cultural construction of moral norms and beliefs; and we explore how this interaction can advance, impede, and reverse moral progress.

Précis of The Evolution of Moral Progress: A Biocultural Theory

2019 ◽  
Vol 41 (2) ◽  
pp. 183-194
Author(s):  
Allen Buchanan ◽  
Russell Powell
Keyword(s):  
Moral Psychology ◽  
Political Thought ◽  
Cultural Construction ◽  
Moral Progress ◽  
Moral Norms ◽  
The Enlightenment ◽  
Psychological Theories ◽  
History Of ◽  
Moral Nature ◽  
First Time

Abstract The idea of moral progress played a central role in liberal political thought from the Enlightenment through the nineteenth century but is rarely encountered in moral and political philosophical discourse today. One reason for this is that traditional liberal theorists of moral progress, like their conservative detractors, tended to rely on under-evidenced assumptions about human psychology and society. For the first time, we are developing robust scientific knowledge about human nature, especially through empirical psychological theories of morality and culture that are informed by evolutionary theory. On the surface, evolutionary accounts of morality paint a rather pessimistic picture of human moral nature, suggesting that certain types of moral progress are unrealistic or inappropriate for beings like us. Humans are said to be ‘hard-wired’ for tribalism. However, such a view overlooks the great plasticity of human morality as evidenced by our history of social and political moral achievements. To account for these changes while giving evolved moral psychology its due, we develop a dynamic, biocultural theory of moral progress that highlights the interaction between adaptive components of moral psychology and the cultural construction of moral norms and beliefs, and we explore how this interaction can advance, impede, and reverse moral progress.

scholarly journals Individualism and the Decision to Withdraw Life Support

Societies ◽  
2018 ◽  
Vol 8 (4) ◽  
pp. 117
Author(s):  
Louise Chartrand
Keyword(s):  
Health Care ◽  
End Of Life ◽  
Decision Maker ◽  
Life Support ◽  
Qualitative Description ◽  
Medical Decision ◽  
End Of Life Decisions ◽  
Patient’S Autonomy ◽  
Withdraw Life Support ◽  
Alternative Decision

The 1996 Health Care Consent Act of Ontario (Canada) is a law that regulates medical decision making. Therefore, it also gives indications on how end of life decisions should be made. The goal of the law was to ensure and protect patient’s autonomy and avoid medical paternalism, especially at the end of life. Throughout this article, I would like to argue that one of the consequences of the 1996 Health Care Consent Act of Ontario is to promote individualism. Therefore, this law makes it improbable to attain a shared decision model. More specifically, the way the 1996 Health Care Consent Act is currently written, a proxy is assigned as a decision-maker for someone who is deemed incompetent. However, it also ensures that the proxy will be the only one with the burden of that decision. This argument will be supported by providing a qualitative description of three cases that I have encountered during my six-month fieldwork in the Intensive Care Unit (ICU) of a hospital located in Ontario. This paper offers a reflection upon the consequences of using an alternative decision maker (proxy) to withdraw life support.

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