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End-of-life decisions in Swedish ICUs: how do physicians from the admitting department reason?
Örebro University, Department of Nursing and Caring Sciences.ORCID iD: 0000-0003-0679-5695
Örebro University, Department of Nursing and Caring Sciences.
2003 (English)In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 19, no 4, p. 241-251Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE:

To study how physicians from the admitting department reason during the decision-making process to forego life-sustaining treatment of patients in intensive care units (ICUs).

DESIGN:

Qualitative interview that applies a phenomenological approach.

SETTING:

Two ICUs at one secondary and one tertiary referral hospital in Sweden.

PARTICIPANTS:

Seventeen admitting-department physicians who have participated in decisions to forego life-sustaining treatment.

RESULTS:

The decision-making process as it appeared from the physicians' experiences was complex, and different approaches to the process were observed. A pattern of five phases in the process emerged in the interviews. The physicians described the process principally as a medical one, with few ethical reflections. Decision-making was mostly done in collaboration with other physicians. Patients, family and nurses did not seem to play a significant role in the process.

CONCLUSION:

This study describes how physicians reasoned when confronted with real patient situations in which decisions to forego life-sustaining treatment were mainly based on medical--not ethical--considerations.

Place, publisher, year, edition, pages
2003. Vol. 19, no 4, p. 241-251
National Category
Nursing
Research subject
Caring sciences
Identifiers
URN: urn:nbn:se:oru:diva-2974DOI: 10.1016/S0964-3397(03)00055-7OAI: oai:DiVA.org:oru-2974DiVA, id: diva2:135872
Available from: 2008-04-22 Created: 2008-04-22 Last updated: 2017-12-14Bibliographically approved
In thesis
1. Postpone death?: Nurse-physician perspectives on life-sustaining treatment and ethics rounds
Open this publication in new window or tab >>Postpone death?: Nurse-physician perspectives on life-sustaining treatment and ethics rounds
2008 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The starting point of the present thesis is nurses’ reported experiences of disagreements with physicians for pushing life sustaining treatment too far. The overall aim was to describe and compare nurses’ and physicians’ perspectives on the boundaries for life-sustaining treatment and to evaluate whether ethics rounds could promote mutual understanding and stimulate ethical reflection. A mixed methods design with qualitative and quantitative data was used, including interviews and questionnaires. The health professionals’ experiences/perceptions were based on known patients foremost from general wards, but also intensive care units, at four Swedish hospitals. The first two studies treated the perspective on boundaries for life-sustaining treatment and the last two evaluated philosopher- ethicist led ethics rounds. Analysis of data was performed using a phenomenological approach and content analysis as well as comparative and descriptive non-parametric statistics.

In the first study, the essence of the physicians’ decision-making process to limit life-sustaining treatment for ICU patients, was a process of principally medical considerations in discussions with other physicians. In the second study, there were more similarities than differences between nurses’ and physicians’ opinions regarding the 714 patients studied. The physicians considered limited treatment as often as the nurses did. The ethics rounds studies generated mixed experiences/perceptions. It seemed that more progress was made toward the goal of promoting mutual understanding than toward the goal of stimulating ethical reflection. Above all, the rounds seemed to meet the need for a forum for crossing over professional boundaries. The most salient finding was the insight to enhance team collaboration, that the interprofessional dialogue was sure to continue. Predominating new insights after rounds were interpreted as corresponding to a hermeneutic approach. One of nurses’ negative experiences of the ethics rounds was associated with the lack of solutions. Based on the present findings, one suggestion for improvement of the model of ethics rounds is made with regard to achieving a balance between ethical analyses, conflict resolution and problem solving. In conclusion, the present thesis provides strong evidence that differences in opinions regarding boundaries for life-sustaining treatment are not associated with professional status. The findings support the notion of a collaborative team approach to end-of-life decision-making for patients with diminished decisionmaking capacity. There is an indication that stimulation of ethical reflection in relation to known patients may foremost yield psychosocial insights. This could imply that social conflicts may overshadow ethical analysis or that ethical conflicts and social conflicts are impossible to distinguish.

Place, publisher, year, edition, pages
Örebro: Örebro universitet, 2008. p. 73
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 16
Keywords
Clinical ethics, Life-sustaining treatment, End-of-life decisions, Attitudes, Nurses, Physicians, Inter-professional relations, Ethics consultation, Ethics rounds
National Category
Clinical Science
Research subject
Surgery
Identifiers
urn:nbn:se:oru:diva-2093 (URN)978-91-7668-596-9 (ISBN)
Public defence
2008-05-16, Wilandersalen, M-huset, Universitetssjukhuset, Örebro, 13:00 (English)
Opponent
Supervisors
Available from: 2008-04-22 Created: 2008-04-22 Last updated: 2017-10-18Bibliographically approved

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Svantesson, MiaThorsén, Håkan

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