Control theory in dying: What do we know?

Abstract

As we try to develop appropriate models for end-of-life care, it is important to review theoretical applications as they relate to current models of care. It is also vital to listen carefully to what patients and theirfamily caregivers tell us about their needs at the end of life. This article explores the issue of control: its application to wellness at the end of life, and patient and family caregiver perceptions about end-of-life control. Interventions and implications for professional caregivers are proposed.

Living with a terminal illness: patients’ priorities

“…In this study, the meaning of 'taking charge' extended beyond that of the notion of 'locus of control', which refers to subjective feelings or beliefs about control over life (Kraus & Stryker 1984, Redding 2000. In contrast, the concept of taking charge assumes that dying people play an active role in control, which may range from their assuming total control to deciding to delegate total control to others.…”

The Socio-Political Debate of Dying Today in the United Kingdom and New Zealand: ‘Letting Go’ of the Biomedical Model of Care in Order to Develop a Contemporary Ars Moriendi

“…Despite the literature appealing to clinicians that PST is a last resort in caring for the dying [19][20][21], and that informed consent be essential when applying this therapy, the Royal Dutch Medical Association [22] suggests that this may not always occur in practice. As such, this has the potential to compromise the reality of individual choice being patient driven [11].…”

“…Fitzmaurice fought, won and went home to his wife and three children, with the aid of a ventilator" [41] (p. 577). 11 Debbie Purdy had multiple sclerosis and in 2009 was given permission to travel with her partner to Dignitas in Switzerland without fear of her partner being prosecuted. This was a landmark case in the UK at the time.…”

“…This, in turn, renders some patients as impotent in the negotiations of choice, as technology can supersede the cultural and humanistic approaches to care [9]. Such technology can provide comfort to some individuals through the attributes of fact and objectivity [9]; however, these inventions are not necessarily driven by a patient's request [10] and, as such, oppose the notion that dying is a natural life event [11]. However, in its guidance towards how the contemporary death may now appear, medicine overlooks the role of individual subjectivity and the preference for specific experiences at this life point.…”

The curious case of Dr. A

“…To have control over another's life is a heady thing. Control theory in dying explores the elements of a physician's control and a patient's control in a physician -patient relationship (Redding, 2000). Although patient control over the dying process is a major factor in quality end-of-life care (Singer et al, 1999), up to two thirds of hospice professionals have difficulty relinquishing control (Rinaldi & Kearl, 1990).…”