Discretionary Death: Conditions, Dilemmas, and Normative Regulation

Abstract

The author examines a major shift in the conceptualization and practices relating to death and dying in Western and other societies with advanced medicine. This shift is the result of socio-technical and cultural developments characterized by but not limited to the routine widespread application of life support technologies in the hospital together with notions of increased patient rights. It has resulted in a class of end-of-life situations, which the author defines as "discretionary death." The concept of discretionary death underscores the role of contextual and discretionary factors in end-of-life decision-making. The author identifies and discusses the necessary and complex process of norm formation that informs and regulates end-of-life medical practice and establishes societal consensus across society with respect to legitimizing "discretionary death."

The enactment stage of end-of-life decision-making for children

“…Deciding on the moment of death has been noted as an increasingly common occurrence in contemporary society (Machado, 2005; Moore et al, 2008). This study's findings are consistent with developments in the knowledge, philosophy, and technology of modern healthcare, which, in many circumstances, enable management of the timing, location, and nature of patients’ dying and death, with the goal of a “good death” (Beckstrand et al, 2006; Leichtentritt & Rettig, 2002; Machado, 2005; Smith, 2000).…”

The Nexus Between the Documentation of End-of-Life Wishes and Awareness of Dying: A Model for Research, Education and Care

“…Increased available medical technology has challenged the understanding of death and dying and created distinct interpretations of what it means to be alive, dead, or near death. The routine widespread availability of life support technology together with increased public focus on patient rights and choice in dying resulted in end-of-life situations that Machado 40 has conceptualized as ''discretionary'' or ''negotiated'' death, underscoring the role of contextual and flexible factors in decision making. Increased attention to death with dignity and physician-assisted dying, medical futility, quality of life, palliation, withdrawal of life support, and foregoing resuscitation have intensified the discourse about choice in dying.…”

“…Increased attention to death with dignity and physician-assisted dying, medical futility, quality of life, palliation, withdrawal of life support, and foregoing resuscitation have intensified the discourse about choice in dying. 40,41 Death in this time of increasing alternatives for care at the end of life may result in growing numbers of people who wish to limit life-sustaining treatment 42 and present new and distinct challenges for providers who are present when someone is dying. Decision making that is directed by advance directives and written orders could be considered to involve negotiated death.…”

The Ontological Representation of Death

“…In Western societies with advanced medicine, the discussions about the conceptualization and the practices inherent to death and dying are getting more and more numerous because the borders between natural life and death have been blurred by medical technique (Machado, 2005; Fonseca & Testoni, 2011). Today, the thanatological studies on the representation of death are innumerable.…”

“…Today, the thanatological studies on the representation of death are innumerable. They include researches from individual to social dimensions: attitudes toward the cycle of life and their assessment (i.e., Gesser, Wong, & Reker, 1987; Neimeyer, Moser, & Wittkowski, 2003); ideation—especially in the risk of suicide (i.e., Oravecz & Moore, 2006; Wong, 2004)—and cognitions connected to the awareness of death (i.e., Taubman-Ben-Ari & Noy, 2010); the role of cultural frame in social relationships (i.e., Terror Management Theory [TMT]; Kastenbaum, 2001) and the moral conception of “good death” (i.e., Kim, Lee, & Kim, 2003; Long, 2004); mind–brain identity conceptions and social determination of death (see Kellehear, 2008); the relationship between conceptualization and normative regulations (i.e., Machado, 2005) relating to the bioethical dilemma at the end-of-life (i.e., Center for Bioethics, 2005), about organ donation (i.e., Bresnahan & Mahler, 2009; Verheijde, Rady, & McGregor, 2009), suicide (i.e., Lester, 2003; Feldman, 2006), and euthanasia (i.e., Lesser, 2010; Onwuteaka-Philipsen, Rurup, Pasman, & Van Der Heide, 2010); the management of after death of next-of-kin (i.e., Becvar, 2001; Williams, Woodby, Bailey, & Burgio, 2008) or bereavement and mourning (i.e., Boerner, 2003; Stroebe, Gergen, Gergen, & Stroebe, 1992; Thomson, 2010); and so on.…”