"Do you want us to try to resuscitate?": Conversational practices generating patient decisions regarding cardiopulmonary resuscitation

Decision-making ethics in regards to life-sustaining interventions: when physicians refer to what other patients decide

“…As other studies have showed, even in specialized healthcare contexts such as palliative care, bringing up end-of-life issues is challenging, even for experienced physicians, and often more subtle cues seem to be preferable to overt ones [33]. Our own findings on how physicians elicit patients' preferences about CPR showed that patients' choices for DNAR are often made in anticipation of an actual request (when given an opportunity) [6]. This supports the reflection that initiating open talk about end-of-life and, implicitly the relevancy of DNAR, might be confrontational for physicians and is best achieved through more subtle resources, such as references to DNAR being what other patients opt for.…”

“…Throughout the data, physicians might refer to other patients on multiple occasions, such as when they talk about the fact that CPR is discussed with all patients ("It's a question we ask everybody") [6]. Here, we are specifically interested in the instance in which physicians refer to other patients' decisions in regard with CPR.…”

“…Compared to other patient view elicitors described in CA literature about decision making, its particularity is that it is accomplished through an open question that, while conveying the idea that several options are available, doesn't specify or list them. Thus it treats the patient as being familiar with these options, and gives the patient full decisional power over naming and selecting the most relevant one [6].…”

“…In this sense, one thing worth noting is that the context in which these discussions are led is perhaps not the most conducive for their finality. As we argue in our previous works [5,6], admission interviews are primarily concerned with obtaining information from the patient (medical history, physical and cognitive exams). It is of no surprise that code status is addressed as an information that patients have and give to the physician, when in reality, this is by no means a unidirectional moment but a decisional one, in which choices should be made or reassessed, with the participation of both the physician and the patient.…”

“…Physicians seem to take for granted that CPR is understood by everyone and does not warrant explanation. The way that physicians ask patients about CPR does not always foster a well-informed exercise of patient autonomy [6].…”