Speaking for the Dying: Life-and-Death Decisions in Intensive Care

Shapiro, Susan P.

doi:10.1093/sf/soaa015

Cited by 7 publications

(13 citation statements)

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“…64 Hence, prognostic information is elusive and often ambiguous, while families receive mixed messages by physicians of different specialities. 65 There is also a reluctance to tell family that further treatment would be futile, while staff would privately discuss it. 65 Evidently, there are 'persistent tensions around choice and relations of obligation at the end of life […][since] dying is a precarious culmination of divergent interests-and that such interests are not necessarily revealed, addressed, or given recognition pre or peri the end of life' (p. 156).…”

Section: Tronto's Care Ethics To Address Medically Futile Treatments ...mentioning

confidence: 99%

“…65 There is also a reluctance to tell family that further treatment would be futile, while staff would privately discuss it. 65 Evidently, there are 'persistent tensions around choice and relations of obligation at the end of life […][since] dying is a precarious culmination of divergent interests-and that such interests are not necessarily revealed, addressed, or given recognition pre or peri the end of life' (p. 156). 62 Patients, family members and different healthcare providers have notably different views on an appropriate course of treatment during a critical illness.…”

Section: Tronto's Care Ethics To Address Medically Futile Treatments ...mentioning

confidence: 99%

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Towards democratic institutions: Tronto’s care ethics inspiring nursing actions in intensive care

Laurin

Martin

2022

Nurs Ethics

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Care as a concept has long been central to the nursing discipline, and care ethics have consequently found their place in nursing ethics discussions. This paper briefly revisits how care and care ethics have been theorized and applied in the discipline of nursing, with an emphasis on Tronto’s political view of care. Adding to the works of other nurse scholars, we consider that Tronto’s care ethics is useful to understand caring practices in a sociopolitical context. We also contend that this vision can be used specifically to politicize nurses, by encouraging them to think critically about the context in which they work and how they can participate to change the status quo, notably by prompting the democratization of care in institutional settings. We illustrate this by demonstrating how moral distress that can occur with aggressive or futile treatments in the intensive care unit can be reduced if nurses are systematically included in the decision-making process. By showing some ways in which nursing political actions can begin to change the status quo as it pertains to futile treatments at the end of life, we can help empower nurses to strive to be included in political spaces and voice their concerns to have their professional needs met.

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Section: Tronto's Care Ethics To Address Medically Futile Treatments ...mentioning

confidence: 99%

Section: Tronto's Care Ethics To Address Medically Futile Treatments ...mentioning

confidence: 99%

Towards democratic institutions: Tronto’s care ethics inspiring nursing actions in intensive care

Laurin

Martin

2022

Nurs Ethics

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“…These means of production of subjectivity could make patients cough out valuations, even when they were initially disinclined to do so. Most commonly, clinicians followed the principle of "substituted judgment" and asked patients' relatives (or other acquaintances) if the patients had ever expressed any stance on end-of-life care (Shapiro, 2019). Patients who had relatives or friends who knew them well, had talked to them about the topic, and were able to reach an agreement over what the patient would say if they were able to speak could present a more solid and undisputed personhood for the patient, in these cases.…”

Section: Economized Selvesmentioning

confidence: 99%

“…Many patients conducted themselves in a fluid, inconsistent, and variable manner, refrained from planning ahead, and tackled problems as they came along. As Susan Shapiro observed, actual severe illness trajectories are unpredictable and people change decisions and the ways they make them as circumstances change (Shapiro, 2019). Yet, even in this realm of unpredictability, the institutional expectation is that people exhibit some degree of consistent agency, fill out an Advance Directive, engage in conversation, or at least produce and endorse a hierarchical list of values through activities such as Go-Wish.…”

Section: Economized Selvesmentioning

confidence: 99%

Toward a sociology of finitude: life, death, and the question of limits

Livne

2021

Theor Soc

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Progressing beyond the given has been a key modern tendency. Yet modern societies are currently facing the problem of how to put limits on progress, expansion, and growth, live within them, and preserve (rather than transcend) the present. Drawing on economic sociology scholarship on valuation and morality in economic life, this article develops and applies the term economization to analyze the enactment of limits on progress. The question of end-of-life care-when to stop medical efforts to prolong life, postpone death, and advance the scientific frontier-serves as an illustrative empirical case that sheds light on limit-setting in general. My analysis of this case combines historical, ethnographic, and in-depth interview data on US palliative care clinicians, who specialize in making life-and-death decisions in acute care hospitals.

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“…During the interviews, there was no ounce of doubt as to the objective of the medical team, where the final decision is to shorten life or hasten the death of the patient [16]. It was in the best interest of the patient, and for the benefit of the patient, not to keep him or her artificially alive.…”

Section: B Consent Is Unavailable Due To Patient's Critical Conditionmentioning

confidence: 99%

Gods or Monsters? Non-Explicit Consent in the hastening of deaths by Intensivists in Belgium

Zeebroeck

2019

SciMed. J.

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The Belgian Euthanasia Act of 2002 (The Act), amended in 2014 to include the Minor Act (The Minor Act), has drawn international criticisms for its liberal laws and practices regarding Euthanasia. This research study is a response to media allegations that the liberal laws on euthanasia has encouraged doctors to adopt a paternalistic approach towards their patients by terminating their lives without their explicit consent, i.e. engaging in involuntary Euthanasia. Although in theory, only voluntary euthanasia (explicit patient request and therefore consent) is permitted in Belgium, the media allegations implied that in practice, involuntary euthanasia (no explicit patient request and therefore no consent) is practiced, especially in the Intensive Care Units (ICUs) in Belgium. One major criticism is that because of its liberal laws, Belgian doctors are killing patients without their non-explicit consent. Specifically, it is alleged that Intensivists are shortening lives or hastening the deaths of their patients without their non-explicit consent in the ICUs in the Wallonia Region in Belgium. This research study conducted an empirical-qualitative study to discover if these media allegations were true or false, by interviewing heads of ICUs in five major hospitals in the Wallonia region in Belgium. The research discovered that the media allegations are true, but they are also false. The media allegations are true because shortening life or hastening the death is sometimes practiced in the ICUs without the patient’s non-explicit consent. The media allegations are false because consent is not available due to the patient’s critical condition, and not because it was not asked for. In other words, what is practiced in the ICUs is non-voluntary euthanasia or where patient is unable to request or consent to euthanasia.

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Speaking for the Dying: Life-and-Death Decisions in Intensive Care

Cited by 7 publications

References 0 publications

Towards democratic institutions: Tronto’s care ethics inspiring nursing actions in intensive care

Towards democratic institutions: Tronto’s care ethics inspiring nursing actions in intensive care

Toward a sociology of finitude: life, death, and the question of limits

Gods or Monsters? Non-Explicit Consent in the hastening of deaths by Intensivists in Belgium

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