Please use this identifier to cite or link to this item: https://hdl.handle.net/2440/17504
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Type: Journal article
Title: End-of-life decision making is more than rational
Author: Eliott, J.
Olver, I.
Citation: Communication and Medicine, 2005; 2(1):21-34
Publisher: Mouton de Gruyter
Issue Date: 2005
ISSN: 1612-1783
1613-3625
Statement of
Responsibility: 
Eliott JA, Olver IN.
Abstract: Most medical models of end-of-life decision making by patients assume a rational autonomous adult obtaining and deliberating over information to arrive at some conclusion. If the patient is deemed incapable of this, family members are often nominated as substitutes, with assumptions that the family are united and rational. These are problematic assumptions. We interviewed 23 outpatients with cancer about the decision not to resuscitate a patient following cardiopulmonary arrest and examined their accounts of decision making using discourse analytical techniques. Our analysis suggests that participants access two different interpretative repertoires regarding the construct of persons, invoking a 'modernist' repertoire to assert the appropriateness of someone, a patient or family, making a decision, and a 'romanticist' repertoire when identifying either a patient or family as ineligible to make the decision. In determining the appropriateness of an individual to make decisions, participants informally apply 'Sanity' and 'Stability' tests, assessing both an inherent ability to reason (modernist repertoire) and the presence of emotion (romanticist repertoire) which might impact on the decision making process. Failure to pass the tests respectively excludes or excuses individuals from decision making. The absence of the romanticist repertoire in dominant models of patient decision making has ethical implications for policy makers and medical practitioners dealing with dying patients and their families.
Keywords: Humans
Neoplasms
Resuscitation Orders
Terminal Care
Emotions
Mental Competency
Family
Physician's Role
Decision Making
Interview, Psychological
Models, Theoretical
Linguistics
Middle Aged
Proxy
Patient Participation
Australia
Female
Male
DOI: 10.1515/come.2005.2.1.21
Description (link): http://www.ncbi.nlm.nih.gov/pubmed/16808705
Appears in Collections:Aurora harvest 6
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