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Speaking for the dying : life-and-death decisions in intensive care

Title
Speaking for the dying : life-and-death decisions in intensive care / Susan P. Shapiro.
ISBN
9780226615608
022661560X
9780226615745
022661574X
9780226615882
Publication
Chicago : The University of Chicago Press, 2019.
Copyright Notice Date
©2019.
Physical Description
ix, 336 pages ; 23 cm.
Summary
Seven in ten Americans over the age of age of sixty who require medical decisions in the final days of their life lack the capacity to make them. For many of us, our biggest, life-and-death decisions - literally - will therefore be made by someone else. They will decide whether we live or die; between long life and quality of life; whether we receive heroic interventions in our final hours; and whether we die in a hospital or at home. They will determine whether our wishes are honored and choose between fidelity to our interests and what is best for themselves or others. Yet despite their critical role, we know remarkably little about how our loved ones decide for us. Speaking for the Dying tells their story, drawing on daily observations over more than two years in two intensive care units in a diverse urban hospital. From bedsides, hallways, and conference rooms, you will hear, in their own words, how physicians really talk to families and how they respond. You will see how decision makers are selected, the interventions they weigh in on, the information they seek and evaluate, the values and memories they draw on, the criteria they weigh, the outcomes they choose, the conflicts they become embroiled in, and the challenges they face. Observations also provide insight into why some decision makers authorize one aggressive intervention after the next while others do not-even on behalf of patients with similar problems and prospects. And they expose the limited role of advance directives in structuring the process decision makers follow or the outcomes that result.
Format
Books
Language
English
Added to Catalog
December 03, 2019
Series
The Chicago series in law and society.
Bibliography
Includes bibliographical references and index.
Contents
Holding life and death in their hands
Is this for me?
The intensive care unit. Personnel ; Rhythms ; Economics
Actors. Patients ; Friends, family, and significant others ; Health care professionals
Decisions. Informed consent ; Venues ; Affect ; Conflict
Prognosis. Evidence ; Timing ; Mixed messages ; Negotiation ; Accuracy ; Prognostic framing
Decision-making scripts. The legal script ; Cognitive scripts ; Conflicts of interest ; Law at the bedside
Improvisation: decisions in the real world. The patient should decide ; Reprising patient instructions ; Standing in the patient's shoes ; Beneficence ; It's God's decision ; What we want ; Denial, opting out
Making a difference? The role of physicians ; Opting for a trajectory ; Outcomes ; I thought the law would take care of this ; Does any of this matter?
The end. Implications ; Before it's too late ; When it's too late ; When "this" happens to me.
Holding life and death in their hands
The intensive care unit
Actors
Decisions
Prognosis
Decision-making scripts
Improvisation
Making a difference?
The end. Implications
Appendix A: The research
Appendix B.1: Patient occupation
Appendix B.2: Patient age, gender and marital status
Appendix B.3: Location and purpose of observed meetings
Appendix C: Relationship between multiple trajectories traversed
Appendix D: Decision trajectory by patient and surrogate characteristics
Appendix E: Advance-directive status and aspects of the decision-making process, outcome, and impact.
Genre/Form
Case studies.
Citation

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