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Negotiating natural death in intensive care

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  • Seymour, Jane Elizabeth

Abstract

Recent empirical evidence of barriers to palliative care in acute hospital settings shows that dying patients may receive invasive medical treatments immediately before death, in spite of evidence of their poor prognosis being available to clinicians. The difficulties of ascertaining treatment preferences, predicting the trajectory of dying in critically ill people, and assessing the degree to which further interventions are futile are well documented. Further, enduring ethical complexities attending end of life care mean that the process of withdrawing or withholding medical care is associated with significant problems for clinical staff. Specific difficulties attend the legitimation of treatment withdrawal, the perceived differences between 'killing' and 'letting die' and the cultural constraints which attend the orchestration of 'natural' death in situations where human agency is often required before death can follow dying. This paper draws on ethnographic research to examine the way in which these problems are resolved during medical work within intensive care. Building on insights from the literature, an analysis of observational case study data is presented which suggests that the negotiation of natural death in intensive care hinges upon four strategies. These, which form a framework with which to interpret social interaction between physicians during end of life decision-making in intensive care, are as follows: firstly, the establishment of a 'technical' definition of dying-informed by results of investigations and monitoring equipment -- over and above 'bodily' dying informed by clinical experience. Secondly, the alignment of the trajectories of technical and bodily dying to ensure that the events of non-treatment have no perceived causative link to death. Thirdly, the balancing of medical action with non-action, allowing a diffusion of responsibility for death to the patient's body; and lastly, the incorporation of patient's companions and nursing staff into the decision-making process.

Suggested Citation

  • Seymour, Jane Elizabeth, 2000. "Negotiating natural death in intensive care," Social Science & Medicine, Elsevier, vol. 51(8), pages 1241-1252, October.
  • Handle: RePEc:eee:socmed:v:51:y:2000:i:8:p:1241-1252
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    Cited by:

    1. Lang, Alexander & Frankus, Elisabeth & Heimerl, Katharina, 2022. "The perspective of professional caregivers working in generalist palliative care on ‘good dying’: An integrative review," Social Science & Medicine, Elsevier, vol. 293(C).
    2. Krawczyk, Marian, 2021. "Organizing end of life in hospital palliative care: A Canadian example," Social Science & Medicine, Elsevier, vol. 291(C).
    3. Marie-Astrid Le Theule & Caroline Lambert & Jérémy Morales, 2017. "Accompanying death, organising the end of life [Accompagner la mort, organiser la fin de vie]," Post-Print hal-03654015, HAL.
    4. Iedema, Rick & Sorensen, Roslyn & Braithwaite, Jeffrey & Flabouris, Arthas & Turnbull, Liz, 2005. "The teleo-affective limits of end-of-life care in the intensive care unit," Social Science & Medicine, Elsevier, vol. 60(4), pages 845-857, February.
    5. Aita, Kaoruko & Kai, Ichiro, 2010. "Physicians' psychosocial barriers to different modes of withdrawal of life support in critical care: A qualitative study in Japan," Social Science & Medicine, Elsevier, vol. 70(4), pages 616-622, February.
    6. Le Theule, Marie-Astrid & Lambert, Caroline & Morales, Jérémy, 2023. "Accounting to the end of life. Scarcity, performance and death," CRITICAL PERSPECTIVES ON ACCOUNTING, Elsevier, vol. 90(C).
    7. Natalie Pattison & Jude Mclellan & Lara Roskelly & Kirsty McLeod & Theresa Wiseman, 2018. "Managing clinical uncertainty: An ethnographic study of the impact of critical care outreach on end‐of‐life transitions in ward‐based critically ill patients with a life‐limiting illness," Journal of Clinical Nursing, John Wiley & Sons, vol. 27(21-22), pages 3900-3912, November.
    8. Carmel, Simon, 2006. "Health care practices, professions and perspectives: A case study in intensive care," Social Science & Medicine, Elsevier, vol. 62(8), pages 2079-2090, April.
    9. Margaret O'Connor, 2006. "Commentary on Trovo de Araujo M and Paes da Silva MJ (2004) Communication with dying patients: perception of intensive care units nurses in Brazil. Journal of Clinical Nursing 13, 143–149," Journal of Clinical Nursing, John Wiley & Sons, vol. 15(1), pages 114-116, January.
    10. Marie-Astrid Le Theule & Caroline Lambert & Jérémy Morales, 2020. "Governing Death: Organizing End-of-life Situations," Post-Print hal-03534172, HAL.
    11. Brummell, Stephen P. & Seymour, Jane & Higginbottom, Gina, 2016. "Cardiopulmonary resuscitation decisions in the emergency department: An ethnography of tacit knowledge in practice," Social Science & Medicine, Elsevier, vol. 156(C), pages 47-54.

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