Brief encounters: end of life decision-making in critical care

Brief encounters: end of life decision-making in critical care

The health care system has, in many respects, been developed to oppose suffering. Yet health care’s almost compulsive urge to treat death as the enemy and to battle disease and injury with all available technology unavoidably results in suffering for someone. This paradox and its impact upon the decision-makers in critical care, has attracted some interest overseas, but none to date in Australia. This study sought to understand the interactions between the key stakeholders in end-of-life decision-making in critical care in the interests of developing strategies to ameliorate the avoidable suffering arising from these processes. A modification of Denzin’s Interpretive Interactionism (Denzin, 1989), was developed to apply the epistemological and ontological principles of the critical paradigm while preserving the advantages of Denzin’s design in the investigation of interactions. Semi-structured interviews with relatives, nurses and doctors from a variety of critical care units in South-East Queensland and New South Wales, provided the data that enriches this study. Using the critical lens, analysis focussed on the interactions (and gaps and silences) between the decision-makers at the key moments of decision-making: initiation, maintenance or withdrawal of life-sustaining treatments. A model of 'best practice' with respect to end-of-life decision-making was produced and concrete recommendations made. This project has found that the amelioration of avoidable suffering in the critical care environment related to end-of-life decision-making requires policy and procedural changes at the organisational level.