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Decisions at the End of Patients’ Lives

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A Guide to Psychosocial and Spiritual Care at the End of Life

Abstract

End-of-life care with the intense emotions, complex technical treatments, and stark life-or-death implications involved presents some of the most difficult clinical decisions of all. Despite medicine’s recent efforts to explain options for care and to consider patients’ wishes, the methods doctors use to make clinical decisions still baffle most patients, family members, and others who have no medical training. Unfamiliarity with the professional medical culture in general and with basic medical concepts in particular causes some of the bafflement. Yet even doctors sometimes do not recognize the decision-making methods they use. To clarify these methods for all parties, this chapter describes clinical decision-making methods. It does so by addressing topics especially relevant to end-of-life care.

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References

  1. Kassirer JP. Teaching clinical reasoning: case-based and coached. Acad Med. 2010;85(7):1118–24.

    Article  PubMed  Google Scholar 

  2. Quill TE. Recognizing and adjusting to barriers in doctor-patient communication. Ann Intern Med. 1989;111(1):51–7.

    Article  CAS  PubMed  Google Scholar 

  3. Riegelman RK. Studying a study and testing a test: how to read the medical literature. Boston: Little, Brown and Company; 1981. p. 127.

    Google Scholar 

  4. Council on Ethical and Judicial Affairs, American Medical Association. Medical futility in end-of-life care. JAMA. 1999;281(10):937–41.

    Article  Google Scholar 

  5. Kasman DL. When is medical treatment futile? A guide for students, residents, and physicians. J Gen Intern Med. 2004;19(10):1053–6.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Alpers A, Lo B. When is CPR futile? JAMA. 1995;273(2):156–8.

    Article  CAS  PubMed  Google Scholar 

  7. Truog R, Brett AS, Frader J. The problem with futility. N Engl J Med. 1992;326(23):1560–4.

    Article  CAS  PubMed  Google Scholar 

  8. Jecker NS, Schneiderman LJ. Futility and rationing. Am J Med. 1992;92(2):189–96.

    Article  CAS  PubMed  Google Scholar 

  9. Schneiderman LJ, Faber-Langendoen K, Jecker NS. Beyond futility to an ethic of care. Am J Med. 1994;96(2):110–4.

    Article  CAS  PubMed  Google Scholar 

  10. Schneiderman LJ, Jecker NS, Jonsen AR. Medical futility: its meaning and ethical implications. Ann Intern Med. 1990;112(12):949–54.

    Article  CAS  PubMed  Google Scholar 

  11. Helft PR, Siegler M, Lantos J. The rise and fall of the futility movement. N Engl J Med. 2000;343(4):293–6.

    Article  CAS  PubMed  Google Scholar 

  12. Friedman LS. Liver, biliary tract and pancreas disorders. In: McPhee SJ, Papadakis MA, Rabow MW, editors. 2012 current medical diagnosis and treatment. New York: McGraw Hill Medical; 2012. p. 663, 672.

    Google Scholar 

  13. Cassileth B, Zupkis RV, Sutton-Smith K, March V. Information and participation preferences among cancer patients. Ann Intern Med. 1980;92(6):832–6.

    Article  CAS  PubMed  Google Scholar 

  14. Blanchard CG, Labrecque MS, Ruckdeschel JC, Blanchard EB. Information and decision-making preferences of hospitalized adult cancer patients. Soc Sci Med. 1988;27(11):1139–45.

    Article  CAS  PubMed  Google Scholar 

  15. Kelner M. Activists and delegators: elderly patients’ preferences about control at the end of life. Soc Sci Med. 1995;41(4):537–45.

    Article  CAS  PubMed  Google Scholar 

  16. Deber RB, Kraetschmer N, Irvine J. What role do patients wish to play in treatment decision making? Arch Intern Med. 1996;156(13):1414–20.

    Article  CAS  PubMed  Google Scholar 

  17. Stewart DE, Abbey SE, Shnek ZM, Irvine J, Grace SL. Gender differences in health information needs and decisional preferences in patients recovering from an acute ischemic coronary event. Psychosom Med. 2004;66(1):42–8.

    Article  PubMed  Google Scholar 

  18. Perkins HS, Cortez JD, Hazuda HP. Differences by ethnic group and gender in patients’ perceptions and preferences about control over treatment decisions in critical or terminal illness. Unpublished manuscript, March 2012.

    Google Scholar 

  19. Hofmann JC, Wenger NS, Davis RB, et al. Patient preferences for communication with physicians about end-of-life decisions. Ann Intern Med. 1997;127(1):1–12.

    Article  CAS  PubMed  Google Scholar 

  20. Happ MB, Swigart VA, Tate JA, Hoffman LA, Arnold RM. Patient involvement in health-related decisions during prolonged critical illness. Res Nurs Health. 2007;30(4):361–72.

    Article  PubMed  Google Scholar 

  21. Lynn J. Death foretold: prophecy and prognosis in medical care. BMJ. 2001;322(7283):43 (17 Feb 2001).

    Google Scholar 

  22. Blackhall LJ, Frank G, Murphy ST, et al. Ethnicity and attitudes towards life sustaining technology. Soc Sci Med. 1999;48(12):1779–89.

    Article  CAS  PubMed  Google Scholar 

  23. Crawley LM, Marshall PA, Lo B, Koenig BA. Strategies for culturally effective end-of-life care. Ann Intern Med. 2002;136(9):673–9.

    Article  PubMed  Google Scholar 

  24. Tulsky JA, Cassileth BR, Bennett CL. The effect of ethnicity on ICU use and DNR orders in hospitalized AIDS patients. J Clin Ethics. 1997;8(2):150–7.

    CAS  PubMed  Google Scholar 

  25. Cykert S, Joines JD, Kissling G, Hansen CJ. Racial differences in patients’ perceptions of debilitated health states. J Gen Intern Med. 1999;14(4):217–22.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Braun UK, Beyth RJ, Ford ME, McCullough LB. Voices of African American, Caucasian, and Hispanic surrogates on the burdens of end-of-life decision making. J Gen Intern Med. 2008;23(3):267–74.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Perkins HS, Cortez JD, Hazuda HP. Advance care planning: does patient gender make a difference? Am J Med Sci. 2004;327(1):25–32.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Ecumenical Center for Religion and Health, The University of Texas Health Science Center, San Antonio, Texas, USA

    Henry S. Perkins

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  1. Henry S. Perkins
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Correspondence to Henry S. Perkins .

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Perkins, H.S. (2016). Decisions at the End of Patients’ Lives. In: A Guide to Psychosocial and Spiritual Care at the End of Life. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-6804-6_3

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  • DOI: https://doi.org/10.1007/978-1-4939-6804-6_3

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  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4939-6802-2

  • Online ISBN: 978-1-4939-6804-6

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