Susan P. Shapiro
- Published in print:
- 2019
- Published Online:
- January 2020
- ISBN:
- 9780226615608
- eISBN:
- 9780226615882
- Item type:
- book
- Publisher:
- University of Chicago Press
- DOI:
- 10.7208/chicago/9780226615882.001.0001
- Subject:
- Sociology, Gerontology and Ageing
Seventy percent of Americans age 60 or over requiring decisions about medical treatment in the final days of life lack capacity to make these decisions. The biggest life-and-death decisions of their ...
More
Seventy percent of Americans age 60 or over requiring decisions about medical treatment in the final days of life lack capacity to make these decisions. The biggest life-and-death decisions of their lives—literally—had to be made by someone else. Yet despite their critical role, we know remarkably little about these surrogate decision makers, the process they follow, the criteria they consider, the choices they make, and the challenges they face. Drawing on observations of two diverse intensive care units, day after day, for more than two years, this book exposes how and why surrogates navigate this grueling role and the impact of the course they fashion. Readers will learn 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. These findings provide important lessons to future patients, their loved ones and surrogates; those who serve, counsel, or care for those as they near life’s end and their families (physicians, nurses, chaplains, social workers, and lawyers); and scholars, bioethicists, and health policy makers as well.Less
Seventy percent of Americans age 60 or over requiring decisions about medical treatment in the final days of life lack capacity to make these decisions. The biggest life-and-death decisions of their lives—literally—had to be made by someone else. Yet despite their critical role, we know remarkably little about these surrogate decision makers, the process they follow, the criteria they consider, the choices they make, and the challenges they face. Drawing on observations of two diverse intensive care units, day after day, for more than two years, this book exposes how and why surrogates navigate this grueling role and the impact of the course they fashion. Readers will learn 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. These findings provide important lessons to future patients, their loved ones and surrogates; those who serve, counsel, or care for those as they near life’s end and their families (physicians, nurses, chaplains, social workers, and lawyers); and scholars, bioethicists, and health policy makers as well.
Susan P. Shapiro
- Published in print:
- 2019
- Published Online:
- January 2020
- ISBN:
- 9780226615608
- eISBN:
- 9780226615882
- Item type:
- chapter
- Publisher:
- University of Chicago Press
- DOI:
- 10.7208/chicago/9780226615882.003.0001
- Subject:
- Sociology, Gerontology and Ageing
Seventy percent of Americans age 60 or over requiring decisions about treatment in the final days of life lack capacity to make these decisions. The biggest life-and-death decisions of their ...
More
Seventy percent of Americans age 60 or over requiring decisions about treatment in the final days of life lack capacity to make these decisions. The biggest life-and-death decisions of their lives—literally—had to be made by someone else. Loved ones hold life and death in their hands because constitutional rights of autonomy and self-determination are extended by law to surrogates authorized to make medical decisions on patients’ behalf when the latter cannot. Yet despite their critical role, we know remarkably little about these surrogates, the decision-making process they follow, the choices they make, and the challenges they face. Drawing on the stories of two families—one demanding that physicians “just pull the damn plug” and another that life support be continued despite brain death—this chapter introduces the surrogates who determine the trajectories of life’s end. Systematic observations in two intensive care units, day after day, for more than two years offer a window on how these end-of-life trajectories take shape and change course. The chapter concludes by showing how lessons from the intensive care units are relevant to future patients and their loved ones as well as physicians, nurses, chaplains, social workers, lawyers, scholars, bioethicists, and policy makers.Less
Seventy percent of Americans age 60 or over requiring decisions about treatment in the final days of life lack capacity to make these decisions. The biggest life-and-death decisions of their lives—literally—had to be made by someone else. Loved ones hold life and death in their hands because constitutional rights of autonomy and self-determination are extended by law to surrogates authorized to make medical decisions on patients’ behalf when the latter cannot. Yet despite their critical role, we know remarkably little about these surrogates, the decision-making process they follow, the choices they make, and the challenges they face. Drawing on the stories of two families—one demanding that physicians “just pull the damn plug” and another that life support be continued despite brain death—this chapter introduces the surrogates who determine the trajectories of life’s end. Systematic observations in two intensive care units, day after day, for more than two years offer a window on how these end-of-life trajectories take shape and change course. The chapter concludes by showing how lessons from the intensive care units are relevant to future patients and their loved ones as well as physicians, nurses, chaplains, social workers, lawyers, scholars, bioethicists, and policy makers.
