Integrating patients' nonmedical status in end-of-life decision making: Structuring communication through ‘conferencing’
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Roslyn Sorensen
Roslyn Sorensen is Senior Lecturer at the Centre for Health Services Management in the Faculty of Nursing, Midwifery and Health at the University of Technology, Sydney. She teaches in the areas of health service organization and management. Her research interests lie in health policy development and implementation, health service governance and accountability, and clinical process management.
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Rick Iedema
Rick Iedema is Associate Professor in the School of Public Health and Community Medicine and Deputy Director at the Centre for Clinical Governance Research at the University of New South Wales. He is currently involved in four Australian Research Council funded projects deploying discourse-oriented, video-ethnographic investigations to illuminate the organization and enactment of safety and quality in acute care. He has published widely across the areas of discourse analysis, health services research, and organization studies.
Abstract
This paper considers the nonmedical status of patients in end-of-life decisions. Considering nonmedical factors is not yet routine, particularly in decisions to withhold or withdraw treatment. The paper advocates that non-medical factors—the capacity and willingness to withstand continuing treatment—are essential to ensure that decisions taken are in the patient's best interest. We argue that including this dimension of patient care not commonly considered gives balance to decisions about continuing treatment where its benefit is diminishing. Drawing on a qualitative study of intensive care nursing in a large public hospital in Sydney, Australia, the paper exemplifies and interprets the tendency of some clinicians to not disclose the medical and nonmedical status to conscious patients, and the environment of mistrust and conflict that can result. We propose a process of ‘conferencing’—a regular, inclusive, ongoing, and dynamic process of communication begun early in the patient's admission—to allow multidisciplinary clinicians to manage their differences, agree on patient-care goals, and prepare the patient and their family for the experience of dying. By integrating both medical and nonmedical factors, conferencing becomes the means of enacting and embedding a multidisciplinary, multidimensional approach to end-of-life care.
About the authors
Roslyn Sorensen is Senior Lecturer at the Centre for Health Services Management in the Faculty of Nursing, Midwifery and Health at the University of Technology, Sydney. She teaches in the areas of health service organization and management. Her research interests lie in health policy development and implementation, health service governance and accountability, and clinical process management.
Rick Iedema is Associate Professor in the School of Public Health and Community Medicine and Deputy Director at the Centre for Clinical Governance Research at the University of New South Wales. He is currently involved in four Australian Research Council funded projects deploying discourse-oriented, video-ethnographic investigations to illuminate the organization and enactment of safety and quality in acute care. He has published widely across the areas of discourse analysis, health services research, and organization studies.
© Walter de Gruyter
Articles in the same Issue
- Disability and anticipatory discourse: The interconnectedness of local and global aspects of talk
- Patient narratives: A micro-interactional analysis
- Unethical bunglers or humane professionals? Discussions in the media of end-of-life treatment decisions
- The rhetorical construction of ethical positions: Policy recommendations for nontherapeutic genetic testing in childhood
- Constructing ‘expertness’: A novice pharmacist's development of interactional competence in patient consultations
- The dynamics of resident–patient communication: Data from Canada
- Loss of self-control as excuse in group-therapy conversations for intimately violent men
- Integrating patients' nonmedical status in end-of-life decision making: Structuring communication through ‘conferencing’
- Index of articles in Volume 3 (2006)
- Announcements: Announcing a proposal for a COMET SOCIETY
Articles in the same Issue
- Disability and anticipatory discourse: The interconnectedness of local and global aspects of talk
- Patient narratives: A micro-interactional analysis
- Unethical bunglers or humane professionals? Discussions in the media of end-of-life treatment decisions
- The rhetorical construction of ethical positions: Policy recommendations for nontherapeutic genetic testing in childhood
- Constructing ‘expertness’: A novice pharmacist's development of interactional competence in patient consultations
- The dynamics of resident–patient communication: Data from Canada
- Loss of self-control as excuse in group-therapy conversations for intimately violent men
- Integrating patients' nonmedical status in end-of-life decision making: Structuring communication through ‘conferencing’
- Index of articles in Volume 3 (2006)
- Announcements: Announcing a proposal for a COMET SOCIETY
