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Communication and Medicine

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End-of-life decision making is more than rational

Jaklin A. Eliott / Ian N. Olver
Published Online: 2005-07-27 | DOI: https://doi.org/10.1515/come.2005.2.1.21


Most medical models of end-of-life decision making by patients assume a rational autonomous adult obtaining and deliberating over information to arrive at some conclusion. If the patient is deemed incapable of this, family members are often nominated as substitutes, with assumptions that the family are united and rational. These are problematic assumptions. We interviewed 23 outpatients with cancer about the decision not to resuscitate a patient following cardiopulmonary arrest and examined their accounts of decision making using discourse analytical techniques. Our analysis suggests that participants access two different interpretative repertoires regarding the construct of persons, invoking a ‘modernist’ repertoire to assert the appropriateness of someone, a patient or family, making a decision, and a ‘romanticist’ repertoire when identifying either a patient or family as ineligible to make the decision. In determining the appropriateness of an individual to make decisions, participants informally apply ‘Sanity’ and ‘Stability’ tests, assessing both an inherent ability to reason (modernist repertoire) and the presence of emotion (romanticist repertoire) which might impact on the decision making process. Failure to pass the tests respectively excludes or excuses individuals from decision making. The absence of the romanticist repertoire in dominant models of patient decision making has ethical implications for policy makers and medical practitioners dealing with dying patients and their families.

Keywords: decision making models; discourse analysis; bioethics; do not resuscitate (DNR); rational; emotions

About the article

Jaklin Eliott, B.A. Dance, B.A. (Hons. Psych.), is a social scientist at the Royal Adelaide Hospital Cancer Center, and a Ph.D. candidate in the Department of Medicine, University of Adelaide. Her research interests include analysis of qualitative data, the decision making of patients at the end of life, bioethics and cultural diversity, and hope. Address for correspondence: Level 7, Rm D7-9, Royal Adelaide Hospital Cancer Research Centre, Royal Adelaide Hospital, North Terrace, Adelaide SA 5000, Australia.

Published Online: 2005-07-27

Published in Print: 2005-01-01

Citation Information: Communication & Medicine, Volume 2, Issue 1, Pages 21–34, ISSN (Online) 1613-3625, ISSN (Print) 1612-1783, DOI: https://doi.org/10.1515/come.2005.2.1.21.

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