Resuscitative decision making: Ethnographic perspectives

Abstract

The topic of resuscitative decision making for hospitalized patients has generated numerous discussions among clinicians and ethicists. Traditionally, their attention has focused on normative standards, describing how decisions should be made, rather than on how they are made in practice. This study uses qualitative techniques, including key informant and participant interviews, participant observation, and microanalysis of in-hospital discussions, to assess what influence the doctor-patient relationship and other sociocultural and contextual determinants have on actual decision making and communication regarding resuscitation. The results suggest that many factors influence these processes. These include issues of competency and ambiguity, prototypical images of life and death, and the use of a structured form for documentation purposes. In light of these findings, the discussion suggests ways in which physicians can improve resuscitative communication with patients and families.