Abstract:
This paper considers the nonmedical status of patients
in end-of-life decisions. Considering nonmedicalfactors
is not yet routine, particularly in decisions to withhold
or withdraw treatment. The paper advocates that nonmedical
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.
