Limitation of medical care

an ethnographic analysis.

W. Ventres, Mark Nichter, R. Reed, R. Frankel

Research output: Contribution to journalArticle

34 Citations (Scopus)

Abstract

This ethnographic study has shown how one attempt to apply ethical principles through a routine procedure failed to fit the clinical context and, in the two cases studied, served to counteract the very foundation these principles were based on--that patients or their families have the right to determine life-and-death decisions regarding code status. The results suggest that the use of well-meaning forms that are intended to facilitate decision making can, in the absence of appropriate guidelines, routinize the doctor-patient discourse to meet bureaucratic needs, narrowing rather than expanding understanding and communication. Bioethical principles implemented in abstraction, apart from the complex intricacies of the doctor-patient-family relationship and the sociocultural influences upon which this relationship is dependent, may be counter-productive to patient interests. As bioethicists and clinicians work to implement the demands of the Patient Self-Determination Act, they will undoubtedly try to forestall legal problems, assure ethical consistency, facilitate auditing, and promote documentation by creating forms. They may look to create inventories, such as the Limitation of Medical Care form described here, or turn to other, less explicit, means of documentation. This study suggests that, in these efforts, genuine attention should be given to patient concerns, not just to the ethical or institutional needs of medicine. This shift in focus from outcome to process can enhance patient and clinician satisfaction, help resolve difficulties in reaching consensus between involved decision makers, and return the power in DNR decision making to patients and families.

Original languageEnglish (US)
Pages (from-to)134-145
Number of pages12
JournalThe Journal of clinical ethics
Volume4
Issue number2
StatePublished - Jun 1993

Fingerprint

medical care
documentation
decision making
auditing
abstraction
self-determination
Documentation
decision maker
Patient Self-Determination Act
Decision Making
act
medicine
Ethicists
death
Value of Life
discourse
communication
Patient Satisfaction
Consensus
Communication

ASJC Scopus subject areas

  • Social Sciences (miscellaneous)

Cite this

Limitation of medical care : an ethnographic analysis. / Ventres, W.; Nichter, Mark; Reed, R.; Frankel, R.

In: The Journal of clinical ethics, Vol. 4, No. 2, 06.1993, p. 134-145.

Research output: Contribution to journalArticle

Ventres, W, Nichter, M, Reed, R & Frankel, R 1993, 'Limitation of medical care: an ethnographic analysis.', The Journal of clinical ethics, vol. 4, no. 2, pp. 134-145.
Ventres, W. ; Nichter, Mark ; Reed, R. ; Frankel, R. / Limitation of medical care : an ethnographic analysis. In: The Journal of clinical ethics. 1993 ; Vol. 4, No. 2. pp. 134-145.
@article{d85389d5d3b24a63934c2b93472bf5f9,
title = "Limitation of medical care: an ethnographic analysis.",
abstract = "This ethnographic study has shown how one attempt to apply ethical principles through a routine procedure failed to fit the clinical context and, in the two cases studied, served to counteract the very foundation these principles were based on--that patients or their families have the right to determine life-and-death decisions regarding code status. The results suggest that the use of well-meaning forms that are intended to facilitate decision making can, in the absence of appropriate guidelines, routinize the doctor-patient discourse to meet bureaucratic needs, narrowing rather than expanding understanding and communication. Bioethical principles implemented in abstraction, apart from the complex intricacies of the doctor-patient-family relationship and the sociocultural influences upon which this relationship is dependent, may be counter-productive to patient interests. As bioethicists and clinicians work to implement the demands of the Patient Self-Determination Act, they will undoubtedly try to forestall legal problems, assure ethical consistency, facilitate auditing, and promote documentation by creating forms. They may look to create inventories, such as the Limitation of Medical Care form described here, or turn to other, less explicit, means of documentation. This study suggests that, in these efforts, genuine attention should be given to patient concerns, not just to the ethical or institutional needs of medicine. This shift in focus from outcome to process can enhance patient and clinician satisfaction, help resolve difficulties in reaching consensus between involved decision makers, and return the power in DNR decision making to patients and families.",
author = "W. Ventres and Mark Nichter and R. Reed and R. Frankel",
year = "1993",
month = "6",
language = "English (US)",
volume = "4",
pages = "134--145",
journal = "Journal of Clinical Ethics",
issn = "1046-7890",
publisher = "Journal of Clinical Ethics",
number = "2",

}

TY - JOUR

T1 - Limitation of medical care

T2 - an ethnographic analysis.

AU - Ventres, W.

AU - Nichter, Mark

AU - Reed, R.

AU - Frankel, R.

PY - 1993/6

Y1 - 1993/6

N2 - This ethnographic study has shown how one attempt to apply ethical principles through a routine procedure failed to fit the clinical context and, in the two cases studied, served to counteract the very foundation these principles were based on--that patients or their families have the right to determine life-and-death decisions regarding code status. The results suggest that the use of well-meaning forms that are intended to facilitate decision making can, in the absence of appropriate guidelines, routinize the doctor-patient discourse to meet bureaucratic needs, narrowing rather than expanding understanding and communication. Bioethical principles implemented in abstraction, apart from the complex intricacies of the doctor-patient-family relationship and the sociocultural influences upon which this relationship is dependent, may be counter-productive to patient interests. As bioethicists and clinicians work to implement the demands of the Patient Self-Determination Act, they will undoubtedly try to forestall legal problems, assure ethical consistency, facilitate auditing, and promote documentation by creating forms. They may look to create inventories, such as the Limitation of Medical Care form described here, or turn to other, less explicit, means of documentation. This study suggests that, in these efforts, genuine attention should be given to patient concerns, not just to the ethical or institutional needs of medicine. This shift in focus from outcome to process can enhance patient and clinician satisfaction, help resolve difficulties in reaching consensus between involved decision makers, and return the power in DNR decision making to patients and families.

AB - This ethnographic study has shown how one attempt to apply ethical principles through a routine procedure failed to fit the clinical context and, in the two cases studied, served to counteract the very foundation these principles were based on--that patients or their families have the right to determine life-and-death decisions regarding code status. The results suggest that the use of well-meaning forms that are intended to facilitate decision making can, in the absence of appropriate guidelines, routinize the doctor-patient discourse to meet bureaucratic needs, narrowing rather than expanding understanding and communication. Bioethical principles implemented in abstraction, apart from the complex intricacies of the doctor-patient-family relationship and the sociocultural influences upon which this relationship is dependent, may be counter-productive to patient interests. As bioethicists and clinicians work to implement the demands of the Patient Self-Determination Act, they will undoubtedly try to forestall legal problems, assure ethical consistency, facilitate auditing, and promote documentation by creating forms. They may look to create inventories, such as the Limitation of Medical Care form described here, or turn to other, less explicit, means of documentation. This study suggests that, in these efforts, genuine attention should be given to patient concerns, not just to the ethical or institutional needs of medicine. This shift in focus from outcome to process can enhance patient and clinician satisfaction, help resolve difficulties in reaching consensus between involved decision makers, and return the power in DNR decision making to patients and families.

UR - http://www.scopus.com/inward/record.url?scp=0027619645&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0027619645&partnerID=8YFLogxK

M3 - Article

VL - 4

SP - 134

EP - 145

JO - Journal of Clinical Ethics

JF - Journal of Clinical Ethics

SN - 1046-7890

IS - 2

ER -