The primary purpose of this proposed research is to identify and understand the factors that impact upon how and whether life-prolonging treatment is withheld or withdrawn from the technology dependent patient judged likely- to-die-soon. Specifically this study aims to answer the following research questions: (1) Who, if anyone, among the family or clinical team takes the responsibility for advocating for the decision/action to withhold/withdraw life-prolonging treatment? (2) With respect to the decisionmakers/actors, how do attitudes towards death, values related to quality of life, and structural/demographic characteristics influence the decision/action? (3) With respect to the situation, how do pain/discomfort of the patient, certainty/uncertainty, available resources, and legal/social ramifications influence the decision/action? (4) Are there differences in the salient factors that influence the decision/action to withhold, as compared to withdraw, treatment? This study will use two research approaches: (1) a social context survey, and (2) a multiple case design in which 10 representative intensive care unit (ICU) patients judged likely-to-die-soon will be selected for comprehensive study in the real-life setting. Activities related to withholding/withdrawing treatment will be followed through the course of the patient's treatment in the ICU. Participant observation, semi-structured interviews, and standard instruments will be used to understand the factors affecting the families and healthcare providers involved in relevant decisions and actions pertinent to the selected patients. Critical inquiry from the discipline of philosophy will be embedded throughout the research process. It is anticipated that this creative and unique research approach will yield information that improves theoretical and real life understanding of the multifaceted and complex issue of withholding/withdrawing life-prolonging treatment. This information, in turn, should facilitate decisionmaking for those faced with agonizing choices, and ultimately lessen the suffering of patients whose dying is painfully prolonged.
| Reckling, J B (1997) Who plays what role in decisions about withholding and withdrawing life-sustaining treatment? J Clin Ethics 8:39-45 |
| Reckling, J B (1995) Withholding and withdrawing life-sustaining treatment. Medsurg Nurs 4:327-30 |
