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首页> 外文期刊>Sociology of health & illness >Negotiating the ‘buffet’ of choice: advances in technology and end‐of‐life decision‐making in the intensive care unit setting
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Negotiating the ‘buffet’ of choice: advances in technology and end‐of‐life decision‐making in the intensive care unit setting

机译：谈判选择的“自助餐”：在重症监护室环境中的技术和生命结束决策的进步

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Abstract In recent years, increases in medical technologies in the critical care setting have advanced the practice of medicine, enabling patients to live longer while also creating dilemmas for end‐of‐life decision‐making. Clinicians have increasingly been called on to involve patients and family members in decision‐making through a process of shared decision‐making ( SDM ), yet less is known about how SDM plays out in the critical care setting and the ways in which clinicians engage in SDM . Using observational data from 14?months of ethnographic fieldwork in two intensive care units and interviews with 33 family members of 25 critically ill patients and 51 clinicians, I explore how clinicians refer to the choices available in medical decision‐making paradoxically as a ‘buffet’ of choice while they simultaneously recognise that such rhetoric is misaligned with complex and emotional decision‐making, often involving pain and suffering. Lastly, this paper considers the role of SDM and the ways in which clinicians push back on the ‘buffet’ rhetoric and engage in practices to guide families in end‐of‐life decision‐making by granting permission for families to make decisions and validating their decisions to decline treatment when there is an opportunity for more treatment.
机译：摘要近年来，在关键护理环境中的医学技术增加了医学的做法，使患者能够更长时间地居住，同时为生命结束决策创造困境。临床医生越来越多地呼吁涉及患者和家庭成员通过共同决策（SDM）的过程中的决策，但尚不熟悉SDM如何在关键护理环境中发挥作用以及临床医生从事的方式SDM。使用14个月的观测数据在两个密集的护理单位和33名家庭成员的访谈中，使用25名危重病人和51名临床医生的访谈，我探讨临床医生如何参考医疗决策中可用的选择作为“自助餐”同时同时认识到这种言论与复杂和情绪决策不对准，往往涉及痛苦和痛苦。最后，本文考虑了SDM的作用以及临床医生推动“自助餐”的言论，并通过授予家庭许可来制定决策并验证其验证和验证他们的职位决策的惯例当有更多待遇时，拒绝治疗的决定。

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