The role of the bioethicist in family meetings about end of life care

Liza T. Watkins, Galit Sacajiu, Alison Karasz

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

There has been little study of the content of bioethicists' communication during family meeting consultations about end of life care. In the literature, two roles for bioethicists are usually described: the "consultant" role, in which bioethicists define and support ethical principles such as those enshrined in the "rational choice" model; and the "mediator" role, which focuses on the enhancement of communication in order to reduce conflict. In this study, we use observational data to explore how bioethicists support the practice of decision making during family meetings about end of life care. In a study conducted in the Bronx, New York, USA, researchers observed and recorded 24 decision-making meetings between hospital staff and family members of elderly patients identified as being in the last stages of illness, who were unable or unwilling to make the decision for themselves. Bioethics consultants were present during five of those meetings. Although bioethicists referred to the "rational choice" decision-making hierarchy, we did not see the systematic exploration described in the literature. Rather, our data show that bioethicists tended to employ elements of the rational model at particular turning points in the decision-making process in order to achieve pragmatic goals. As mediators, bioethicists worked to create consensus between family and staff and provided invaluable sympathy and comfort to distressed family members. We also found evidence of a context-dependent approach to mediation, with bioethicists' contributions generally supporting staff views about end of life care. Bioethicists' called to consult on family meetings about end of life care do not appear to adhere to a strict interpretation of the official guidelines. In order to negotiate the difficult terrain of end of life decision making, our data show that bioethicists often add a third role, "persuader", to official roles of "consultant" and "mediator".

Original languageEnglish (US)
Pages (from-to)2328-2341
Number of pages14
JournalSocial Science and Medicine
Volume65
Issue number11
DOIs
StatePublished - Dec 2007

Fingerprint

Ethicists
Terminal Care
decision making
Decision Making
family member
staff
hospital staff
communication
sympathy
bioethics
Consultants
decision-making process
mediation
pragmatics
illness
family
End of Life Care
End of life care
Communication
interpretation

Keywords

  • Bioethics
  • Bioethics consultation
  • End of life
  • Family decision making
  • Palliative care
  • USA

ASJC Scopus subject areas

  • Economics and Econometrics
  • Public Health, Environmental and Occupational Health
  • Social Psychology
  • Development
  • Health(social science)

Cite this

The role of the bioethicist in family meetings about end of life care. / Watkins, Liza T.; Sacajiu, Galit; Karasz, Alison.

In: Social Science and Medicine, Vol. 65, No. 11, 12.2007, p. 2328-2341.

Research output: Contribution to journalArticle

Watkins, Liza T. ; Sacajiu, Galit ; Karasz, Alison. / The role of the bioethicist in family meetings about end of life care. In: Social Science and Medicine. 2007 ; Vol. 65, No. 11. pp. 2328-2341.
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