Speaking for the Dying: Life-and-Death Decisions in Intensive Care

Product Description

Seven in ten Americans over the age of age of sixty who require medical decisions in the final days of their life lack the capacity to make them. For many of us, our biggest, life-and-death decisions—literally—will therefore be made by someone else. They will decide whether we live or die; between long life and quality of life; whether we receive heroic interventions in our final hours; and whether we die in a hospital or at home. They will determine whether our wishes are honored and choose between fidelity to our interests and what is best for themselves or others. Yet despite their critical role, we know remarkably little about how our loved ones decide for us.

              Speaking for the Dying tells their story, drawing on daily observations over more than two years in two intensive care units in a diverse urban hospital. From bedsides, hallways, and conference rooms, you will hear, in their own words, how physicians really talk to families and how they respond. You will see how decision makers are selected, the interventions they weigh in on, the information they seek and evaluate, the values and memories they draw on, the criteria they weigh, the outcomes they choose, the conflicts they become embroiled in, and the challenges they face. Observations also provide insight into why some decision makers authorize one aggressive intervention after the next while others do not—even on behalf of patients with similar problems and prospects. And they expose the limited role of advance directives in structuring the process decision makers follow or the outcomes that result.
           
Research has consistently found that choosing life or death for another is one of the most difficult decisions anyone can face, sometimes haunting families for decades. This book shines a bright light on a role few of us will escape and offers steps that patients and loved ones, health care providers, lawyers, and policymakers could undertake before it is too late.
 

Review

"Essential."
―
Choice, Outstanding Academic Titles, 2019



"[This] book is . . . a thoughtful evidence-based reminder of the need to correct our public discourse on death and dying."
―
American Journal of Sociology



"
Speaking for the Dying is a remarkably vivid account of intensive care medicine with important findings that will help patients, families, and researchers better understand the process of surrogate decision-making and the social structure that shapes how decisions are made."
―
Social Forces
About the Author

Susan P. Shapiro is a sociologist and research professor at the American Bar Foundation. She is the author, most recently, of
Tangled Loyalties.
 

Excerpt. © Reprinted by permission. All rights reserved.
Speaking for the Dying
Life-and-Death Decisions in Intensive Care

By Susan P. Shapiro
The University of Chicago Press


Copyright © 2019 The University of Chicago
All rights reserved.

ISBN: 978-0-226-61560-8


Contents

ONE / Holding Life and Death in Their Hands,
Is This for Me?,
TWO / The Intensive Care Unit,
Personnel,
Rhythms,
Economics,
Conclusion,
THREE / Actors,
Patients,
Friends, Family, and Significant Others,
Health Care Professionals,
Conclusion,
FOUR / Decisions,
Informed Consent,
Venues,
Affect,
Conflict,
Conclusion,
FIVE / Prognosis,
Evidence,
Timing,
Mixed Messages,
Negotiation,
Accuracy,
Prognostic Framing,
Conclusion,
SIX / Decision-Making Scripts,
The Legal Script,
Cognitive Scripts,
Conflicts of Interest,
Law at the Bedside,
Conclusion,
SEVEN / Improvisation: Decisions in the Real World,
The Patient Should Decide,
Reprising Patient Instructions,
Standing in the Patient's Shoes,
Beneficence,
It's God's Decision,
What We Want,
Denial, Opting Out,
Conclusion,
EIGHT / Making a Difference?,
The Role of Physicians,
Opting for a Trajectory,
Outcomes,
I Thought the Law Would Take Care of This,
Does Any of This Matter?,
NINE / The End,
Implications,
Before It's Too Late,