Not if, but how: one way to talk with patients about forgoing life support
Rurik Löfmarka, Tore Nilstunb
a Department of
Medicine, Länssjukhuset, SE-801 87 Gävle, Sweden, b Department of Medical Ethics,
University of Lund, SE-222 22 Lund, Sweden
Submitted 21 May
1999;
Accepted 12 July 1999
May the common clinical conversation be used to explore whether
or not seriously ill patients want to talk about possible limitations
of life support? In order to answer this question, a series of 20 seriously ill patients took part in an interview. The clinical
conversations were taped and transcribed, and recurrent themes were
identified and organised into categories. After talking about their
diagnosis and prognosis, most patients said it was natural to talk
about possible limitations of life support, and a substantial number
immediately indicated that they did not want any life-sustaining
treatment. Although their emotional reactions were different, no one
seemed to be upset by talking about such issues. Many but not all
patients said that they wanted a family member and possibly also a
nurse to participate in the conversation. Every doctor learns to
conduct a clinical conversation and this approach may be applied when
talking with seriously ill patients about difficult treatment decisions.
Keywords: resuscitation decisions; clinical conversation
© 2000 by The Fellowship of Postgraduate Medicine
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