5th Global Conference
Conference Programme, Abstracts and Papers
Session 6a: Hospital Experience
Chair: Eileen Sutton
AED and the Socio-Technological Shaping of Death
and Loss
Brian
Crosbie
School of Nursing-Post Graduate Division, University of
Nottingham, Queen's Medical Centre, Nottingham, United Kingdom
This
analysis forms part of a larger study into AED (automatic external defibrillation)
and lay persons’ use of resuscitation technology
in public areas such as shopping malls and airport terminals. Secondary
analysis shows that in some cases where heart attack victims actually
die, the AED technology may be used first-aiders to postpone the acknowledgment
of death.
The literature describes technology as having ‘affordance’ which
allows particular actions on the part of users. By means of ‘affordance’ individuals
come to trust the use of AED technology: inasmuch as the lay person relies on
their inability to over-ride the technology.
However, affordance is not limited
to the specification of the technology. Analysis
indicates that users may place an interpretation on information from
the AED technology in such a way as to forestall the announcement of death. The
data indicates that first-aiders ‘use’ the technology as
a resource in which to interpret the resuscitation attempt as still viable;
and therefore are able to move the victim from the scene. This affords
postponing the death announcement (a professional/technological judgement)
to any family present at the time of the attack until an appropriate
time and place. We argue that this phenomenon resonates with cultural
notions of appropriate place and spaces for dying and that culturally
places have the potential to be violated, both in terms of their designated
socio-cultural activity and the death taboo.
The paper theorises through
the use of empirical data that perhaps contrary to views on the clear
cut use of medical technology, its use is interpreted in context; shaped
and shaping within the socio-cultural space in which it is deployed.
When End of Life becomes an Emergency:
Dealing with Death and Dying in the Emergency Department
Cara
Bailey
School of Nursing, Faculty of Medicine and Health Sciences, The University
of Nottingham, Queens Medical Centre, Nottingham, United Kingdom
The
Emergency Department (ED) is witness to many different kinds of death. Those
that are sudden and unexpected, accidental and traumatic; some that are
planned attempts of suicide and those that result from terminality or
frailty. Within society, the ED is
often viewed as a place where life is saved. Yet, it is a place
where emergency staff encounter death, dying and bereavement on a daily
basis. Living in an age of advanced technology, it is sometimes
possible to ‘save life’ that may be deemed unworthy of
life at costs which are far greater than just financial. Recent
initiatives such as the NHS End of Life Care Programme aim to improve
end of life care and provide training for staff to deliver quality
care to patients. Existing strategies are difficult to apply
to the ED because of its unpredictable and complex nature. They
fail to acknowledge the needs of the bereaved and the needs of the
staff dealing with death as ‘routine’. This lack of support
along with the fear of litigation over end of life decision making
is known to be a major source of occupational stress.
The paper discusses the implications when end of life becomes an emergency. The
discussion comes from work in progress on a qualitative study exploring end of
life care in the ED from the perspectives of the emergency staff, patients with
terminal illnesses and life threatening conditions, their carers and the recently
bereaved. The paper draws on the literature and preliminary findings following
informed observation of emergency staff caring for the dying and the bereaved. It
looks at the business of dealing with death in the emergency environment where
technology has provided so many options, at a time when more people than ever
before are spending the end of their life in the acute hospital setting.
Is Religion Harmful to Patients at the End-of-Life?
The Impact of Religion on End-of-Life Decision-Making
Kate
Coleman
London, United Kingdom
Individuals may count different aspects of human
functioning as more important than others. Religious patients evaluate
the potential impact of a proposed course of action on their religious
life as well as considering how other areas of life will be affected.
Hence, a patient may see acts that negatively affect her religious life
as at least equally harmful to those that negatively impact upon her
physical existence. Practices of fully informed consent and full disclosure
of diagnosis and prognosis may not be acceptable to patients from traditions
that do not place a high value on individual rights and autonomy. Placing
the sole burden of decision-making on an individual from a tradition
where the emphasis is on interdependence, obligations, and collective
decision-making may be both distressing and disrespectful.
A review of
the literature identified four quantitative studies and two qualitative
studies examining the relationship between religion and end-of-life treatment
preferences. The studies were diverse in terms of methods, religions
represented, definition and measurement of religiosity, and definition
of end-of-life treatment. Three studies found that religious affiliation
and/or religiosity had an effect on preference for life-sustaining interventions.
One study reported an association between religiosity and intervention
use. With respect to attitudes towards advance directives and healthcare
proxies, the results obtained for populations from Western monotheistic
religions were consistent and contrasted with those obtained for populations
from Eastern religions.
Research and theory suggest that religious considerations
influence the decision-making process and the actual decisions made by
religious patients concerning their medical treatment at the end of life.
This has implications for healthcare professionals who may need to adapt
their methods of working. Professionals may find it beneficial to call
upon appropriately qualified and informed religious experts.
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