Behandlingsbegrensning: hva intenderer leger?

Abstract

ABSTRACT Purpose The purpose of the study was to investigate whether physicians find non-treatment decisions ethically challenging in their practice and what their intentions behind such decisions are. If physicians find non-treatment ethically challenging, then to explore how exactly do they find it challenging. Furthermore, how do physicians analyze their actions in light of the concepts of hastening, causing, and intending the patient s death? Do they find these ethical terms at all relevant for their non-treatment decision-making? Methods A qualitative analysis framework according to Malterud was used to analyze sixteen Norwegian physicians from relevant specialties' interviews. Interviews were divided in two parts. In part one the physician told their story where they performed non-treatment decision-making. In part two the interviewers asked the physician questions regarding the concepts of hastening, causing, and intending the patient s death, applied to the stories they had related. Results When analyzing the interviews, it became very clear that none of the physicians used ethical terms when describing their non-treatment decisions. Concepts such as hastening, causing and intending the patient s death seemed almost foreign to most of them in their practical considerations. There was almost a consensus amongst physicians in finding such concepts irrelevant to the moral assessment of their end-of-life practices. Physicians were always attempting to achieve the proper balance of the level of treatment at life s end; this was also their main dilemma. When framing their dilemmas, physicians did so not in ethical terms but medical terms. Conclusion Through the study, it became clear that the core concepts of traditional medico-ethical analyses of end-of-life decision-making (intending, causing and hastening death) do not match up with the practical landscape. There is, therefore, a need to rethink the ethical analysis of non-treatment decision, as well as the ethical concepts and their place in such an analysis.

ABSTRACT Purpose The purpose of the study was to investigate whether physicians find non-treatment decisions ethically challenging in their practice and what their intentions behind such decisions are. If physicians find non-treatment ethically challenging, then to explore how exactly do they find it challenging. Furthermore, how do physicians analyze their actions in light of the concepts of hastening, causing, and intending the patient s death? Do they find these ethical terms at all relevant for their non-treatment decision-making? Methods A qualitative analysis framework according to Malterud was used to analyze sixteen Norwegian physicians from relevant specialties' interviews. Interviews were divided in two parts. In part one the physician told their story where they performed non-treatment decision-making. In part two the interviewers asked the physician questions regarding the concepts of hastening, causing, and intending the patient s death, applied to the stories they had related. Results When analyzing the interviews, it became very clear that none of the physicians used ethical terms when describing their non-treatment decisions. Concepts such as hastening, causing and intending the patient s death seemed almost foreign to most of them in their practical considerations. There was almost a consensus amongst physicians in finding such concepts irrelevant to the moral assessment of their end-of-life practices. Physicians were always attempting to achieve the proper balance of the level of treatment at life s end; this was also their main dilemma. When framing their dilemmas, physicians did so not in ethical terms but medical terms. Conclusion Through the study, it became clear that the core concepts of traditional medico-ethical analyses of end-of-life decision-making (intending, causing and hastening death) do not match up with the practical landscape. There is, therefore, a need to rethink the ethical analysis of non-treatment decision, as well as the ethical concepts and their place in such an analysis.