Background: The Patient Self-Determination Act of 1991 implicitly encourages physicians to discuss advance directives and no-code orders with their patients. The medical literature to date, however, has done little to place resuscitative decision making in the context of how physicians, patients, and families communicate with one another. This paper investigates how interactions between involved parties affect the process and outcome of this decision making.
Methods: Participant observation and open-ended interviews were conducted with patients, their families, resident physicians, and family medicine faculty members.
Results: This report describes three social and cultural issues that commonly influence and shape the process of do-not-resuscitate decision making: judging competency and capacity, dealing with uncertainty, and recognizing attitudes toward death.
Conclusions: Improved understanding of the communicative process can facilitate the establishment of meaningful, therapeutic alliances between physicians, patients, and families at an influential juncture in the family life cycle.