Life-Support Withdrawal

Paper Summary:

This research proposal involves an examination of how the decision to remove life-sustaining interventions in the intensive care unit (ICU) comprises a most significant event that encapsulates diverse experiences for families. The methodology used consists of a sample of four to five families who will be contacted through ICU family conferences in one or two hospitals. The research design is based on interpretive phenomenology, according to the work of M. van Manen and its focus on direct experience. The paper maintains that family members' experience of decision making related to withdrawal of life support is subjective, but also universal in many respects. The decision to withhold or withdraw interventions involves a complex process that occurs in stages. The paper concludes that the goal of the study is to show how this process is either facilitated or made more problematic for families.

Outline:
Introduction
Research Design
Theoretical Underpinning
Strengths and Limitations of Design
Participant Selection
Study Setting
Data Collection
Data Analysis
Steps to Ensure Rigor
Dissemination of Findings
Conclusion

From the Paper:

"The theory underlying this study ultimately is found in the writings of Heidegger (1975, p. 11) who maintained that the individual worldview is not relative because whenever a worldview is developed, what it contains "can be formulated in propositions and rules which are related in their meaning to a specific really existing world". Individual experience, then, reflects universal experience. According to Phillips and Brown (1993), a critical hermeneutic approach proves useful in investigating the management of meaning. The approach is based on hermeneutics as an area of philosophy which relates to the theory and practice of interpretation, but is critical because it enables self-conscious reflection on social conditions. When the hermeneutic perspective is combined with a critical approach, the result is a structured approach to the analysis of the role of meaning in people's experience (Phillips & Brown, 1993). Researchers use the approach to associate ideas and symbols in ways which will explain the creation or maintenance of a permanent pattern of social relations. These include any activity which affects the network of symbols through which the individual or group understands reality. Critical hermeneutics is especially useful since it extends existing interpretive approaches (Phillips & Brown, 1993). The method can be used in longitudinal studies, in studies comparing cultural management, or in the study of groups and inter-group conflict."

Sample of Sources Used:

• Heidegger, M. (1975). The basic problems of phenomenology. Notre Dame, Indiana: Indiana University Press.
• Kwak, J. & Haley, W. (2005). Current research findings on end-of -life decision making among racially or ethnically diverse groups. The Gerontologist, 45 (5), 634-642.
• Lang, F. & Quill, T. (2004). Making decisions with families at the end of life. American Family Physician, 70 (4), 719-724.
• McHale Wiegand, D. (2006). Withdrawal of life-sustaining therapy after sudden, unexpected life-threatening illness or injury: Interactions between patients' families, healthcare providers, and the healthcare system. American Journal of Critical Care, 15 (2), 178-186.
• Phillips, N. & Brown, J. (1993). Analyzing communication in and around organizations: A critical hermeneutic approach. Academy of Management Journal, 36 (6), 1547-1577.

More papers on Life-Support Withdrawal:

• Research Proposal # 102269 : "Life Support Withdrawal: Family Decisions"
• Research Paper # 132143 : "Life Support Withdrawal"
• Research Paper # 102416 : "Families' Experiences and Life-Support Withdrawal"

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