Understanding and managing health care interventions in the terminally ill

Abstract

There is a growing consensus that there are often excessive medical interventions in terminally ill patients. This problem is usually seen as stemming from physician decisions in applying new technology in a context in which financial costs have been borne by third parties. We believe this is, at best, a partial explanation for the phenomenon. The tendency to escalate commitment—to persist in failing courses of action—has been found by social scientists to occur in a wide variety of decision contexts. In ethnographically examining health care interventions in terminally ill patients, we found that a wide range of rational calculus, psychological, social, organizational, and contextual factors interact over time to contribute to excessive persistence. Intervention decisions reflect a complex, fluid interplay between patients, health care providers, institutions, and an array of external stakeholders. Effective revisions of current patterns of care practices must address the nature and complexity of the sources of the problem. We suggest a series of strategies including a new medical specialty to deal with these issues.

Citation

Ross, J. and Albrecht, G.L. (2000), "Understanding and managing health care interventions in the terminally ill", Jacobs Kronenfeld, J. (Ed.) Health Care Providers, Institutions, and Patients: Changing Patterns of Care Provision and Care Delivery (Research in the Sociology of Health Care, Vol. 17), Emerald Group Publishing Limited, Leeds, pp. 3-29. https://doi.org/10.1016/S0275-4959(00)80036-8