On the Boundary of Life and Death: The Definition of Dying by Medical Residents

If patients are not defined as dying until they are very close to physiological death, they are not treated as dying persons and consequently may receive, in the attempt to “save” them, the very intensive technological interventions that conjure up frightening images of horrible, machine-dependent deaths.

Abstract

The care given to terminally ill or dying patients by American physicians has been discussed extensively in recent years in the media, popular press, and scholarly journals alike. Physicians in particular have been criticized for their "aggressive" approach to terminally ill patients: for continuing treatment which has a minimal chance of success; for fruitlessly prolonging a life that is only biologically functional with a plethora of technological equipment and machines; and for failing to allow patients to die peacefully, "with dignity." Although a number of reasons have been advanced to account for these approaches to dying persons -including the physicians' fear of failure and defeat, fear of death, and fear of malpractice suits — one facet of this issue which remains largely unexplored concerns the effect of how and when physicians determine that patients are dying. If patients are not defined as dying until they are very close to physiological death, they are not treated as dying persons and consequently may receive, in the attempt to "save" them, the very intensive technological interventions that conjure up frightening images of horrible, machine-dependent deaths.KeywordsChronic Obstructive Pulmonary DiseaseLiver TransplantChest TubeMedical ResidentHepatorenal SyndromeThese keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.