Multiple Perspectives, One Decision: An Ethnographic Study of Life Support Withdrawal After Severe Traumatic Brain Injury
"An ethnography of a ""difficult"" case involving withdrawal of life support after severe traumatic brain injury (TBI) underscores the cultural contexts, national, biomedical, and local, in which medical decisions are made. The contributions of this project are threefold: (1) contextualization of clinical neuropsychology, (2) recognition of the body in cultural psychology, and (3) exploration of ethical concerns. The ethnography focuses on a case of a European American adolescent woman from a Midwestern town who sustained a TBI from a motor vehicle accident. Modes of inquiry include participant observation in an intensive care unit, medical chart review, community observation, and in-depth interviews. Interviews were conducted with eleven key staff members involved in the case (physicians, nurses, neuropsychologists, a bioethicist), two family members (the young woman's mother and father), and three community members (a high school vice principal, guidance counselor and best friend of the young woman). A complex and multiply determined picture of life support withdrawal after severe TBI emerges. Key themes include difficulties in predicting prognosis in severe TBI, the role of autonomy in medical practice, the importance of timing, and the role of quality of life in ethical medical decision-making. The ethnography also explores the ethics committee process, death and dying practices, spirituality, community responses to loss, parental perspectives on the ICU experience, decision to withdraw support and grief over losing their daughter, and staff perspectives on negotiating a difficult case. Implications for practice and policy are discussed. Adopting a cultural perspective allows the invisibility of national, biomedical, and local cultural practices to become apparent."
University of Illinois - Urbana-Champaign
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University of Illinois at Urbana-Champaign