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Sanctity of Social Life, The

Sanctity of Social Life, The: Physician's Treatment of Critically Ill Patients

Diana Crane
Copyright Date: 1975
Published by: Russell Sage Foundation
Pages: 304
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  • Book Info
    Sanctity of Social Life, The
    Book Description:

    Reexamines the nature of death and dying as seen from the physician's point of view. Unlike other treatments of the subject, this study is concerned not with what physician's should do for the critically ill, but with their actual behavior. Based on extensive interviews with physicians in several medical specialties, more than 3000 questionnaires completed by physicians in four specialties, and studies of the records of actual hospital patients, the book shows that while withdrawal of treatment in certain types of cases is widespread, euthanasia is rare.

    eISBN: 978-1-61044-155-1
    Subjects: Sociology, Health Sciences

Table of Contents

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  1. Front Matter
    (pp. i-vi)
  2. Table of Contents
    (pp. vii-x)
  3. Foreword
    (pp. xi-xiv)
    Charles D. Cook

    For most of the recorded history of man, death has been accepted as a natural event and frequently as a relief from life’s pain and sorrow. “Swing low sweet chariot, comin’ for to carry me home,” was, even in my youth, a meaningful and heartfelt spiritual. If the world’s food supply and population continue to become more and more out of balance, early death will be for many not only an inevitable but also perhaps a desirable possibility. In one country with recent crop failures mothers reportedly were praying for the early death of their children as an escape from...

  4. Preface
    (pp. xv-xviii)
    Diana Crane
  5. Chapter 1: Introduction
    (pp. 1-16)

    In recent years, the subject of death and dying has become increasingly popular in the mass media. It appears that death is no longer, as it was once described (Lester 1967), a matter of indifference to the average person. Numerous popular articles describe the plight of families facing the dilemmas posed by hospitalization of dying relatives. The number of courses on dying and death offered to college students has multiplied. At the same time, therc has bcen an increase in interest in this subject among physicians and social scientists who have produced a steady stream of articles and books.


  6. Chapter 2: Controversy and the Clinical Mentality: Some Methodological Problems and Their Effects on the Research Design
    (pp. 17-32)

    Few physicians write about the ethics of medical practice. Those who do are probably not representative of their colleagues. They are usually committed to a relatively extreme view and either defend the traditional belief in the preservation of life or advocate a position close to that of the euthanasia movement. In order to develop a framework in which to study decisions to treat critically ill patients, it was essential to discuss the issues with physicians who fell at different points along the continuum between thesc two categories. Critically ill patients were defined as patients (1) who probably would die if...


    • Chapter 3: Decisions to Treat Critically Ill Patients: Social Versus Medical Considerations
      (pp. 35-66)

      In the first chapter, a model was proposed which predicts the conditions under which an individual will be likely to receive treatment, given different categories of debilitating conditions ranging from acute illness, chronic conditions, and terminal illncsses or conditions. According to this model, the patient’s potential capacity to perform his social roles is the decisive factor determining how actively hc will be treated.

      If the traditional norm governing medical practice werc being followed consistently, social considerations would have no weight in these decisions. All the hypothetical cases which were presented to specialists on the questionnaires would be treated actively. This...

    • Chapter 4: The Terminal Patient: Treatment of the Dying and the Dead
      (pp. 67-84)

      Modern medical technology combined with the nature of many types of chronic diseases has given the physician considerable control over the process of dying. There are many decisions to be made, most of which are still controversial in one way or another. For example, the physician can choose to accelerate the dying process either by withdrawing treatment or by directly bringing about the death of the patient. It is not clear whether there is a meaningful difference between omission of treatment which is needed to maintain the patient’s life (for example, antibiotics in the case of a terminal patient who...

    • Chapter 5: Decision-Making Viewed Through Hospital Records
      (pp. 85-102)

      A reasonable criticism of the type of data which have been presented in the previous chapters is that it may not reflect the actual behavior of physicians. In order to validate these findings, attempts were made to obtain information from hospital records concerning the treatment of critically ill patients. The principal problem in conducting such studies is to find suitable samples of cases. After much consideration, it was decided that the most appropriate way to validate the study of doctors’ attitudes toward the treatment of critically ill adult patients was through: (1) Examination of the hospital charts for all patients...


    • Chapter 6: Context for Decision-Making: The Hospital Setting
      (pp. 105-136)

      Having identified the criteria which physicians use in deciding to treat critically ill patients, we will attempt in this and in subsequent chapters to identify the characteristics of physicians which are associated with preferences for conservative norms concerning patient care, on the one hand, and for more permissive norms on the other. A number of variables will be examined in this and in the subsequent chapter, including organizational setting, professional and social values, and personal characteristics of the physician, such as social class origin and religious affiliation. In a sense, we are asking whether the physician is autonomous in making...

    • Chapter 7: The Active Physician: Cultural Influences Upon Medical Decisions
      (pp. 137-180)

      In previous chapters, the influence of medical institutions upon medical decision-making has been examined. In this chapter, we will expand the range of variables considered in order to study the role of cultural influences. It is possible that cultural institutions play important roles in shaping the attitudes of physicians toward the treatment of critically ill patients. In spite of the professionalization of medical practice, one would expect that attitudes and values acquired through religious socialization would affect physicians’ decisions concerning patients. In a rapidly changing society, one would also expect to find generational differences in attitudes toward these matters. Variations...

    • Chapter 8: Departmental Dynamics and the Development of New Medical Technology
      (pp. 181-198)

      In previous chapters, we have discussed the allocation of medical care to patients under the conditions of normal medical practice. There are, however, a number of special medical situations where new medical technology is being developed and utilized in the treatment of patients. The best known examples of these situations are heart transplantation, kidney transplantation and cancer chemotherapy. Under these conditions, the allocation of medical resources is undoubtedly different in some ways from that to be found in general medical practice. These situations represent a variant of a more frequent but atypical situation in medical practice, that of medical experimentation....

    • Chapter 9: Conclusion
      (pp. 199-212)

      Evidence from the present study suggests that physicians respond to the chronically ill or terminally ill patient not simply in terms of physiological definitions of illness but also in terms of the extent to which the patient is capable of interacting with others.¹ The treatable patient is one who can interact or who has the potential to interact in a meaningful way with others in his environment. The physically damaged salvageable patient whose life can be maintained for a considerable period of time is more likely to be actively treated than the severely brain-damaged patient or the patient who is...

  9. Appendix 1: Charts
    (pp. 213-218)
  10. Appendix 2: Questionnaires
    (pp. 219-268)
  11. Glossary of Medical Terms
    (pp. 269-270)
  12. Bibliography
    (pp. 271-278)
  13. Index
    (pp. 279-285)