M.Cur. / Modern technology has brought on the possibility to sustain life for an indefinit3e period, but does not give answers to the questions arising from such situations. In view of shrinking resources available for tertiary care, and the growing awareness of justice, indefinite continuation of life-support therapy has been subjected to scrutiny. Traditionally the treating physician made all decisions regarding therapy. In Western culture the public are more aware of their right to self-determination and participation in decision making with the autonomy to do so. The nurse's role also changed from "handmaiden" to an independent practitioner who takes part in decision making regarding her patient. Decisions regarding life-support therapy is sensitive and becomes more complicated the more people become involved. The following question can then be asked: What are all the factors in decision making concerning life-support therapy? The aim of this study is to identify the factors in decision making concerning life support, as the first step in defining the parameters in decision making. The design chosen to identify these factors is a qualitative, exploratory, contextual, phenomenological case-study design. one case study was done on a patient where the continuation of life support was questioned. All persons involved with the patient were included in the case study. Interviews were conducted, observations and field notes were made and patient records were explored to identify factors in decision making. A narrative was written to present this information. As these constituted the micro-level, a literature study was done to identify factors on the macro- and meso-levels. The results of the analysis are presented as a list of factors in decision making concerning life-support therapy.

Thesis (LLM (Private Law))--University of Stellenbosch, 2006. / End of life decisions regarding defective babies raise several controversial questions. The root of the problem in withdrawing or withholding life-sustaining treatment from defective babies lies in the conflict between human emotions, technological advancements and legal considerations. As a result of advances in medical science and neonatal technology, the lives of defective babies can often be saved or indefinitely prolonged. The question has become not whether we can treat these babies, but rather whether we should. Whether or not a defective baby’s life must be prolonged raises serious moral and ethical issues. A life compromised by severe physical and mental handicaps is weighed against an early and painless death. The best interest of the baby is the primary consideration from a legal point of view. Various factors must be taken into account to give content to this concept. Another central question is to determine who the decision maker(s) should be and what weight should be given to their opinions. Due to the fact that defective babies can not participate in this decision making process or communicate their wishes and preferences, surrogate decision makers must decide on their behalf. In sharp contrast to England, America and Canada, there is hardly any literature and no reported case law in South Africa to demonstrate the complexity of end of life decisions regarding defective babies. Selective non-treatment of defective babies have received little attention in the South African law. The Bill of Rights, inspired by regional and international Conventions determine the framework from a juristic perspective wherein decisions must be made and justified. This framework requires that the focus must be on the most vulnerable and dependant, namely the defective baby.

Indiana University-Purdue University Indianapolis (IUPUI) / African Americans' tendency to choose life-prolonging treatments (LPT) over comfort focused care (CFC) at end-of-life is well documented but poorly understood. There is minimal knowledge about African American (AA) perceptions of decisions to continue or discontinue LPT. The purpose of this study was to examine AA family members' perceptions of factors that influenced end-of-life care decision-making for a relative who recently died from serious illness. A conceptual framework informed by the literature and the Ottawa Decision Support Framework was developed to guide this study. A retrospective, mixed methods design combined quantitative and qualitative descriptive approaches. Forty-nine bereaved AA family members of AA decedents with serious illness who died between 2 to 6 months prior to enrollment participated in a one-time telephone interview. Outcomes examined include end-of-life treatment decision, decision regret, and decisional conflict. Quantitative data were analyzed using descriptive statistics, independent-sample t-tests, Mann-Whitney U tests, chi-square tests, Spearman and Pearson correlations, and linear and logistic regressions. Qualitative data were analyzed using content analysis and qualitative descriptive methods. Family members' decisional conflict scores were negatively correlated with their quality of general communication (rs = -.503, p = .000) and end-of-life communication scores (rs = -.414, p = .003). There was a significant difference in decisional regret scores between family members of decedents who received CFC versus those who received LPT (p = .030). Family members' quality of general communication (p = .030) and end-of-life communication (p = .014) were significant predictors of family members' decisional conflict scores. Qualitative themes related to AA family members' experiences in end-of-life decision-making included understanding (e.g., feeling prepared or unprepared for death), relationships with healthcare providers (e.g., being shown care, distrust) and the quality of communication (e.g., being informed, openness, and inadequate information). Additional qualitative themes were related to perceptions of the decision to continue LPT (e.g., a lack of understanding, believe will benefit) or discontinue LPT (e.g., patient preferences, desire to prevent suffering). In conclusion, this study generated new knowledge of the factors that influenced AA bereaved family members' end-of-life decision-making for decedents with serious illnesses. Directions for future research were identified.