Fræðigrein

Læknablaðið 2005; 91: 517-32

Objective: This study is done to examine the ideas of elderly individuals on life, death and end-of-life treatment in order to understand how they interact and influence choices of treatment.

Design: A phenomenological study. Eight Icelandic individuals 70 years old or more were interviewed in their homes. The interviews were open with two main questions. A special emphasis was on views toward life and death as studies have indicated their importance.

Results: All participants had a history of a good life despite experiences of death and loss. Enjoyment of life was evident along with an accepting attitude towards death. Everyone agreed on the neccessity to limit life prolongation if there was no hope of recovery, much suffering, mental and physical ability compromised, no possibility of living a good life and being a burden to others. The participants based their attitudes toward end-of-life treatment on the likely outcome; evaluation of their own live; the impact on loved ones and experience of loss, grief and death.

Discussion: A model of end-of-life discussion between a physician and a patient is presented: The discussion takes place within an ethical and cultural framework, which is sometimes discussed. Phycisians give information on diagnosis, prognosis, treatment options and the likely outcome. The patient evaluates the information in view of his/her own life based on age, health and views on life and death. The patient considers the impact of the decision made on loved ones and evaluates own experiences and that of others. Each factor has a negative and a positive side towards treatment. The decision on treatment is then made collectively.

Conclusion: Discussion on end of life treatment involves following themes: Ethical, medical, the patients? evaluation of his/her own life, the impact of the decision on loved ones and experiences of loss, grief and death.