DECISION-MAKING PROCESS FOR DEALING WITH DEATH AND DYING
This research paper discusses the decision-making process involved with patients who are dying in hospitals, nursing homes and other extended care facilities, including the role of institutional review boards or ethics committees and mediation techniques. Although it has its pitfalls, mediation offers a promising alternative to other methods of decision-making in many such cases, especially those in which the patient is incompetent to decide for himself what, if any, further treatment he wants. The cultural and legal framework in which such decisions are often made in the United States militate against prompt and humane outcomes, but nonetheless clarify some of the legal and moral principles involved.
Death, the ultimate bane of all existence, and the process of dying involve great anguish and sometimes present excruciating dilemmas for those involved, first and foremost the patient, who may or may not be aware of what is transpiring, and for others closely involved, including relatives, friends, physicians, nurses and other care givers and the health institutions where the dying process occurs, hospital administrators, special review boards, social workers, bioethicists, representatives of the community, public officials, lawyers and sometimes the courts. As late as 1950, more than half of all dying patients died at home in the presence of intimates. Hafemeister says that "only twenty-five years ago, a decision regarding life-sustaining medical treatment . . . was the exclusive province of the patient, the patient's family and the treating physician." Today, approximately 80 percent of patients, in 1994 in America 5,500 people a day, die in hospitals and other institutions. In 1950, 600,000 people in the United States were age 85 or older; by the year 2030, an estimated eight million Americans will reach that age. In 1989, 12 percent of that population was over age 6...