The Challenges of Using Ethnographic Methods to Research End-of-Life Decision Making in Older Hospitalised Patients

Wednesday, 24 July 2013: 10:50 AM

Catherine Sarah O'Neill, PhD, BA, MA, MSocSc, RGN
School of Nursing and Midwifery, PO Box 15503, Bahrain, Bahrain

Learning Objective 1: The learner will be able to be aware of, and sensitive to, the ethical issues involved in using ethnographic research methods.

Learning Objective 2: The learner will learn from the presentation how to develope strategies to manage the ethical challenges of ethnographic research methods .

Purpose:  This  paper examines the ethical and methodological challenges of using ethnographic methods to develop knowledge around the processes involved when decisions relating to medical treatments are made in the care of older patients in hospitals. For some patients, decisions to withdraw  medical treatments or not to treat, resulted in the end-of -life.

Methods: An ethnographic approach was used to generate data. This involved extensive fieldwork over a period of two years in two acute university hospitals in Dublin, Ireland. The study participants were family members, patients, doctors, nurses and other allied health care practitioners. In total,  42 interviews were carried out and  13 patient cases were followed. 

Results:  The findings evidenced that frequently, older patients, because of their illness, were unable and uninterested in being actively involved in the treatment decision making process. They left decisions to family members, nurses and doctors. Clinicians used thin technical scientific discourses to talk to patients and family members about diagnoses and treatments. Family member’s decision making processes drew on the themes of the patient’s biography, the patient’s values and the social knowledge of other people in similar situations.  Balancing of the dual roles of professional responsibility as a researcher, while engaging in human relationships and generating data around the sensitive issues of death and dying were challenging.  Issues of representation in the final write up demanded continued ethical sensitivity to maintain the dignity, privacy, and integrity of all participants, while simultaneously constructing an academically robust text. 

Conclusion: There are many ethical dimensions embedded in the use of ethnographic research methods. These ethical dimensions, however, should not preclude research on sensitive topics related to patient care. In particular older patients preferences concerning treatments at what may,   for some, be  an end- of- life decision.