Prognostic Conflict in Life-and-Death Decisions: The Organization as an Ecology of Knowledge

Publisher Website
Google Scholar
Abstract
This paper examines prognostic conflict in life-and-death decisions in intensive care units for newborn infants. The data were collected during 16 months of field research in two intensive care nurseries which differed with respect to their size, relative prestige, referral patterns, and the demographic composition of their clientele. This analysis approaches life-and-death decisions from the standpoint of the sociology of knowledge, which relates decisions to the social context in which they take place. Prognostic conflict is used as a paradigmatic case to illustrate how the organization as an ecology of knowledge allocates different information to those who reach life-and-death decisions. A major finding is that physicians and nurses, because of their experiences in the intensive care nursery, differ systematiclaly in their views of infants'' prognoses. Residents, whose contact with infants is limited and technologically focused, assess prognosis largely on the basis of diagnostic technology. Nurses, who sustain continuous contact with infants, also assess prognosis on the basis of cues gleaned from interactions with infants, but may assume a more pessimitic attitude toward infants who pose management difficulties. These contrasting and "partial" views of reality are rooted in the culture and social structure of technology-intensive medical settings. Following medical historians, we suggest that medical practice has been characterized by a diminishing attention to patients'' subjective symptoms, a waning confidence in clinical observation, and an increasing reliance on diagnostic technology. These organizational features of neonatal intensive care units complicate life-and-death decisions. By implication, a change in some of these features might result in more informed and equitable decision-making.

This publication has 0 references indexed in Scilit: