Death Organized by the Doctor: End-of-Life Decisions in Intensive Care Units

Intensive care and the intensive care techniques in use have considerably changed our attitude towards death and dying -a process that had already been medicalized and professionalized. This study of four intensive care units (ICUs) in France and Britain brings to light the reality of death-related practices and resituates that reality at the core of professional relations and personal experience. Study results strongly suggest that the end-of-life decision is a genuine social construction: far from being purely objective and medical, it is heavily conditioned by context and actors' commitment. The search for professional autonomy and self-regulation has increased the ambivalence of the dying process, already complex because governed by extremely heterogeneous types of logic. This study shows that patient's death in an ICU is more dependant on the organization and culture of the ICU than on patient's own wishes or those of close relatives.