Doctors asserted their discretion in several ways. First, doctors made decisions without asking families on the assumption that families would agree with their decisions. Second, doctors sometimes ignored a family’s stated decisions, arguing that it was cruel to force a family to make life-or-death decisions it might later regret. Third, doctors might respect a family’s wishes, but only after first shaping those wishes through providing information selectively. This information included de- fining the patient as terminally ill or not—a highly significant designation because ethical guidelines permit health care workers to withhold or terminate treatment only for terminally ill patients. Fourth, when doctors failed to shape a family’s wishes, the doctors could discount those wishes on the grounds that the family was too emotionally distraught to decide rationally.
Finally, and perhaps most important, doctors continued to assert their discretion by defining the decision to withhold treatment as merely a technical prob- lem and thus defining family members’ wishes as irrelevant. For example, doctors might acknowledge families’ general wishes regarding how aggressively treatment should proceed but then define each specific intervention as a technical decision best left to doctors.
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