The Karamazov complex: Dostoevsky and DNR orders

Area of Science:

• Medical Ethics
• Psychology
• Literary Analysis

Background:

• Families in intensive care units (ICUs) face complex end-of-life decisions.
• Prevailing individualistic models of autonomy do not fully capture family decision-making processes.
• Families may exhibit avoidance and denial of complicity in critical care choices.

Purpose of the Study:

• To examine how families make tragic end-of-life decisions in the ICU.
• To explore communication patterns and accountability in these decisions.
• To identify clinical implications for physicians discussing do not resuscitate (DNR) orders.

Main Methods:

• Analysis of two novels: Dostoevsky's The Brothers Karamazov and Kenzaburo Oe's A Personal Matter.
• Examination of a case study from a neonatal intensive care unit.
• Comparison of literary portrayals with actual family decision-making processes.

Main Results:

• Families engage in complex communication to test complicity and manage accountability.
• Decision-making involves patterns of sharing or submerging responsibility.
• Psychological processes in literature mirror those observed in clinical settings.

Conclusions:

• Understanding these psychological patterns is crucial for effective end-of-life care communication.
• Physicians can improve discussions about do not resuscitate (DNR) orders by recognizing family dynamics.
• Literary analysis offers valuable insights into real-world clinical challenges in ICUs.