title: Clinical decision making in palliative care and end of life care.
abstract: Clinical decision making involves a consideration of multiple factors; clinical options are constructed based on the objective clinical data and evidence-based standards. Technologic advances have led not only to life saving interventions, but also to the use of these technologies when benefit to the patient was unclear or unexamined. The cases of Karen Quinlan, Nancy Cruzan, and Terri Schiavo provide a framework for examining the evolution of clinical decision making, including when to use or not to use technologies such as ventilators and artificial nutrition and hydration, and the role of specific questions in the process. Advance directives are a means to convey patient preferences, however, in the absence of advance directives, skilled questioning can elicit patient preferences. Nurses' roles in clinical decision making are often nebulous but can be enhanced by understanding these interrelated processes, as well as by knowing the policies and procedures of their institutions.
authors.affiliation: Palliative Care and Ethics, School of Nursing, George Mason University, 4400 University Drive, Mail Stop 3C4, Fairfax, VA 22030, USA. mmahon@gmu.edu
authors.forename: Margaret M
authors.initials: MM
authors.lastname: Mahon
mesh_terms: D000328:Adult; D003657:Decision Making / Q000941:ethics*; D004993:Ethics, Nursing; D005260:Female; D006801:Humans; D008020:Life Support Care / Q000941:ethics* / Q000331:legislation & jurisprudence*; D009729:Nursing; D010166:Palliative Care / Q000941:ethics / Q000331:legislation & jurisprudence; D018458:Persistent Vegetative State / Q000628:therapy*; D035521:Supreme Court Decisions; D013727:Terminal Care / Q000941:ethics / Q000331:legislation & jurisprudence; D014481:United States