Voor een ander : beslissingsverantwoordelijkheden in de verpleeghuisgeneeskunde

Abstract

What is the right thing to be done for this patient? This question is the central point in medicine. Usually physician and patient discuss what is needed and what is wanted. When the patient suffers from dementia or is otherwise not capable of deciding for herself, a third party enters the scene: a representative or proxy decision maker. Most of the time this is a family member of the patient. He or she has the task to decide on behalf of the patient. But even when you know each other well and have known each other for a long time, to decide for some one else is a difficult matter. And what, for example, is the significance of former preferences by the patient, and his of her actual expressions of will? In this thesis the theme of family involvement in the decision making for elderly nursing home patients is thought through, based on extensive patient histories gathered from qualitative research in nursing homes (using the method of participant observation). Central question is the relation between the responsibility of the physician versus the ideas of family members about what is the right thing to do for the patient.