Objective
To understand the end-of-life phenomenon in the intensive care setting in Macedonia
through the experiences of health professionals and family members of terminally-ill
patients in its social and cultural context.
Methods
Participant observation in surgical intensive care units and in-depth interviews with
health professionals who had professional experience with terminally-ill patient(s)
and family members of terminally-ill patients who died or had any limitation of lifesustaining
medical intervention are principal methods.
Results
The context analysis revealed opportunity for integration of palliative care in the
intensive care units as an alternative to separate palliative care services in the country.
The study reveals surgical intensive care units and emergency departments and the
professionals providing service to be involved in the treatment of terminally-ill
patients. Both withholding and withdrawal of treatment in terminal patients are
accepted practices in terminal patients. Social, cultural, economic factors influence
the decision making process. Families and patients are rarely involved in the decision
making process, especially in emergency cases. Communication is reported as a point
to improvement from both sub-samples. Disclosing diagnosis and prognosis, as well
as informed consent to treatment, though legally secured, undergo cultural reshape.
Conclusion
How terminally-ill patients are managed in the intensive care setting in Macedonia is
shaped through the interplay of professional, cultural, ethical and social factors. The
identified factors represent potential threats and opportunities to profile palliative care
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programs in the intensive care setting. Limitation of life-sustaining measures in
terminally-ill patients is accepted among the medical professionals as an alternative to
redundant prolongation of life and time of death. Patient and family inclusion in
decision-making and communication is insufficient. Ethical principle of autonomy
should be shaped in the cultural context. Public, ethical, professional and legal
consensus is needed to improve current practice. Though this research pioneers in the
understanding of the end-of-life phenomenon and identified its components and their
interaction in the context, more research is needed to describe the role and needs of
the patients in terminal condition and their families and decision-making surrogates.