Evid Based Nurs 7:64 doi:10.1136/ebn.7.2.64
  • Qualitative

The covenantal or communal values of surgeons and intensivists influenced end-of-life care in 3 intensive care units

 Q How does end-of-life care differ in intensive care units (ICUs) that use different administrative models?


Ethnographic observation.


Surgical ICUs in St Louis, Missouri and San Antonio, Texas, and a medical-surgical ICU in Auckland, New Zealand.


Approximately 600 physicians, nurses, allied health professionals, patients, family members, and friends.


The first author spent 18 months in the ICU in Missouri; 3 weeks in the ICU in Texas; and 10 weeks in the ICU in New Zealand. Her participation varied by site and included observation of rounds, patient care, and end-of-life discussions with families, as well as interviewing health professionals.


A semi-closed unit with conflicting ethics (Missouri). On this unit, surgeons and intensivists shared responsibility for patient care, but conceptualised this responsibility quite differently. Surgeons appeared to act based on a covenantal ethic, which focused on an individual commitment to battle death on each patient’s behalf. In other words, if a patient had a chance to live, it would be morally wrong to …

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