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

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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 …

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  • For correspondence: Dr J Cassell, Department of Surgery, Washington University School of Medicine, St Louis, Missouri, USA.

  • Source of funding: in part, National Institute of Nursing Research.