Abstract

The purpose of this study is to explore decision-making regarding potential end-of-life medical treatment. Specifically, three research questions are addressed: can all individuals interviewed be classified by their present desire to formalize advance directives about their end-of-life medical treatment? do the categories of writers, refusers, and thinkers describe the respondents interviewed for this dissertation? is the model proposed adequate to describe the actual results, or does the model require modification to more adequately frame the components of treatment decisions? ;The review of literature provides evidence that decision-making regarding advance directives for future medical treatment is not adequately explored by current research. Andersen's model for health care utilization provides the theoretical basis to explore the dependent variable, treatment decision. Within this model the independent variables are organized by demographics, knowledge/experience, values, financial considerations, social support available, and health expectations. ;Fifty-one respondents were interviewed concerning their experiences with medical decision-making. These respondents reside in northeast Ohio, and represent diversity in age, social class and marital status. Interviews lasted from 45 to 90 minutes, were audio taped, transcribed, and then analyzed. To insure consistency, all respondents were asked to respond to questions regarding each of the variables in the model. ;Three categories of decision-makers emerge: those respondents who have executed written an advance directive. These respondents are called writers. The second group, the thinkers, are those respondents who may write an advance directive in the future. The final group are those who stated that they would not write an advance directive regarding their end-of-life medical decisions, the refusers. Results further indicate that Andersen's model for health care utilization provides an appropriate theoretical foundation for this research, though suggested modifications to variables within the model may provide better insight into potential end-of-life treatment decision-making. These modifications include the addition of two new variables and redefinition of several existing variables. Finally, the limitations of this study and recommendations for future research are discussed