Chapter 10: Individualistic and Organizational Analyses of Informed Consent

Frederick Wiseman’s (1989) film, Near Death, follows the lives of several patients as they, their families, and their medical caregivers confront lifethreatening illnesses. The scenes were filmed at a major, urban, tertiarycare medical center. One patient’s “story” was selected for analysis by the authors of the articles that follow. Each author, analyzing the same film sequences, brings a particular perspective to the task of examining the process of informed consent in the context of the conversation in the film.

The film story involves the care of “Betty” who has been intubated five times in 6 months as a result of chronic obstructive pulmonary disease (COPD) and has recently suffered a stroke. She is in the intensive care unit (ICU), presently intubated, unable to speak, and able to gesture only with great difficulty. She is conscious and apparently competent. From a medical standpoint, the choices include removing the intubation tube, the possible need to reintubate or possible performance of a tracheotomy, or foregoing any of these interventions with the likely consequence of death.