Life-Sustaining Treatment Decision-Making for Unrepresented Adults from Korean Hospital Staff's Perspectives: A Qualitative Descriptive Study

Abstract

ObjectivesUnrepresented adults - incapacitated individuals lacking surrogates and documented treatment preferences - pose profound clinical and ethical care challenging. This qualitative descriptive study explored hospital staff's encounters with unrepresented adults, their characteristics, and life-sustaining treatment decision-making for this population in South Korea.MethodsWe conducted semi-structured interviews with 48 hospital staff including physicians, nurses, and social workers across South Korea who provided care for unrepresented adults. Data were analyzed using directed content analysis.ResultsParticipants frequently encountered these adults, typically socioeconomically vulnerable middle-aged or older men exhibiting complex care needs, requiring prolonged hospitalization. The life-sustaining treatment decision-making involved physician-led decision-making, consultation with other professionals, alternative consent strategies, and constrained withdrawal and selective withholding of such treatment. Staff navigated these ethically complex decisions by weighing patients' recoverability, presumed life values, and the ethical principle of justice in resource allocation. Crucially, participants experienced significant clinical distress constrained by the lack of legal frameworks and standardized clinical guidelines.ConclusionsAd-hoc life-sustaining treatment decision-making for unrepresented adults places an immense ethical burden on healthcare providers.Clinical implicationsSafeguarding this vulnerable population and alleviating provider distress urgently requires robust legal frameworks, standardized clinical guidelines, and institutional multidisciplinary ethics support.