In:
Médecine Intensive Réanimation, Societe de Reanimation de Langue Francaise, Vol. 28, No. 4 ( 2019-07), p. 333-338
Abstract:
A self-fulfilling prophecy refers to the fact that belief in a situation leads to its fulfillment, reinforcing the initial belief. First described in sociology, the notion of selffulfilling prophecy is also relevant in medicine where clinical practice is largely based on the prognosis of patients and their diseases. Therefore, the belief in a pejorative prognosis can lead to medical management that will result in an unfavourable evolution or will not prevent it. This risk is acute in intensive care medicine with practice of withholding or withdrawal of life support situations with share decision making that frequently lead to the death of the patient. It is a significant matter because the large data series from which a patient’s prognosis is evaluated in current clinical practice include patients who have been the subject of withholding or withdrawal of life support decisions. This might lead to a circular reasoning that is difficult to interrupt. Neuroresuscitation patients, with strokes, anoxo-ischemic encephalopathies after cardiac arrest, or head injuries, are particularly at risk of self-fulfilling prophecy because the perspective of severe neurological sequelae often motivates a decision of withholding or withdrawal of life support. Departing from self-fulfilling prophecies requires a compromise between the observation time necessary to establish the most accurate prognosis possible, and the prolongation of invasive treatments that would prove to be unnecessary a posteriori in the case of patients with no hope of neurological improvement.
Type of Medium:
Online Resource
ISSN:
2496-6142
DOI:
10.3166/rea-2019-0122
Language:
French
Publisher:
Societe de Reanimation de Langue Francaise
Publication Date:
2019
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