The ends of care: decision-making processes, advanced life support and palliative care

Abstract

In this article, I reflect on the production of care in clinical practice in palliative care. Based on ethnographic research, resulting from the observation of care provided by the Palliative Care Service of a teaching hospital in the state of São Paulo to people with life-threatening illnesses, I discuss how the decision-making processes around the use of advanced life support make explicit the contradictions, adjustments and situationality of producing care in this context. Thus, from the extensive description of care practices and routines developed by the health team, I argue that care and what is handled as “good care” (Mol, 2008) is produced in the temporariness of the interactions that are established among various actors – palliative care team, specialties, family members – and in the sliding of the intricate dynamics that traverse particular diagnoses, bad prognoses, physiological responses, intervention modalities, decisions about therapeutic conducts and subjectivities.