Navigating Life’s End: Task-Centered Versus Event-Centered Orientations Among Respiratory Therapists Withdrawing Mechanical Ventilation

Terminal extubation, the planned withdrawal of mechanical ventilation from patients who will not recover, presents significant technical, ethical, and emotional challenges for respiratory therapists (RTs), yet their perspectives remain underexamined. Using Max Weber's concept of ideal types, this interpretive description study explored how RTs understand and enact their role at life's end. Twenty-nine RTs (20 in Canada and 9 in the United States) participated in semi-structured video interviews. Analysis revealed a continuum between two orientations: task-centered RTs emphasize technical precision, protocol adherence, and emotional detachment, often relying on informal or maladaptive coping strategies. Event-centered RTs approach extubation as a shared human experience, integrating emotional presence with clinical skill and supporting families and teams, though institutional support for such practices is limited. These orientations are fluid and context-dependent. Findings extend Weberian theory by showing how instrumental, value-rational, affective, and traditional motives converge in a single clinical act. To better support RTs, we recommend (a) inclusion in decision-making and debriefing, (b) training that blends technical and relational competencies, and (c) policies that legitimize diverse ways of "doing" terminal extubation. These shifts could reduce burnout, foster collaboration, and improve end-of-life care for patients and families.