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Buckley, Tom; Crippen, David; DeWitt, Anthony L; Fisher, Murray; Liolios, Antonios; Scheetz, Christine L; Whetstine, Leslie M.

doi:10.1186/cc2451

Cited by 15 publications

(3 citation statements)

References 2 publications

(1 reference statement)

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“…In Costa Rica, where the elderly population is growing, a whole discussion as a society has become necessary. In agreement with Buckley (Buckley, T., Crippen, D., DeWitt, A.L. et al, 2004), when declaring that, "common law courts are poor substitutes for family in end-of-life decision-making because they do not apply the standards of the family, and instead apply legal standards that are easily manipulated", laws responding to an ethical reflection do not necessarily adopt beneficence for all, and the lawmakers' response JOSÉ ERNESTO PICADO OVARES Y ALLAN GONZÁLEZ ESTRADA to a particular moral view may add a great deal of pressure on physicians who ultimately will try to make a decision where consensus is not reached.…”

Section: The Feeding Tube: Treatment or Relentless Therapysupporting

confidence: 78%

La toma de decisiones en pacientes con demencia avanzada y disfagia en Costa Rica: un análisis clínico y filosófico

Ovares¹,

Estrada

2021

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El uso de tubos de alimentación en pacientes con demencia avanzada sugiere varias preocupaciones éticas, no solo para los profesionales de la salud, sino también para las familias del paciente. Un punto poco explorado, del que trata este escrito, es el del simbolismo asociado entre la comida y la idea de una buena vida y vitalidad (visto en Costa Rica y otros países latinoamericanos), ya que la solicitud de las familias, de utilizar sonda de alimentación en una persona con demencia avanzada, puede explicarse en términos de los razonamientos sobre esta asociación. De esta manera, el proceso de toma de decisiones entre la familia, el personal sanitario y los propios pacientes se vuelve complicado, no solamente desde el punto de vista ético, sino lógico y de simbolismos asociados. Tal discusión se analiza en términos del principio de autonomía y el principio de humanidad para comprender los deseos y creencias que participan en las decisiones sobre el final de la vida. En consecuencia, esta investigación tiene como objetivo indagar ese proceso de razonamiento involucrado en la propia decisión en términos del modus ponens, como un fuerte razonamiento lógico que conduce a la decisión. Sin embargo, tal decisión puede verse comprometida cuando el modus ponens se desvía hacia una falacia, al negar las consecuencias. Posteriormente, esto puede derivar en una cadena de deducciones que pueden socavar la consideración del principio de autonomía y el principio de humanidad para decidir si utilizar la sonda de alimentación. Esta investigación también sugiere la necesidad de un proceso educativo extenso para alentar la decisión temprana de terminar con la vida de una persona. Finalmente, esta investigación apela a una evaluación de las leyes que rigen la decisión sobre el final de la vida en Costa Rica, incluidas las políticas médicas y judiciales. Se presenta al final un cuadro con las consideraciones clínicas y éticas asociadas al uso de tubos de alimentación en pacientes con demencia avanzada.

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Section: The Feeding Tube: Treatment or Relentless Therapysupporting

confidence: 78%

La toma de decisiones en pacientes con demencia avanzada y disfagia en Costa Rica: un análisis clínico y filosófico

Ovares¹,

Estrada

2021

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“…It goes without saying that the first course of action should be to direct effort into consensus building which would lead to the resolution of discord, thus leading to least anguish experienced by everybody; indeed, much previous work has studied how this challenge should be approached best and what particular concerns tend to create the greatest contention. [58][59][60] My focus here is on the problem which presents itself when this resolution proves impossible.…”

Section: Divergence Of Views Within the Patient's Kinmentioning

confidence: 99%

Resolving the ethical quagmire of the persistent vegetative state

Arandjelović

2023

Evaluation Clinical Practice

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BackgroundA patient is diagnosed with the persistent vegetative state (PVS) when they show no evidence of the awareness of the self or the environment for an extended period of time. The chance of recovery of any mental function or the ability to interact in a meaningful way is low. Though rare, the condition, considering its nature as a state outwith the realm of the conscious, coupled with the trauma experienced by the patient's kin as well as health care staff confronted with painful decisions regarding the patient's care, has attracted a considerable amount of discussion within the bioethics community.AimsAt present, there is a wealth of literature that discusses the relevant neurology, that elucidates the plethora of ethical challenges in understanding and dealing with the condition, and that analyses the real‐world cases which have prominently featured in the mainstream media as a result of emotionally charged, divergent views concerning the provision of care to the patient. However, there is scarcely anything in the published scholarly literature that proposes concrete and practically actionable solutions to the now widely recognized moral conundrums. The present article describes a step in that direction.Materials & MethodsI start from the very foundations, laying out a sentientist approach which serves as the basis for the consequent moral decision‐making, and then proceed to systematically identify and deconstruct the different cases of discord, using the aforementioned foundations as the basis for their resolution.ResultsA major intellectual contribution concerns the fluidity of the duty of care which I argue is demanded by the sentientist focus.DiscussionThe said duty is shown initially to have for its object the patient, which depending on the circumstances, can change to the patient's kin, or the health care staff themselves.ConclusionIn conclusion, the proposed framework represents the first comprehensive proposal regarding the decision‐making processes involved in the deliberation on the provision of life sustaining treatment to a patient in a PVS.

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“…It goes without saying that the first course of action should be to direct effort into consensus building which would lead to the resolution of discord, thus leading to least anguish experienced by everybody; indeed, much previous work has studied how this challenge should be approached best and what particular concerns tend to create the greatest contention (Buckley et al, 2004;Nelson and Nazareth, 2013;Graham et al, 2015). My focus here is on the problem which presents itself when this resolution proves impossible.…”

Section: Divergence Of Views Within the Patient's Kinmentioning

confidence: 99%

Resolving the Ethical Quagmire of the Persistent Vegetative State

Arandjelović¹

2023

Preprint

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A patient is diagnosed with the persistent vegetative state (PVS) when they show no evidence of the awareness of the self or the environment for an extended period of time. The chance of recovery of any mental function or the ability to interact in a meaningful way is low. Though rare, the condition, considering its nature as a state outwith the realm of the conscious, coupled with the trauma experienced by the patient's kin as well as health care staff confronted with painful decisions regarding the patient's care, has attracted a considerable amount of discussion within the bioethics community. At present, there is a wealth of literature that discusses the relevant neurology, that elucidates the plethora of ethical challenges in understanding and dealing with the condition, and that analyses the real-world cases which have prominently featured in the mainstream media as a result of emotionally charged, divergent views concerning the provision of care to the patient. However, there is scarcely anything in the published scholarly literature that proposes concrete and practically actionable solutions to the now widely recognized moral conundrums. The present article describes a step in that direction. I start from the very foundations, laying out a sentientist approach which serves as the basis for the consequent moral decision-making, and then proceed to systematically identify and deconstruct the different cases of discord, using the aforementioned foundations as the basis for their resolution. A major intellectual contribution concerns the fluidity of the duty of care which I argue is demanded by the sentientist focus. The said duty is shown initially to have for its object the patient, which depending on the circumstances, can change to the patient's kin, or the health care staff themselves. In conclusion, the proposed framework represents the first comprehensive proposal regarding the decision-making processes involved in the deliberation on the provision of life sustaining treatment to a patient in a PVS.

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Untitled

Cited by 15 publications

References 2 publications

La toma de decisiones en pacientes con demencia avanzada y disfagia en Costa Rica: un análisis clínico y filosófico

La toma de decisiones en pacientes con demencia avanzada y disfagia en Costa Rica: un análisis clínico y filosófico

Resolving the ethical quagmire of the persistent vegetative state

Resolving the Ethical Quagmire of the Persistent Vegetative State

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