A Systematic Review of Stakeholder Perspectives of Dignity and Assisted Dying

Quah, Elaine Li Ying; Chua, Keith Zi Yuan; Lua, Jun Kiat; Wan, Darius Wei Jun; Chong, Chi Sum; Lim, Yun Xue; Krishna, Lalit Kumar Radha

doi:10.1016/j.jpainsymman.2022.10.004

Cited by 11 publications

(10 citation statements)

References 120 publications

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“…The frequent presence of boundary-crossings and their impact upon a physician’s belief system, professional identity and patient care underlines the need for access to longitudinal and accessible support. This will help them as they confront boundary-crossings and the closely related issues of moral distress and emotional, ethical and practical issues surrounding care of dying patients [ 17 , 28 , 30 – 32 , 39 ]. This model also echoes concepts behind reflective practice and the teaching of empathy.…”

Section: Resultsmentioning

confidence: 99%

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Physician-patient boundaries in palliative care

Lim

Rahman

et al. 2023

BMC Palliat Care

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Background Nurturing effective physician-patient relationships is essential to the provision of patient-centred care. Palliative care physicians may apply boundary-crossings or breaches in professional standards to nurture effective physician-patient relationships. Being highly individualized and shaped by the physician’s narratives, clinical experience, and contextual considerations, boundary-crossings are susceptible to ethical and professional violations. To better appreciate this concept, we employ the Ring Theory of Personhood (RToP) to map the effects of boundary-crossings on the physician’s belief systems. Methods As part of the Tool Design SEBA methodology, a Systematic Evidence-Based Approach (SEBA) guided systematic scoping review was employed to guide the design of a semi-structured interview questionnaire with palliative care physicians. The transcripts were simultaneously content and thematically analysed. The themes and categories identified were combined using the Jigsaw Perspective and the resulting domains formed the basis for the discussion. Results The domains identified from the 12 semi-structured interviews were catalysts and boundary-crossings. Boundary-crossings attempt to address threats to a physician’s belief systems (catalysts) and are highly individualized. Employ of boundary-crossings depend on the physician’s sensitivity to these ‘catalysts’, their judgement and willingness to act, and their ability to balance various considerations and reflect on their actions and their ramifications. These experiences reshape belief systems, understandings of boundary-crossings and may influence decision-making and practice, underscoring the potential for greater professional breaches when unchecked. Conclusion Underlining its longitudinal effects, the Krishna Model underscores the importance of longitudinal support, assessment and oversight of palliative care physicians, and lays the foundation for a RToP-based tool to be employed within portfolios.

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Section: Resultsmentioning

confidence: 99%

“…Adapting Krishna’s Systematic Evidence Based Approach (SEBA), the two-staged Tool Design SEBA methodology (Fig. 1 ) was used [ 28 – 32 ]. In the first stage, a systematic scoping review was employed to guide the design of the tool.…”

Section: Methodsmentioning

confidence: 99%

Physician-patient boundaries in palliative care

Lim

Rahman

et al. 2023

BMC Palliat Care

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“…Each ring possesses a belief system containing the patient's values, beliefs and principles. The Innate Identity considers religious, gender, cultural, communitybased beliefs, moral values and ethical principles [19][20][21][22][23]. The Individual Identity encompasses personal values, beliefs, and personalities [24][25][26][27] whilst the Relational and Societal Identities pivot on familial and societal values, beliefs, expectations, and principles, respectively [24][25][26][27].…”

Section: The Theoretical Lens: the Ring Theory Of Personhoodmentioning

confidence: 99%

Role modelling in professional identity formation: a systematic scoping review

Koh

Renganathan

et al. 2023

BMC Med Educ

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Background Role modelling’s pivotal part in the nurturing of a physician’s professional identity remains poorly understood. To overcome these gaps, this review posits that as part of the mentoring spectrum, role modelling should be considered in tandem with mentoring, supervision, coaching, tutoring and advising. This provides a clinically relevant notion of role modelling whilst its effects upon a physician’s thinking, practice and conduct may be visualised using the Ring Theory of Personhood (RToP). Methods A Systematic Evidence Based Approach guided systematic scoping review was conducted on articles published between 1 January 2000 to 31 December 2021 in the PubMed, Scopus, Cochrane, and ERIC databases. This review focused on the experiences of medical students and physicians in training (learners) given their similar exposure to training environments and practices. Results 12,201 articles were identified, 271 articles were evaluated, and 145 articles were included. Concurrent independent thematic and content analysis revealed five domains: existing theories, definitions, indications, characteristics, and the impact of role modelling upon the four rings of the RToP. This highlights dissonance between the introduced and regnant beliefs and spotlights the influence of the learner’s narratives, cognitive base, clinical insight, contextual considerations and belief system on their ability to detect, address and adapt to role modelling experiences. Conclusion Role modelling’s ability to introduce and integrate beliefs, values and principles into a physician’s belief system underscores its effects upon professional identity formation. Yet, these effects depend on contextual, structural, cultural and organisational influences as well as tutor and learner characteristics and the nature of their learner-tutor relationship. The RToP allows appreciation of these variations on the efficacy of role modelling and may help direct personalised and longitudinal support for learners.

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“…Bioethical concerns about the clinical deployment of embryonic stem cells have sparked political debates and influenced legislative decisions regarding funding and regulation of stem cell research (Charitos et al, 2021; Fabbri et al, 2023; Inoue et al, 2023). Bioethical dimensions of patient autonomy and the right to die with dignity regularly influence political debates about the legalization of euthanasia and assisted suicide (Campbell, 2019; Picón-Jaimes, 2022; Quah et al, 2023).…”

Section: Response To Possible Objectionsmentioning

confidence: 99%

Might the bioethical principle of individual decisional autonomy have a politically liberalizing effect on soft authoritarian communities?

Gregg

2023

Polit. life sci.

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According to the bioethical principle of individual decisional autonomy, the patient has a right of informed consent to any medical or experimental procedure. The principle is politically liberal by advocating significant individual freedom as guaranteed by law and secured by civil liberties. When practiced in illiberal communities, might it have a political liberalizing effect? I respond first by analyzing cross-national norms of individual decisional autonomy to identify tensions with illiberal community; second, by examining examining Singapore in a single case study to show that liberal bioethics does not promote political liberalization; and third, by showing that the possibility of practicing liberal bioethics in research, clinically as well as in education, does not require a democratic order, and that liberal bioethics is unlikely to encourage the liberalization of illiberal political communities. Hence, it may never contribute to the development of globally effective cross-national norms for the legal regulation of bioethical research and clinical practice. Fourth, to bolster this analysis, I anticipate several possible objections to various of its aspects.

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A Systematic Review of Stakeholder Perspectives of Dignity and Assisted Dying

Cited by 11 publications

References 120 publications

Physician-patient boundaries in palliative care

Physician-patient boundaries in palliative care

Role modelling in professional identity formation: a systematic scoping review

Might the bioethical principle of individual decisional autonomy have a politically liberalizing effect on soft authoritarian communities?

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