Relational autonomy in end-of-life care ethics: a contextualized approach to real-life complexities

Gómez-Vírseda, Carlos; Maeseneer, Yves De; Gastmans, Chris

doi:10.1186/s12910-020-00495-1

Cited by 70 publications

(57 citation statements)

References 87 publications

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“…Barrere and Durkin (2014) argued that nurses' sensitivity toward the patient continued in end-of-life care, and nurses tried to provide good-quality care. Considering that one of the most important responsibilities in the profession of nursing is providing care in light of ethical principles, nursing students' sensitivity toward end-of-life care is a phenomenon that is important in terms of the quality of the care they will provide (Cerit et al, 2021;Gómez-Vírseda et al, 2020;Hsu et al, 2021;Leget & Kohlen, 2020;Özgönül et al, 2020;Svenaeus, 2020).…”

Section: Discussionmentioning

confidence: 99%

What Intern Nursing Students in Turkey Think About Death and End-of-Life Care? A Qualitative Exploration

Dalcalı

Taş

2021

J Relig Health

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This descriptive qualitative study was planned to determine the views of intern nursing students about death and end-of-life care. The study was completed with 12 intern students based on the criterion of data saturation. As a result of the study, the categories of 'end,' 'uncertainty,' 'fear,' 'beginning,' 'helplessness' under the theme of death, 'ensuring peace,' 'continuing communication' 'providing psychosocial/ spiritual support,' 'acting in conformity with principles of ethics/morality,' 'continuing to provide physical care,' 'supporting the family,' 'making the best use of the limited remaining time or helping the patient's last wishes come true' under the theme of end-of-life care emerged.

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Section: Discussionmentioning

confidence: 99%

What Intern Nursing Students in Turkey Think About Death and End-of-Life Care? A Qualitative Exploration

Dalcalı

Taş

2021

J Relig Health

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“…Furthermore, there are considerable individual differences in rates of developmental maturation among adolescents [5]. Moreover, adolescents are profoundly influenced by other persons, especially parents, health professionals and peers [37,38].…”

Section: Decision-making Capacity In Adolescencementioning

confidence: 99%

Perceived facilitators of and barriers to mental health treatment engagement among decision-making competent adolescents in Greece

et al. 2021

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Background A subset of adolescents with mental disorders are likely to have decision-making capacity that facilitates their therapy engagement. However, there are high rates of drop-out in mental health settings. Aim This study aims to identify perceived barriers to or facilitators of mental health care engagement among adolescents with decision-making competence in Greece. Methods A qualitative study was conducted using semi-structured interviews of adolescents with a wide range of mental health problems. In addition, two psychometric assessment measures were used to define who to include or exclude from the study sample. Results Positive attitudes and experiences with therapy were reported as strong (“major”) facilitators of therapy engagement for adolescents with mental disorders, whereas negative experiences with therapy were reported as strong barriers to it. Furthermore, and most importantly, a “good” adolescent-therapist relationship was reported as a strong facilitator, whereas negative experiences of participants with their therapist were reported as strong barriers. Moreover, goals such as getting rid of symptoms, improving personal well-being, and improving social skills and relationships (especially with peers) emerged as strong facilitators of therapy engagement. Importantly, the early remission of symptoms emerged from the study as a strong barrier to therapy engagement for participants. Among the weaker (“minor”) perceived facilitators were goals such as confessing to a trustworthy person, becoming able to achieve personal expectations and life goals, enhancing independence and self-esteem, and developing a positive self-image. The (active or supportive) role of family emerged as a facilitator. The stigma related to mental health emerged as both a (“minor”) facilitator of and barrier to therapy engagement for participants. Friends were reported as having a role ranging from neutral to mildly supportive. Conclusion A number of more or less strong barriers and facilitators were identified that, for the most part, were consistent with prior literature. However, the authors identified some nuances that are of clinical importance. For instance, adolescents are most likely to terminate the treatment prematurely if they experience early symptom remission. Highlighting the role of therapy in achieving their goals or improving their families’ well-being might be used by therapists to reduce the attrition rate.

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“…Likewise, when someone else decides for us, they certainly decide for us but also for themselves. None of the involved subjects-patient, family members, health personnel-can be considered neutral: each subject is involved in his/her own identity, in respect of their respective roles [31][32][33]. Therefore, when it is necessary to reconstruct, as in the two cases that we have analyzed, the will of an individual who is no longer able to express himself/herself-especially, but not only, when there are no written statements-it is necessary to interpret his/her wishes taking his/her relationships into due account [34] Only this hermeneutic work will make statements made at different times and in different contexts univocal.…”

Section: Reconstruction Of Self-expressionmentioning

confidence: 99%

Analyzing the paradigmatic cases of two persons with a disorder of consciousness: reflections on the legal and ethical perspectives

Picozzi

Panzeri

Torri³

et al. 2021

BMC Med Ethics

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Background Media have increasingly reported on the difficulties associated with end-of-life decision-making in patients with Disorders of Consciousness (DOC), contextualizing such dilemma in detailed accounts of the patient’s life. Two of the first stories debated in the scientific community were those related to the cases of two women, one American, the other Italian, who captured attention of millions of people in the first years of this third millennium. Methods Much has been written about the challenges of surrogate decision-making for patients in DOC, but less has been written comparing these challenges across legal systems and cultures. In our paper, we propose a systematic analysis of the final legal documents written by the American and Italian Courts in relation to the two cases, developing our discussion around three areas: the level of certainty/reliability of diagnosis and prognosis, the reconstruction of self-expression, time of illness and time of care. They are examples of the typical issues discussed by legal authors and allow us to understand the link and the difference between the legal and ethical perspectives. Results The legal approach to the two cases has some common elements: the need to be certain about the diagnosis and prognosis and the fact that the clinical criteria are necessary in determining the most appropriate treatments, although these criteria are not sufficient unless they are supplemented by the patient’s will. The issue of relations takes on importance both from a legal and an ethical point of view, but from two different perspectives. While ethics safeguards relationships by guaranteeing their differences and makes them reconcilable, law safeguards relationships by guaranteeing the cold forms of respect, equality, impartiality, symmetry, reciprocity, and irreversibility. In this perspective, the link between the time of care and the decision of the family members assumes importance. Conclusions The most interesting point that emerges from our analysis is the issue of relationships and how they affect decisions, both from a legal and ethical point of view. For this reason, during the patients’ hospitalization, it is necessary to identify ways in which they might give their opinion about the moral issues underlying their choices.

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Relational autonomy in end-of-life care ethics: a contextualized approach to real-life complexities

Cited by 70 publications

References 87 publications

What Intern Nursing Students in Turkey Think About Death and End-of-Life Care? A Qualitative Exploration

What Intern Nursing Students in Turkey Think About Death and End-of-Life Care? A Qualitative Exploration

Perceived facilitators of and barriers to mental health treatment engagement among decision-making competent adolescents in Greece

Analyzing the paradigmatic cases of two persons with a disorder of consciousness: reflections on the legal and ethical perspectives

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