Truth telling and advance planning at the end of life: Problems with autonomy in a multicultural world.

Candib, Lucy M.

doi:10.1037/h0089471

Cited by 92 publications

(75 citation statements)

References 59 publications

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“…[37][38][39][40] This does not mean that patients wish to be passive, even the seriously ill and the elderly. 41 In some cases, however, clinicians unwittingly impose autonomy on patients.…”

Section: Implications For Autonomymentioning

confidence: 99%

The Biopsychosocial Model 25 Years Later: Principles, Practice, and Scientific Inquiry

Carrió¹

2004

The Annals of Family Medicine

1,102

646

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The biopsychosocial model is both a philosophy of clinical care and a practical clinical guide. Philosophically, it is a way of understanding how suffering, disease, and illness are affected by multiple levels of organization, from the societal to the molecular. At the practical level, it is a way of understanding the patient's subjective experience as an essential contributor to accurate diagnosis, health outcomes, and humane care. In this article, we defend the biopsychosocial model as a necessary contribution to the scientifi c clinical method, while suggesting 3 clarifi cations: (1) the relationship between mental and physical aspects of health is complex-subjective experience depends on but is not reducible to laws of physiology; (2) models of circular causality must be tempered by linear approximations when considering treatment options; and (3) promoting a more participatory clinicianpatient relationship is in keeping with current Western cultural tendencies, but may not be universally accepted. We propose a biopsychosocial-oriented clinical practice whose pillars include (1) self-awareness; (2) active cultivation of trust; (3) an emotional style characterized by empathic curiosity; (4) self-calibration as a way to reduce bias; (5) educating the emotions to assist with diagnosis and forming therapeutic relationships; (6) using informed intuition; and (7) communicating clinical evidence to foster dialogue, not just the mechanical application of protocol. In conclusion, the value of the biopsychosocial model has not been in the discovery of new scientifi c laws, as the term "new paradigm" would suggest, but rather in guiding parsimonious application of medical knowledge to the needs of each patient. GEORGE ENGEL'S LEGACYT he late George Engel believed that to understand and respond adequately to patients' suffering-and to give them a sense of being understood-clinicians must attend simultaneously to the biological, psychological, and social dimensions of illness. He offered a holistic alternative to the prevailing biomedical model that had dominated industrialized societies since the mid-20th century. 1 His new model came to be known as the biopsychosocial model. He formulated his model at a time when science itself was evolving from an exclusively analytic, reductionistic, and specialized endeavor to become more contextual and cross-disciplinary.2-4 Engel did not deny that the mainstream of biomedical research had fostered important advances in medicine, but he criticized its excessively narrow (biomedical) focus for leading clinicians to regard patients as objects and for ignoring the possibility that the subjective experience of the patient was amenable to scientifi c study. Engel championed his ideas not only as a scientifi c proposal, but also as a fundamental ideology that tried to reverse the dehumanization of medicine and disempowerment of patients (Table 1). His model struck a resonant chord with those sectors of the medical profession that wished to bring more empathy and compassion into ...

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Section: Implications For Autonomymentioning

confidence: 99%

The Biopsychosocial Model 25 Years Later: Principles, Practice, and Scientific Inquiry

Carrió¹

2004

The Annals of Family Medicine

1,102

646

View full text Add to dashboard Cite

show abstract

“…[3,4,19,29,38]). Although I cannot go into too much detail here, I want to illustrate my argument that preferences and practice vary significantly among individuals not only because of personal but also because of cultural framings, for example of belonging to a specific ethnic and religious group.…”

Section: Influence Of Socio-cultural Variables On Advance Directivesmentioning

confidence: 99%

“…According to various US American studies, belonging to an ''ethnic group'' is an important factor in explaining significant differences between the attitudes of patients [2,3,9]. For example Mexican-Americans and Korean-Americans participating in the surveys had a significantly greater preference for decisions by family proxies than European-Americans or African-Americans.…”

Section: Influence Of Socio-cultural Variables On Advance Directivesmentioning

confidence: 99%

Interpreting Advance Directives: Ethical Considerations of the Interplay Between Personal and Cultural Identity

Schicktanz

2009

Health Care Anal

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In many industrialized countries ethicists and lawyers favour advance directives as a tool to guarantee patient autonomy in end-of-life-decisions. However, most citizens seem reluctant to adopt the practice; the number of patients who have an advance directive is low across most countries. The article discusses the key argument for seeing such documents as an instrument of self-interpretation and life-planning, which ultimately have to be interpreted by third parties as well. Interpretation by third parties and the process of self-reflection are conceptually linked by a qualitative concept of identity. Identity is conceived here as constructed in a processual dialogue between a personal and a cultural perspective. How the cultural dimension comes into play in understanding the motivation, rejection or content of wished for end-of-lifedecisions, is shown by a brief review of empirical and cultural studies. Understanding advance directives as a culturally embedded tool of self-interpretation should help to overcome urgent moral problems in clinical settings: how to interpret such documents, how to deliberate on the content and on the best form.

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“…Broad culture-specific issues have previously been identified in relation to terminal illness disclosure, breaking bad news, advance planning and locus of decision-making (Searight & Gafford, 2005). Some cultures advocate explicit disclosure of diagnosis and frank planning for end-of-life care (Candib, 2002). Other cultural groups place higher value on family connectedness than on individual autonomy and may value life at all costs over an easy death.…”

Section: Knowledge and Skills Of Culturally Competent Caringmentioning

confidence: 99%

Meeting the End of Life Needs of Older Adults with Intellectual Disabilities

McCallion¹,

McCarron²,

Fahey-McCarthy³

et al. 2012

Contemporary and Innovative Practice in Palliative Care

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Truth telling and advance planning at the end of life: Problems with autonomy in a multicultural world.

Cited by 92 publications

References 59 publications

The Biopsychosocial Model 25 Years Later: Principles, Practice, and Scientific Inquiry

The Biopsychosocial Model 25 Years Later: Principles, Practice, and Scientific Inquiry

Interpreting Advance Directives: Ethical Considerations of the Interplay Between Personal and Cultural Identity

Meeting the End of Life Needs of Older Adults with Intellectual Disabilities

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