A good death

Background: On a day to day basis, nurses are facing more ethical dilemmas during end-of-life care resulting in not being able to actualize a good death for patients. Research objective: The purpose of this study was to explore how experienced hospice nurses resolve day to day ethical dilemmas during end-of-life care. Research design: The study used a qualitative narrative approach. Participants: Through purposeful sampling, a total of six experienced hospice nurse participated. Ethical considerations: Approval from the researcher’s university Institutional Review Board for ethical review was obtained. Findings: Using core story creation, several different ethical dilemmas were identified divulging struggles with key stakeholders including family members and providers. Thematic analysis generated three main themes: Ethics within Practice, Ethical Knowledge, and Ethical Solutions. Discussion: The participants told their stories depicting a keen awareness of ethical conflicts situated by contextual factors including social, political, and personal issues. The nurses’ deliberations were informed through formal, experiential, and intuitive knowledge. Ethical predicaments were resolved by either following rules or choosing acts of resistance. Conclusion: A better understanding was obtained on how experienced hospice nurses successfully resolve ethical dilemmas culminating in better deaths for patients.

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Exploring the Ethical Dilemmas in End-of-Life Care and the Concept of a Good Death in Bhutan

Asian Bioethics Review ◽

10.1007/s41649-021-00199-7 ◽

2022 ◽

Author(s):

Thinley Dorji ◽

Nidup Dorji ◽

Kinley Yangdon ◽

Dorji Gyeltshen ◽

Langa Tenzin

Keyword(s):

End Of Life ◽

End Of Life Care ◽

Ethical Dilemmas ◽

Good Death ◽

Life Care

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Ethical challenges during the COVID-19 pandemic: Perspectives of nursing students

Nursing Ethics ◽

10.1177/09697330211030676 ◽

2021 ◽

pp. 096973302110306

Author(s):

Domingo Palacios-Ceña ◽

Juan Francisco Velarde-García ◽

Marta Mas Espejo ◽

Raquel González-Hervías ◽

Beatriz Álvarez-Embarba ◽

...

Keyword(s):

Nursing Students ◽

End Of Life ◽

End Of Life Care ◽

Ethical Dilemmas ◽

Life Care ◽

Ethical Challenges ◽

Structured Interviews ◽

Patient Death ◽

Ethical Conflicts ◽

The Government

Background: The first wave of the COVID-19 pandemic caused a shortage of qualified nurses in Spain. As a result, the government authorized the hiring of senior students. Objectives: To explore the ethical dilemmas and ethical conflicts experienced by final-year nursing students who worked during the first outbreak of the COVID-19 pandemic in Spain. Research design: A qualitative exploratory study was conducted using purposive sampling. Semi-structured interviews were carried out using a question guide. Interviews took place via a private video chat room platform. A thematic, inductive analysis was performed of the information gathered. Participants and research context: Eighteen nursing students were recruited from two universities of Madrid, aged between 18 and 65 years old, enrolled in the fourth year of nursing studies and who were hired under a relief contract for health professionals during the pandemic. Ethical considerations: The present study was carried out in accordance with the Declaration of Helsinki, and the study was approved by the Local Ethics Committee of Universidad Rey Juan Carlos. Results: Three specific themes emerged: (a) coping with patient triage, (b) difficulties in providing end-of-life care, and (c) coping with patient death. Nursing students participated in the process of patient selection for resource allocation and ICU bed occupancy. They were shown how to care for patients who were not admitted to the ICU, in their last moments and were faced with the difficulties of applying end-of-life care. Finally, the nursing students were confronted with the death of their patients, in overwhelming numbers and under adverse conditions. Conclusions: These findings can help shed light on the ethical dilemmas and ethical conflicts faced by novice nursing students, incorporated into the workforce during the COVID-19 pandemic. Moreover, it was described that students may normalize the death due to the exhaustion and overwhelmed routine.

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End of life care in chronic obstructive pulmonary disease: in search of a good death

International Journal of Chronic Obstructive Pulmonary Disease ◽

10.2147/copd.s698 ◽

2008 ◽

Vol Volume 3 ◽

pp. 11-29 ◽

Cited By ~ 25

Author(s):

Sara Booth

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

End Of Life ◽

Pulmonary Disease ◽

End Of Life Care ◽

Good Death ◽

Chronic Obstructive ◽

Life Care ◽

Obstructive Pulmonary Disease

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When Conscience Wavers. Some Reflections on the Normalization of Euthanasia in Belgium

Euthanasia: Searching for the Full Story ◽

10.1007/978-3-030-56795-8_3 ◽

2021 ◽

pp. 25-37

Author(s):

Willem Lemmens

Keyword(s):

End Of Life ◽

End Of Life Care ◽

Psychiatric Patients ◽

Therapeutic Option ◽

Good Death ◽

Life Care ◽

Philosophical Perspective ◽

Established Fact ◽

The Law

AbstractIn this chapter, I evaluate from a philosophical perspective the ongoing discussions in the Belgian civil society triggered by the euthanasia law and its implementation in end-of-life care since 2002. I challenge the idea that the so-called normalization of euthanasia is an established fact and I contend that the ongoing discussions on the possible abuses of the law and the practice of euthanasia are unavoidable. I see three reasons for this. First, in contrast with what some think, euthanasia can never become a “normal” therapeutic option, that could be integrated in standard medical practice. Euthanasia is, by its very nature, a transgression of a fundamental moral taboo and will thus always, however liberal the law might be, challenge the conscience of some physicians. Secondly, because of its transgressive meaning, every act of euthanasia can always be contested by family members or the larger society. This is the case when euthanasia is given to patients who are not terminally ill (such as psychiatric patients), but also when a physician performs euthanasia in an undignified and negligent way. Thirdly, the very existence of the law puts pressure not only on patients and physicians but also the larger society. By making euthanasia into a symbol of the good death, a whole society loses its sensitivity for the intrinsic transgressive nature of euthanasia and creates all sorts of strategies to mask the wavering of conscience that results from this collective negligence. There is no way, so I conclude, to avoid this. The wavering of conscience will continue to haunt the end-of-life care in Belgium as long as the law on euthanasia remains as it is.

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What is a good death? A critical discourse policy analysis

BMJ Supportive & Palliative Care ◽

10.1136/bmjspcare-2019-002173 ◽

2020 ◽

pp. bmjspcare-2019-002173

Author(s):

Erica Borgstrom

Keyword(s):

Discourse Analysis ◽

Critical Discourse Analysis ◽

End Of Life ◽

End Of Life Care ◽

Critical Discourse ◽

Good Death ◽

Complex Nature ◽

Life Care ◽

Advance Care ◽

Motivating Factor

ObjectiveThe concept of a good death is a motivating factor for end of life care policy; this article examines what English end-of-life care (EOLC) policy defines as a good death.MethodsCritical discourse analysis of policy documents and policy-promoting materials published between 2008 and 2016.ResultsPolicy explicitly defines a good death as having the following attributes: being treated as an individual, with dignity and respect; being without pain and other symptoms; being in familiar surroundings and being in the company of close family and/or friends. Critical discourse analysis of 54 documents found that rather than just being an outcome or event, descriptions of what makes a death good also include many processes. A more extended definition includes: the person receives holistic EOLC; the dying person is treated with dignity and respect; the death is not sudden and unexpected; people are prepared and have ideally done some advance care planning; people are aware that someone is dying and openly discuss this; on knowing the dying person’s preferences, all involved are to work towards achieving these; the place of death is important; the person’s family are involved and the needs of the bereaved are considered.ConclusionThis analysis indicates the complex nature of the current discourses around good death in EOLC policy, which often focuses on care rather than death. Policy should focus on outlining what quality end-of-life care looks like, rather than assume ‘good death’ is a suitable outcome statement.

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