A History of Physician “Truth Telling,” Informed Consent, Legal and Religious Perspectives on End-of-Life Care

2019 ◽  
pp. 29-44
Author(s):  
H. Russell Searight
Keyword(s):  
Informed Consent ◽  
End Of Life ◽  
End Of Life Care ◽  
Life Care ◽  
Truth Telling ◽  
Religious Perspectives ◽  
History Of

Reasoning about truth-telling in end-of-life care of patients with acute stroke

2016 ◽  
Vol 24 (1) ◽  
pp. 100-110 ◽  
Author(s):  
Åsa Rejnö ◽  
Gunilla Silfverberg ◽  
Britt-Marie Ternestedt
Keyword(s):  
Acute Stroke ◽  
End Of Life ◽  
End Of Life Care ◽  
Common Morality ◽  
Life Care ◽  
Best Interest ◽  
Truth Telling ◽  
Team Members ◽  
Individual Interviews ◽  
Stroke Team

Background: Ethical problems are a universal phenomenon but rarely researched concerning patients dying from acute stroke. These patients often have a reduced consciousness from stroke onset and thereby lack ability to convey their needs and could be described as ‘incompetent’ decision makers regarding their own care. Objective: The aim of the study was to deepen the understanding of stroke team members’ reasoning about truth-telling in end-of-life care due to acute stroke. Research design: Qualitative study based on individual interviews utilizing combined deductive and inductive content analysis. Participants and research context: A total of 15 stroke team members working in stroke units of two associated county hospitals in western Sweden participated. Ethical considerations: The study was approved by the Regional Ethics Review Board, Gothenburg, Sweden. Findings: The main findings were the team members’ dynamic movement between the categories ‘Truth above all’ and ‘Hide truth to protect’. Honesty was highly valued and considered as a reason for always telling the truth, with the argument of truth as common morality. However, the carers also argued for hiding the truth for different reasons such as not adding extra burden in the sorrow, awaiting a timely moment and not being a messenger of bad news. Withholding truth could both be seen as a way of protecting themselves from difficult conversations and to protect others. Discussion: The results indicate that there are various barriers for truthfulness. Interpreted from a virtue of ethics perspective, withholding of truth might also be seen as an expression of sound judgement to put the patient’s best interest first. Conclusion: The carers may need support in the form of supervision to be given space to reflect on their experience and thereby promote ethically justified care. Here, the multi-professional team can be of great value and contribute through inter-professional sharing of knowledge.

Respecting and Promoting Patient Autonomy in Research, End-of-Life Care, and Chronic Illness Care

2016 ◽  
Author(s):  
Mark D. Sullivan
Keyword(s):  
Informed Consent ◽  
Chronic Illness ◽  
Clinical Research ◽  
End Of Life ◽  
End Of Life Care ◽  
Patient Autonomy ◽  
Chronic Illness Care ◽  
Life Care ◽  
General Ability ◽  
A Value

Bioethics teaches us to respect patients as persons by respecting their decisional autonomy. We respect patient autonomy by seeking patients’ informed consent, a policy was first developed for clinical research, where it has worked reasonably well. In other areas, most notably end-of-life care, it has not worked as well. Respecting patient autonomy is not adequate respect for them as ill persons. Rather than opposing physician beneficence and patient autonomy, as is customary in bioethics, we should consider the promotion of patient autonomy as a part of physician beneficence. This recasts the conflict between beneficence and autonomy as the conflict between respecting and promoting patient autonomy. This autonomy needs to be understood not just as the ability to make decisions but also as the general ability to do and be things of value (i.e. agency). This autonomy is not just a value that qualifies care, but is a goal of care.

Comfort while Dying: a Transnational History of Pediatric End of Life Care

2018 ◽  
Author(s):  
Emilie Hill-Smith
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Hospice Care ◽  
Well Being ◽  
Life Care ◽  
The Public ◽  
Depth Analysis ◽  
Personal Experiences ◽  
History Of ◽  
Being There

Through an in-depth analysis of current and historical literature, this thesis explores the question: what is hospice and end of life care for children? I will dissect the various dimensions of children’s hospice care and how it has evolved over time. Also in my thesis, I will draw from my personal experiences in volunteering at a children’s hospice to discuss the support and care that volunteers receive. Through this literature review I hope to bring to light to a subject that is often overlooked or too difficult for people to discuss. I will propose plans to better the care for children and families who are facing the end of life. My thesis will summarize the current literature available about the type of care that children receive worldwide and how this care affects families and children’s well-being. There has been minimal research done on children in end of life due to the topic’s sensitive nature. My goals is to inform the public of an under discussed but important topic in paediatric medicine.

Strengthening End-of-Life Care for African-American Patients and Families through Education and Community Outreach

2013 ◽  
Vol 67 (1-2) ◽  
pp. 115-119 ◽  
Author(s):  
Eric C. Holmstrom
Keyword(s):  
African American ◽  
End Of Life ◽  
Healthcare System ◽  
End Of Life Care ◽  
Effective Means ◽  
Healthcare Providers ◽  
Community Outreach ◽  
Life Care ◽  
Unique Challenge ◽  
History Of

Care for African-American patients and families at the end of life presents a unique challenge to healthcare providers. Providers need to be culturally and historically competent to effectively serve persons with a long history of distrust of the white-dominated healthcare system. Effective means of addressing outreach, access, and service issues for this community need to be twofold. They must focus on those who deliver the care and those who receive it. This twofold focus inspired the education and community outreach that were key elements in this ACE Project. The resources of the Duke Institute on Care at the End of Life (ICEOL), particularly their APPEAL curriculum, was key to strengthening end-of-life care in the internal culture of Abington Memorial Hospital and the community they serve.

Seventh-Day Adventists and Care for the Newborn

2019 ◽  
pp. 213-232
Author(s):  
Gerald R. Winslow
Keyword(s):  
Health Care ◽  
Intensive Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Neonatal Intensive Care ◽  
Family Members ◽  
Newborn Infants ◽  
Life Care ◽  
Freedom Of Conscience ◽  
History Of

As a practical expression of their faith, Seventh-day Adventists have established healthcare institutions, including facilities for the intensive care of newborn infants. This chapter provides a brief history of Adventist engagement in health care and seeks to explain how core Adventist convictions provide the motivation for providing such care and shape the way it is given. The chapter also describes how Adventist beliefs may affect the ways in which Adventists or their family members receive health care. This includes beliefs in divine creation, human wholeness, freedom of conscience, spiritual commitment to health, and worldwide mission. Adventists believe that, by the Creator’s design, each person is a spiritual and physical unity. Using the example of a specific case of neonatal intensive care, the chapter explores how Adventist convictions are likely to support and inform caregiving and care receiving. Also described are Adventist principles for end-of-life care.

Advanced and End-of-Life Care

Almost Over ◽  
2020 ◽  
pp. 85-120
Author(s):  
F. M. Kamm
Keyword(s):  
Informed Consent ◽  
Best Practices ◽  
End Of Life ◽  
End Of Life Care ◽  
General Public ◽  
Assisted Suicide ◽  
Good Life ◽  
Framing Effects ◽  
Life Care

Chapter 4 considers proposals for advanced and end-of-life care and for helping the general public make decisions about such care. Possible conflicts are identified between the aim of respecting people’s preferences and meeting objective standards of best practices, satisfying family preferences, and meeting requirements of informed consent. The chapter considers in detail questions suggested for conversations about advanced and end of life care. It locates imprecision, nudging, and framing effects in those questions that may interfere with their correctly eliciting people’s preferences. It also suggests that there may be attempts to promote specific values and goals favored by end-of-life care professionals, such as peacefulness and avoiding invasive treatments. The possible connection between the aim of a good life to the end and the use of assisted suicide is also examined.

Important aspects of end-of-life care. Survey of patients visiting the primary care office

2011 ◽  
Vol 152 (27) ◽  
pp. 1082-1092 ◽  
Author(s):  
Ágnes Csikós ◽  
Lajos Nagy ◽  
Csilla Busa ◽  
János Kállai
Keyword(s):  
Primary Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Hospice Care ◽  
Psychosocial Support ◽  
Death And Dying ◽  
Life Care ◽  
Truth Telling ◽  
Convenience Sample ◽  
To Receive

Introduction: Death and dying are still taboo topics in Hungary. The care of the dying, the adequate relief of their symptoms and the psychosocial support of both patients and their caregivers are not yet well addressed. Aims: Authors obtained information about the feelings and thoughts of patients on death and dying, and about their expectations for end-of-life care. Methods: Mailed questionnaire was send to a convenience sample of 29 adult primary care offices where a total of 845 unselected patients completed the questionnaire. Results: More than two thirds (69%) of respondents would like to receive end of life care in their home. Only 19% of respondents would prefer to die in a hospital. Respondents’ greatest fear was to lose their autonomy (55%). The second most noted concern was fear from pain (38%). According to 93% of the participants, truth telling is very important in the event of terminal illness. Conclusions: Hungarian patients prefer to receive end of life care in their home. Our data support the need for improvement in three primary areas, physician communication skills, pain and symptom management, and expansion of home hospice care. Orv. Hetil., 2011, 152, 1082–1092.

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