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

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

A good death

2016 ◽  
Vol 24 (1) ◽  
pp. 9-19 ◽  
Author(s):  
Judith L Hold
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Ethical Dilemmas ◽  
Good Death ◽  
Ethical Review ◽  
Life Care ◽  
Hospice Nurses ◽  
Institutional Review ◽  
Purposeful Sampling ◽  
Ethical Conflicts

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.

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

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.

What is a good death? A critical discourse policy analysis

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.

Integrating care when the end is near: Ethical dilemmas in end-of-life care.

2013 ◽  
Vol 31 (1) ◽  
pp. 75-83 ◽  
Author(s):  
Tziporah Rosenberg ◽  
Jenny Speice
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Ethical Dilemmas ◽  
Life Care

A Qualitative Metasynthesis From Nurses' Perspective When Dealing With Ethical Dilemmas and Ethical Problems in End-of-Life Care

2015 ◽  
Vol 19 (1) ◽  
pp. 40-48 ◽  
Author(s):  
Margareta Karlsson ◽  
Ingela Berggren ◽  
Anne Kasén ◽  
Carola Wärnå-Furu ◽  
Maud Söderlund
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Ethical Dilemmas ◽  
Life Care ◽  
Ethical Problems

scholarly journals Making good death more accessible: end-of-life care in the intensive care unit

2016 ◽  
Vol 42 (8) ◽  
pp. 1258-1260 ◽  
Author(s):  
Anita Ho ◽  
Daniel Fu-Chang Tsai
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Good Death ◽  
Life Care

scholarly journals Dilema Etik dalam Merawat Pasien Terlantar yang Menjelang Ajal di IGD

2017 ◽  
Vol 3 (2) ◽  
pp. 145
Author(s):  
Maria Imaculata Ose
Keyword(s):  
Emergency Department ◽  
End Of Life ◽  
End Of Life Care ◽  
Qualitative Method ◽  
Ethical Dilemmas ◽  
Life Care ◽  
Interpretive Phenomenology ◽  
Emergency Department Nurses ◽  
Depth Interview ◽  
Research Findings

ABSTRAK Perawat IGD memiliki beban kerja yang lebih tinggi dibandingkan dengan perawat yang berkerja diruang lain. Kepadatan pasien di IGD selain mengupayakan keselamatan pasien, juga mengancam privasi pasien, dan membuat frustasi staf di  IGD. Dilema etik sering dialami oleh perawat IGD dalam merawat pasien terlantar yang berada dalam fase menjelang ajal, namun tidak memiliki identitas. Fokus perawatan yang diberikan pada fase menjelang ajal dikenal dengan istilah End Of Life Care. Ketidakhadiran keluarga untuk mendampingi pasien dan tingginya beban kerja perawat yang tidak seimbang seringkali menyebabkan perawat tidak dapat fokus memberikan pendampingan menyebabkan timbulnya dilema etik. Tujuan penelitian ini adalah untuk mengeksplorasi makna dilema etik perawat dalam merawat pasien terlantar yang menjelang ajal di IGD. Desain penelitian ini  menggunakan metode kualitatif dengan pendekatan fenomenologi interpretif, yang melibatkan 7 orang perawat IGD. Data dikumpulkan melalui indepth interview dan dianalisis secara tematik Braun dan Clark. Hasil penelitian didapatkan bahwa tiga tema yaitu: 1) Menyadari pasien terlantar menjelang ajal bukan prioritas pertama di IGD; 2) Bersikap profesional dan bertanggung Jawab; dan 3) Penerapan kebijakan yang menunjukan respect dan mendukung perawatan pasien terlantar. Kesimpulan: Kehadiran pasien terlantar menimbulkan dilema etik, perawat memaknai walaupun pasien tersebut bukanlah pasien prioritas tetapi harus bersikap professional dan bertanggung jawab. Dengan adanya dukungan dan kebijakan dalam penanganan pasien terlantar penerapan caring dapat tetap diberikan walaupun perawatan End of life care yang diberikan di IGD belum optimal.  ABSTRACT Nurses who work in the emergency department have more workload compared to nurses who come from other departments. In the emergency department, the nurses not only have to struggle for the patients’ safety but they also need to deal with the patients’ privacy which is frustrating. Therefore, the nurses are often faced with many ethical dilemmas especially when they need to take care of homeless patients whose identity are not yet verified. The focus of the treatment is known as the End Of Life Care. The absence of the patients’ family members makes it harder for the nurses to focus on giving an assistance. As a result, ethical dilemmas may arise. The objective of this study, thus, was to explore the meaning of ethical dilemmas faced by the nurses when taking care of the homeless in the emergency department of RSSA Malang. Research design: this research employed a qualitative method using the interpretive phenomenology approach which involved 7 emergency department nurses. Data was collected through in-depth interview and analyzed thematically (Braun and Clark, 2006). Research Findings were categorized into 3 themes that are: 1) Recognizing dormant patients before death is not the first priority in the emergency department; 2) Be professional and responsible; and 3) Implementation of policies that show respect and support the care of abandoned patients. Conclusion: The presence of displaced patients raises ethical dilemma, nurses interpret the patient even though the patient is not a priority but should be professional and responsible. On the other hand with the support and policy in handling these abandoned patients so that the application of caring is given although the care of End of life care provided in the emergency department has not been optimal 

Comparison of Thai older patients’ wishes and nurses’ perceptions regarding end-of-life care

2019 ◽  
Vol 26 (7-8) ◽  
pp. 2006-2015 ◽  
Author(s):  
Manchumad Manjavong ◽  
Varalak Srinonprasert ◽  
Panita Limpawattana ◽  
Jarin Chindaprasirt ◽  
Srivieng Pairojkul ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Older Patients ◽  
Cross Sectional Study ◽  
Self Report ◽  
Good Death ◽  
Life Care ◽  
Cross Sectional ◽  
Adequate Knowledge

Background: Achieving a “good death” is a major goal of palliative care. Nurses play a key role in the end-of-life care of older patients. Understanding the perceptions of both older patients and nurses in this area could help improve care during this period. Objectives: To examine and compare the preferences and perceptions of older patients and nurses with regard to what they feel constitutes a “good death.” Research design: A cross-sectional study. Participants and research context: This study employed a self-report questionnaire that asked about various options for end-of-life care. It was distributed to older patients who attended the outpatient clinic of internal medicine and nurses who worked at two medical schools in Thailand from September 2017 to February 2018. Patients were asked to respond to the questions as if they were terminally ill, and nurses were asked to imagine how older patients would answer the questions. Ethical consideration: Approval from Institutional Review Board was obtained. Findings: A total of 608 patients and 665 nurses responded to the survey. Nurses agreed with concepts of palliative care, but they rated themselves as having poor knowledge. The patient respondents felt that it was most important that they receive the full truth about their illnesses (29.2%). The nurses thought the most important issue was relief of uncomfortable symptoms (25.2%). On seven out of the 13 questions, nurses overestimated the importance of the relevant issue to patients and underestimated the importance on one question (p < 0.05). Discussion: Both nurses and older patients signified concepts of palliative care, but nurses felt that they lacked adequate knowledge. Nurses estimated that patients would have positive attitudes toward autonomy and the closure of life affairs to a significantly greater degree than the patient respondents. Conclusions: We recommend that palliative care education be improved and that steps be taken to allow for more effective nurse–patient communication with regard to the patients’ end-of-life wishes.

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