Countertransference and ethics: A perspective on clinical dilemmas in end-of-life decisions

2003 ◽  
Vol 1 (4) ◽  
pp. 367-375 ◽  
Author(s):  
BRIAN J. KELLY ◽  
FRANCIS T. VARGHESE ◽  
DAN PELUSI
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Assisted Suicide ◽  
Clinical Decision Making ◽  
Ethical Dilemmas ◽  
Clinical Decision ◽  
Life Care ◽  
End Of Life Decisions ◽  
The Relationship ◽  
Dying Patient

Ethical dilemmas in end-of-life care, such as the request for assisted suicide, must be understood in the context of the relationship that exists between patients and the clinicians treating them. This context includes the way health professionals respond to the tasks in caring for a dying patient. This article reviews the literature exploring the factors the influence clinical decision making at the end of life. The interplay of ethics, countertransference and transference are explained in detail.

scholarly journals The study protocol of: ‘Initiating end of life care in stroke: clinical decision-making around prognosis’

2014 ◽  
Vol 13 (1) ◽  
Author(s):  
Christopher R Burton ◽  
Sheila Payne ◽  
Mary Turner ◽  
Tracey Bucknall ◽  
Jo Rycroft-Malone ◽  
...  
Keyword(s):  
Decision Making ◽  
End Of Life ◽  
Study Protocol ◽  
End Of Life Care ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Life Care

scholarly journals Ethical considerations at the end-of-life care

2021 ◽  
Vol 9 ◽  
pp. 205031212110009
Author(s):  
Melahat Akdeniz ◽  
Bülent Yardımcı ◽  
Ethem Kavukcu
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Assisted Suicide ◽  
Healthcare Professionals ◽  
Ethical Decision Making ◽  
Biomedical Ethics ◽  
Artificial Nutrition ◽  
Life Care ◽  
Ethical Challenges ◽  
Physician Assisted Suicide

The goal of end-of-life care for dying patients is to prevent or relieve suffering as much as possible while respecting the patients’ desires. However, physicians face many ethical challenges in end-of-life care. Since the decisions to be made may concern patients’ family members and society as well as the patients, it is important to protect the rights, dignity, and vigor of all parties involved in the clinical ethical decision-making process. Understanding the principles underlying biomedical ethics is important for physicians to solve the problems they face in end-of-life care. The main situations that create ethical difficulties for healthcare professionals are the decisions regarding resuscitation, mechanical ventilation, artificial nutrition and hydration, terminal sedation, withholding and withdrawing treatments, euthanasia, and physician-assisted suicide. Five ethical principles guide healthcare professionals in the management of these situations.

scholarly journals Last Place of Care and End-of-Life Quality of Life in the United States: Evidence From a National Representative Data Set

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 17-17
Author(s):  
Yifan Lou ◽  
Nan Jiang ◽  
Katherine Ornstein
Keyword(s):  
Quality Of Life ◽  
Older Adults ◽  
End Of Life ◽  
End Of Life Care ◽  
The United States ◽  
Life Care ◽  
Person Centered Care ◽  
Centered Care ◽  
The Relationship

Abstract Background: Quality of life (QoL) during last stage of life has raised expanded interests as an important aspect of person-centered care. Last place of care (LPC), refer to the last place decedents received their formal end-of-life care (EOLC), has been identified as a key indicator of older adults’ end-of-life QoL, but the relationship was understudied. This study explores the association between LPC and end-of-life QoL among American older adults. Methods: Data used seven waves of Last Month of Life data with a total sample of 3068 Medicare decedents in NHATS. Outcome is end-of-life QoL assessed by eleven measures on four domains: pain and symptoms management (SP), quality of healthcare encounter (HE), person-centered care (PC), and overall quality of care (QC). LPC was categorized into home, hospital, nursing home, and residential hospice. Multivariate logistic regression analyses were used to examine the relationship with covariates. Results: LPC varied by most demographic characteristics, except immigration status and education. Older adults whose LPC is hospital, compared to those who had home-care, were less likely to have great experiences on HE, PC, and QC. People dying at nursing homes are more likely to receive care meeting their dyspnea and spiritual needs. Residential hospice is negatively related to respected care, clear coordination, and keeping family informed, but are more likely to provide PS and spiritual care. Discussion: Home-based end-of-life care has certain advantages but still has room to improve on SP and religious concerns. Hospitals should keep reforming their service delivery structure to improve patients’ QoL.

Is Presence Always Complicity? An Analysis of Presence, Its Moral Objects, and Scandal in Proximity to Physician-Assisted Suicide and Euthanasia

2021 ◽  
Vol 82 (3) ◽  
pp. 487-508
Author(s):  
Daniel Fleming
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Assisted Suicide ◽  
Moral Action ◽  
Theological Ethics ◽  
Life Care ◽  
Physician Assisted Suicide ◽  
Recent Letter ◽  
Action Intention ◽  
Catholic Theological

Catholic chaplains and clinicians who exercise their vocations in contexts wherein physician-assisted suicide and euthanasia (PAS-E) are legal may need to confront the difficult question of whether or not their presence in proximity to these acts and the processes that govern them is consistent with Catholic ethics. Debate on this question to date has focused on complicit presence and scandal. Drawing on Catholic theological ethics and the vision for end-of-life care espoused in the Congregation for the Doctrine of the Faith’s recent letter, Samaritanus Bonus, I argue that some forms of presence in proximity to PAS-E are ethically justifiable. Core to this argument are the three elements of moral action: intention, object, and circumstance, alongside efforts to mitigate the risk of scandal informed by the teaching of Aquinas.

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