Decision making by health professionals during COVID-19: an integrative review

ABSTRACT Objective: To analyze the scientific production on the decision making of health workers during the COVID-19 pandemic. Methods: Integrative review in the databases CINAHL, MEDLINE, Scopus, ScienceDirect, WoS, and BVS. Inclusion criteria: original articles available in full, in any language, related to the object investigated. Results: During this pandemic, health workers have been making decisions based on ethical/bioethical principles (utility, beneficence, non-maleficence, autonomy, justice, proportionality, flexibility, clinical prognosis, duration of the need, and fair health attention), values (solidarity, equality, equity, utilitarianism, relational autonomy, reliability, reciprocity, maximization of the benefits and resources, and prioritization of those in worse conditions), beliefs and personal motivation, protocols, directives, tools, algorithms, recommendations, and criteria. Final considerations: Decision making has never been so necessary as in this pandemic. This article is not a recipe for the professionals, since decision making is based on numerous factors. However, it provides them with a foundation that can be helpful in this difficult process.

Decadence and relational freedom among China's gay migrants: Subverting heteronormativity by ‘lying flat’

Departing from the prevailing, individualist perspective of freedom, emphasizing individuals’ independence and the maximization of self-interest via unconstrained decision-making, this article applies the concepts of practised freedom and relational autonomy to explore the lived experience of Chinese rural-to-urban migrant gay men. Drawing on our ethnographic fieldwork in the ‘urban villages’ (城中村) of South China, we examine the ways in which rural migrant gay men achieve a sense of freedom, which is dependent on rural-to-urban migration, informal manufacturing jobs, and other queer peers, thus demonstrating a certain level of relational autonomy. Our article clearly shows how these men have come to identify as homeless guabi (挂逼, local slang for those who suffer a tragic and mysterious fate) and spend their days wandering, with no interest in stable work or long-term monogamous relationships. Our research offers a first-hand anthropological account of young adults from the rural working classes who prefer to ‘lie flat’ (躺平) – they refuse to strive for upward social mobility because they believe that upward social mobility is unattainable and a factory job too taxing.

Experiences of influencing one's own life when living with working-age dementia

Having opportunities to make decisions and choices regarding one's life is crucial when living with dementia. This inter-disciplinary study draws on the concept of relational autonomy to explore how working-age people living dementia seek to influence their lives, and what makes it easier or more difficult for them in their everyday life. The data consist of three focus group discussions conducted with 12 retired adults who developed dementia while still employed. The results illuminate various resources that enable a person to (a) handle their difficulties at work and related consequences with dignity, (b) manage everyday tasks and live a fulfilling life, and (c) fight the stigma associated with (working-age) dementia. Challenges related to these aspects reported by the participants reveal gaps and obstacles that impede the full realisation of the rights of people living with early onset dementia. This research highlights the need for workplace education for different stakeholders, equal and ongoing access to guidance and counselling for younger people who live with dementia, and an effort by society as a whole to eradicate stigma.

Relational Autonomy, the Right to Reject Treatment, and Advance Directives in Japan

Although the patient’s right to decide what they want for themselves, which is encompassed in the notion of ‘patient-centred medicine’ and ‘informed consent’, is widely recognised and emphasised in Japan, there remain grave problems when it comes to respecting the wishes of the no-longer-competent when death is imminent. In general, it is believed that the concepts above do not include the right to refuse treatment when treatment withdrawal inevitably results in death, even when the patient previously expressed the wish to exercise this right when competent. In this paper, I first explain the current social and legal situation in Japan, where the lack of legal clarity regarding the right to reject treatment tends to result in doctors adopting the interpretation of patients’ words that is least conducive to treatment withdrawal. I then argue that the right to refuse treatment should be taken seriously, even when the patient is no longer competent, or the treatment refusal will result in death. I suggest that the concept of relational autonomy might have some practical and valuable implications in a country where individual autonomy is considered incompatible with societal values. Finally, I answer possible objections to relational autonomy and address the widespread societal concern about sliding down the slippery slope from allowing the right to refuse treatment to the obligation to die.