Àgbájọ Ọwọ́ : An African Moral Theory of Survival in the Age of Covid-19

This paper examines some of the moral questions surrounding the novel coronavirus, the cause of a new pandemic that just hit the world between late 2019 and early 2020. Coronaviruses are highly contagious and deadly infectious diseases, and victims are urged to do all within their power to ensure that the infection is not spread to healthy people. The central questions involved include the following: why should a person suffer and possibly die alone due to an infection that they must have contracted from someone else? Why should they choose to act ethically in the face of impending death? Why should people who have contracted the disease through no known fault of their own choice to protect others from contracting it? In summary, why should a person who has contracted coronavirus act selflessly? When the cure is eventually discovered, why should knowledge of it be democratized in a capitalist world? These are some of the questions that this paper addresses by juxtaposing Hobbes’ argument that human beings are fundamentally selfish with the African ethical theory of Àgbájọ ọwọ́. The paper argues that the moral theory, which enhances survival is best in the age of the COVID-19 pandemic.

The GP’s perceived role and use of language concerning the existential dimension of palliative patients

Background: Palliative patients have to cope with their disease and impending death. Knowing what this means for a patient is crucial for person-centrered care. Although guidelines state it is a GP core task to explore existential issues of palliative patients, this is not standard practice.Aim: Exploring Dutch GPs’ perceived role regarding addressing the existential dimension of palliative patients, and which vocabulary is used.Design and Setting: Qualitative study among Dutch GPs. Participants were recruited by purposive sampling and snowballing, considering gender, working experience and world view.Method: Semi-structured in-depth interviews were performed, transcribed and analysed using content analysis.Results: Seventeen GPs participated. Three themes were identified: Language, Perceived role and Practice. Interviewees generally saw it as their role to pay attention to the existential dimension of their palliative patients. However, not all knew how to define this role, or how to refer patients with existential struggles to a spiritual counsellor. The multidisciplinary Dutch guideline ‘Existential and Spiritual Aspects of Palliative Care’ seemed largely unknown. Interviewees mostly fulfilled their role in an intuitive, pragmatic way. Questions such as “What does it mean for you to be seriously ill?” or “Do you have support from someone or something?” fitted daily practice.Conclusion: This study emphasizes the importance of basic GP education in exploring existential issues. The coexistence of a professionally obliged attention and an intuitive approach seems to be in conflict. We recommend enhancing collaboration between GPs and spiritual counsellors, appropriate training, and implementation of the relevant guideline on well-known platforms.

End of Life Neuropsychological Impairments and Psychological Care of Persons With Advanced Parkinsonism

Decline in executive functioning, before frank dementia occurs, has been reported in patients with a history of stroke and malignant brain tumors. This may also be true in patients with advanced Parkinson’s disease (PD). In this paper, we summarize the limited research on the motor and cognitive predictors of mortality in advanced PD. We then provide 2 case vignettes of patients with end of life advanced PD who demonstrated a substantial decline in working memory and speech festination. We contrast these patients’ neuropsychological features to a third patient with advanced PD who shows no signs of impending death. Monitoring neuropsychological signs of executive dysfunction, explaining the neuropsychological dysfunctions to the patient and spouse while recognizing the past and retained cognitive competencies of the person is an important component of end of life psychological care. In the context of this type of consultation, the patient may experience an opportunity to communicate their emotional concerns prior to death which further reduces the anxiety associated with death.

Physiology of dying

This chapter discusses the physiological changes that occur in the last weeks and days of life, and how this understanding can help in providing better care for patients and families. Starting in the last months of life with an accelerating course in the last several weeks, patients with advanced illnesses typically develop a characteristic decline in their physical function, nutritional status, respiratory function, and cognition as a result of progressive cancer and acute symptomatic complications. These changes correspond with worsening performance status, anorexia-cachexia, breathlessness, and delirium, which are prognostic factors in patients with advanced illnesses. In the last days of life, other physiological changes involving the neurological, neuromuscular, cardiovascular, and respiratory systems become apparent. The presence of telltale signs such as non-reactive pupils, Cheyne–Stokes breathing, inability to close eyelids, grunting of vocal cords, respiration with mandibular movement, death rattle, drooping of nasolabial fold, pulselessness of radial artery, hyperextension of neck, and decreased urine output significantly increase the likelihood of impending death within 3 days, although the absence of these signs cannot rule out impending death. Physiological monitoring such as vital signs, phase angle, cardiac electrophysiology, and bispectral index may provide further insights into the dying process.

The Elusive Everyday in the Fiction of Marilynne Robinson

Framing Robinson’s fiction within the dynamics of everyday life, this study highlights the tensions of form and content that haunt moments of transcendence in her work. Robinson’s novels, it argues, construct a world that is mimetic as well as symbolic and revelatory. Although the heightened apprehension of the quotidian in Robinson’s novels often registers powerfully and beautifully in representational terms, its aesthetic intensity is enacted at the expense of characters who patrol the margins of the ordinary with unceasing vigilance. Inhabiting the everyday self-consciously, her protagonists perform a forced relationship to the ordinary that seldom relaxes into the natural or the familiar; scarred by grief, illness, aging, and trauma, they inhabit a world of transcendent beauty suffused with the terrifying threat of loss. The signature acts of transfiguration that punctuate Robinson’s narratives originate from and anticipate the inevitability of absence: the death of loved ones (Housekeeping), the impending death of the self (Gilead), the fracture of family (Home), the repetition of trauma and abandonment (Lila), and the prohibition of everyday intimacy in interracial romance (Jack). Highlighting the tensions of the uncomfortable ordinary that disrupt a trajectory of transcendence in her fiction, this book situates Robinson’s novels within sociological, psychological, and phenomenological studies of trauma, grief, aging, race, and gender, as well as narrative theory and everyday life studies. Focusing on the experiential dynamics of the lived worlds her novels invoke, The Elusive Everyday argues for the complexity, relevance, and contemporaneity of Robinson’s fiction.

The “Oceanic Feeling” and Confrontation with Death

Freud’s explanation of Rolland’s “oceanic feeling” is reconsidered in the light of similar phenomena that occur in the face of impending death, such as the experiences described by Socrates in Plato’s Phaedo, and the aesthetic and transformational experiences described by Christopher Bollas. These phenomena are included in what Karl Jaspers calls “ciphers.” Other examples are presented to indicate the need to consider such phenomena in human psychology, phenomena that have been neglected in psychoanalysis due to the profound but arbitrary influence of Freud’s analysis of the “oceanic feeling,” an analysis based on the outmoded rigid assumptions of classical nineteenth-century science.

The Lived Experience of Patients and Family Caregivers in Managing Pneumoconiosis

The daily challenges of patients with pneumoconiosis and their caregivers in living with and providing care for this disease remain unexplored. As guided by the interpretive description, we found that pneumoconiosis patients suffered from highly anxiety-provoking symptoms and physical debilitation, which evoked high levels of distress and sense of impending death. The reduced functional capacity disrupted patients’ role functioning and self-esteem. The perceived stigma of the embarrassing symptoms and treatments further disrupted their self-concept and social lives. Providing care for pneumoconiosis patients was demanding and burdensome, which jeopardized family caregivers’ physical, emotional, and social well-being, and the relationship strain with the patients added further frustration to them. The perceived caregiving gain supported them to fully engage in daily caregiving. To improve the well-being of pneumoconiosis patients, a comprehensive empowerment-based dyadic care model is required to optimize adaptive behavioral changes and self-esteem, and improve self-efficacy in disease management for this cohort.