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Yeoh LH, Tan B, Rhee J, Sinclair C. Attitudes and Perceptions on Advance Care Planning Among Chinese-Speaking Older Australians. Am J Hosp Palliat Care 2024; 41:814-823. [PMID: 37658638 PMCID: PMC11070119 DOI: 10.1177/10499091231200366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/03/2023] Open
Abstract
BACKGROUND Current literature indicates low uptake of advance care planning (ACP) among the Chinese-speaking community in Australia. To increase the uptake of ACP among the Chinese-speaking community, a better understanding of their attitudes and perceptions on end-of-life (EOL) matters, and ACP is required. OBJECTIVE This study aimed to identify significant events and social and cultural factors that influence participants' values and characterize the attitudes and perceptions towards ACP among older Chinese-speaking Australians. METHODS A qualitative study explored participants' experiences through semi-structured one-to-one interviews. The interviews were conducted in Mandarin, Cantonese or English, then translated and transcribed into English. The transcripts were coded and analysed thematically. RESULTS Twenty participants were recruited (14 female, six male). Participants typically reported a preference to make health-related decisions autonomously. Their perspectives were grounded in past experiences of illnesses and EOL decision-making of loved ones, personal values, and perceived needs. Family dynamics and intimacy of relationships appeared to influence the role and responsibility of family members in EOL decision-making and ACP. Most participants perceived the need to engage in ACP only when encountering significant health changes or higher care needs. CONCLUSION Healthcare professionals should initiate ACP discussion using culturally appropriate communication with consideration of personal values, past experiences and family dynamics. Efforts should be invested in raising public awareness of ACP within the Chinese-Australian community.
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Affiliation(s)
- Ling H. Yeoh
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Benjamin Tan
- School of Nursing, Faculty of Health, Charles Darwin University, Darwin, NT, Australia
| | - Joel Rhee
- School of Population Health, University of New South Wales, Sydney, NSW, Australia
| | - Craig Sinclair
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
- Neuroscience Research Australia, Sydney, NSW, Australia
- UNSW Ageing Futures Institute, Sydney, NSW, Australia
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2
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Björk J. "It is very hard to just accept this" - a qualitative study of palliative care teams' ethical reasoning when patients do not want information. BMC Palliat Care 2024; 23:91. [PMID: 38575905 PMCID: PMC10996159 DOI: 10.1186/s12904-024-01412-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 03/15/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND The aim of this study was to explore how palliative care staff reason about the autonomy challenge that arises when a patient who has first said he wants full information appears to change his mind and rejects being informed. METHODS The study had a qualitative and exploratory design. Participants (physicians, registred nurses, social workers, physiotherapists and occupational therapists) were recruited from palliative care teams in southern Sweden. Six separate focus group interviews with a total number of 33 participants were conducted. The teams were asked to discuss a fictional case of a man who first wants, then rejects, information about his situation. The interviews were audiotaped and transcribed verbatim. Reflexive thematic analysis following Braun and Clarke was undertaken to analyse data. RESULTS The analysis resulted in three themes: Patients have a right to reject information, Questioning whether this patient WANTS to reject information and There are other values at stake, too. Although participants endorsed a right to reject information, they were unsure whether this right was relevant in this situation, and furthermore felt that it should be balanced against counteracting factors. The effect of such balancing was that participants would aim to find a way to present relevant information to the patient, but in a probing and flexible way. CONCLUSIONS In their work with dying patients, palliative care staff meet many autonomy challenges. When faced with a choice to withhold information as per a patient's wishes, or to provide information with the patient's best interest in mind, staff find it hard to balance competing values. Staff also find it hard to balance their own interests against a purely professional stance. The overall strategy seems to be to look for caring ways to impart the information.
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Affiliation(s)
- Joar Björk
- Centre for Research Ethics and Bioethics (CRB), Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
- Department of Research and Development, Region Kronoberg, Växjö, Sweden.
- Stockholm Centre for Healthcare Ethics (CHE), LIME, Karolinska Institutet, Stockholm, Sweden.
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3
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Zhou X. Care in transition: Global norms, transnational adaptation, and family-centered gender-affirming care in China. Soc Sci Med 2024; 344:116658. [PMID: 38359525 DOI: 10.1016/j.socscimed.2024.116658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 01/11/2024] [Accepted: 02/05/2024] [Indexed: 02/17/2024]
Abstract
In recent years, trans medicine has increasingly shifted towards gender-affirming care, focusing on assisting transgender people in finding safe and effective ways to support their gender identity. Through standards of care, clinical guidelines, and classification systems, international experts have established global norms with profound downstream implications. However, how local providers respond to these new norms remains underexplored. Drawing on ethnographic work in clinical settings, conferences, and 30 in-depth interviews with healthcare providers, I argue that family-centered gender-affirming care has emerged in China as providers strive to balance global ideals of "good" trans medicine with the constraints of the local healthcare system. While international standards assist providers in adopting a less pathologizing and binary view of care, they provide limited practical guidance for navigating local social and institutional challenges. Faced with a lack of legal and institutional support, providers increasingly rely on family members' involvement to mitigate medical dispute risks. This reliance manifests in two forms: restrictive gatekeeping, where care is delayed or denied based on family members' attitudes and providers' assessment of transgender adults' ability to lead a "normal life," and affective gatekeeping, where providers use psychological support and gender diversity education to involve family members as caregivers. These findings enrich sociological studies in global health by illustrating how the interactions between global norms and local healthcare systems can both alleviate and reproduce barriers to care.
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Affiliation(s)
- Xiaogao Zhou
- Department of Sociology, The University of Chicago, United States.
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4
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Chen W, Zhang H, Xu M, Huang R. Differences in shared decision-making: the East-West divide. BMJ Evid Based Med 2023:bmjebm-2023-112451. [PMID: 37940418 DOI: 10.1136/bmjebm-2023-112451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/20/2023] [Indexed: 11/10/2023]
Affiliation(s)
- Weihua Chen
- Deparment of Cardiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Huangruowen Zhang
- College of Biology Science, University of California Davis, Davis, California, USA
| | - Mingyue Xu
- Department of Geriatrics, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Rongchong Huang
- Deparment of Cardiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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Manrique de Lara A, Colmenares-Roa T, Pascual-Ramos V, Moctezuma-Rios JF, Contreras-Yañez I, Guaracha-Basañez GA, Álvarez-Hernández E, Meza-López Y Olguín G, Peláez-Ballestas I. Sociocultural and moral narratives influencing the decision to vaccinate among rheumatic disease patients: a qualitative study. Clin Rheumatol 2023:10.1007/s10067-023-06609-5. [PMID: 37129776 PMCID: PMC10152007 DOI: 10.1007/s10067-023-06609-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 04/16/2023] [Accepted: 04/21/2023] [Indexed: 05/03/2023]
Abstract
INTRODUCTION/OBJECTIVES Vaccination is a process that involves individual, social, and ethical aspects, beyond public governance of vaccines or vaccination as a public health concern. The aim of this study is to describe the sociocultural and moral narratives that influence the decision to vaccinate in general and to vaccinate against COVID-19 specifically, among patients at the rheumatology units of two hospitals. METHODS Qualitative study involving individual semi-structured interviews following an interview guide. We conducted a thematic analysis using the ATLAS.ti software, with further triangulation to verify concordance and aid in the interpretation of the data from a medical anthropology framework and using a narrative ethics approach to gain insight into the participants' underlying moral values. RESULTS We interviewed 37 patients in total, along with 3 rheumatologists. Five core themes emerged from the analysis to understand the decision to vaccinate: (1) information about vaccines and disease, (2) perceived risk-benefit of vaccination, (3) the physician-patient relationship, (4) governance of vaccination programs, (5) attitudes towards vaccines. Individual and family experiences with vaccination are diverse depending on the type of vaccine. The COVID-19 vaccine, as a new medical technology, is met with more controversy leading to hesitancy. CONCLUSIONS The decision to vaccinate among Mexican rheumatic disease patients can sometimes involve doubt and distrust, especially for those with a lupus diagnosis, but ultimately there is acceptance in most cases. Though patients make and value autonomous decisions, there is a collective process involving sociocultural and ethical aspects. Key points • The complexity of vaccine decision-making is better identified through a narrative, qualitative approach like the one used in this study, as opposed to solely quantitative approaches • Sociocultural and moral perspectives of vaccination shape decision-making and, therefore, highlight the importance of including patients in the development of effective clinical practice guidelines as well as ethically justified public policy • Sociohistorical context and personal experiences of immunization influence vaccine decision-making much more than access to biomedical information about vaccines, showing that approaches based on the information deficit model are inadequate to fight vaccine hesitancy.
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Affiliation(s)
| | | | - Virgina Pascual-Ramos
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas Y Nutrición Salvador Zubirán, Mexico City, México
| | | | - Irazú Contreras-Yañez
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas Y Nutrición Salvador Zubirán, Mexico City, México
| | | | | | | | - Ingris Peláez-Ballestas
- Hospital General de Mexico "Dr. Eduardo Liceaga", Mexico City, México.
- Rheumatology Unit, Hospital General de Mexico "Dr. Eduardo Liceaga", Mexico City, México.
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Li S, Xie J, Chen Z, Yan J, Zhao Y, Cong Y, Zhao B, Zhang H, Ge H, Ma Q, Shen N. Key elements and checklist of shared decision-making conversation on life-sustaining treatment in emergency: a multispecialty study from China. World J Emerg Med 2023; 14:380-385. [PMID: 37908803 PMCID: PMC10613793 DOI: 10.5847/wjem.j.1920-8642.2023.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 06/20/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND Shared decision-making (SDM) has broad application in emergencies. Most published studies have focused on SDM for a certain disease or expert opinions on future research gaps without revealing the full picture or detailed guidance for clinical practice. This study is to investigate the optimal application of SDM to guide life-sustaining treatment (LST) in emergencies. METHODS This study was a prospective two-round Delphi consensus-seeking survey among multiple stakeholders at the China Consortium of Elite Teaching Hospitals for Residency Education. Participants were identified based on their expertise in medicine, law, administration, medical education, or patient advocacy. All individual items and questions in the questionnaire were scored using a 5-point Likert scale, with responses ranging from "very unimportant" (a score of 1) to "extremely important" (a score of 5). The percentages of the responses that had scores of 4-5 on the 5-point Likert scale were calculated. A Kendall's W coefficient was calculated to evaluate the consensus of experts. RESULTS A two-level framework consisting of 4 domains and 22 items as well as a ready-to-use checklist for the informed consent process for LST was established. An acceptable Kendall's W coefficient was achieved. CONCLUSION A consensus-based framework supporting SDM during LST in an emergency department can inform the implementation of guidelines for clinical interventions, research studies, medical education, and policy initiatives.
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Affiliation(s)
- Shu Li
- Department of Emergency Medicine, Peking University Third Hospital, Beijing 100191, China
| | - Jing Xie
- Department of Infectious Diseases, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Ziyi Chen
- Department of Neurology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
| | - Jie Yan
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing 100034, China
| | - Yuliang Zhao
- Department of Nephrology, West China Hospital, West China School of Medicine, Chengdu 610041, China
| | - Yali Cong
- Institute of Medical Humanities, School of Foundational Education, Peking University Health Science Center, Beijing 100191, China
| | - Bin Zhao
- Department of Emergency Medicine, Beijing Jishuitan Hospital, Fourth Medical College of Peking University, Beijing 100035, China
| | - Hua Zhang
- Clinical Epidemiology Research Center, Peking University Third Hospital, Beijing 100191, China
| | - Hongxia Ge
- Department of Emergency Medicine, Peking University Third Hospital, Beijing 100191, China
| | - Qingbian Ma
- Department of Emergency Medicine, Peking University Third Hospital, Beijing 100191, China
| | - Ning Shen
- Department of Pulmonary and Critical Care Medicine, Peking University Third Hospital, Beijing 100191, China
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Qin S, Sheehan L, Yau E, Chen Y, Wang Y, Deng H, Lam C, Chen Z, Zhao L, Gan S, Mao H, Mo X, Yang L, Zhang F, Corrigan P. Adapting and Evaluating a Strategic Disclosure Program to Address Mental Health Stigma Among Chinese. Int J Ment Health Addict 2022. [DOI: 10.1007/s11469-022-00911-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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8
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Choi HR, Rodgers S, Tocher J, Kang SW. Nurse's, physician's and family member's experiences of withholding or withdrawing life-sustaining treatment process in an intensive care unit. J Clin Nurs 2022. [PMID: 36217241 DOI: 10.1111/jocn.16556] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 08/31/2022] [Accepted: 09/26/2022] [Indexed: 11/29/2022]
Abstract
AIMS To explore nurse's, physician's and family member's experiences of withholding or withdrawing life-sustaining treatment in an intensive care unit. BACKGROUND In South Korea, withholding or withdrawing life-sustaining treatment is legalised by the enforcement of the Hospice, Palliative Care and Life-sustaining Treatment Decision-making Act (2018). The Act (2018) is the first legal ground for making decisions regarding life-sustaining treatment in South Korea. DESIGN Focused ethnography. The standards for reporting qualitative research checklist is used. METHODS Interview data are collected between August 2018 and January 2019 using semi-structured interviews with 23 nurses, 10 physicians and four family members in a South Korean intensive care unit. The interview data are analysed following the thematic analysis of Braun and Clarke. RESULTS An overarching theme of 'constructing death' is identified from the experiences of nurses, physicians and family members regarding withholding or withdrawing life-sustaining treatment in a South Korean intensive care unit. Family members had the strongest power in the withholding or withdrawing life-sustaining treatment process whilst the process had to be based on medical consideration. All the research participants shared the purpose and motivation of withholding or withdrawing life-sustaining treatment as the dying patient's dignity. Due to the South Korean national health insurance system, the relationships between medical staff and family members were driven by customer ideology. CONCLUSION The impact and linkage of the context of familism culture and health insurance with the process of withholding or withdrawing life-sustaining treatment in South Korea are shown in this research. The findings of this research inspire future studies to uncover the impact of the cultural context in the decision-making process of a patient's death, to explore the dynamics of family members under cultural values and to explore the influence of the healthcare system and medical costs on the relationships between medical staff and family members. RELEVANCE TO CLINICAL PRACTICE By integrating the experiences of nurses, physicians and family members, the findings of this study inform the shared values in the context of familism culture and the health insurance system. In particular, understanding family dynamics when a patient's dying and death as a result of withholding or withdrawing life-sustaining treatment informs nurses to provide quality of care in the intensive care setting. Therefore, the findings of this research contribute to distinguishing the priority in care when withholding or withdrawing life-sustaining treatment, rapidly changing the aims of care from the patient's recovery to a dignified death.
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Affiliation(s)
- Hye Ri Choi
- School of Nursing, University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Sheila Rodgers
- Nursing Studies, University of Edinburgh, Edinburgh, United Kingdom
| | - Jennifer Tocher
- Nursing Studies, University of Edinburgh, Edinburgh, United Kingdom
| | - Sung Wook Kang
- Department of Pulmonary and Critical Care Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Korea
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9
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Chen RY, Li YC, Hsueh KC, Wang FW, Chen HJ, Huang TY. Factors influencing terminal cancer patients' autonomous DNR decision: a longitudinal statutory document and clinical database study. BMC Palliat Care 2022; 21:149. [PMID: 36028830 PMCID: PMC9419392 DOI: 10.1186/s12904-022-01037-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 08/02/2022] [Indexed: 11/30/2022] Open
Abstract
Objective Much of our knowledge of patient autonomy of DNR (do-not-resuscitate) is derived from the cross-sectional questionnaire surveys. Using signatures on statutory documents and medical records, we analyzed longitudinal data to understand the fact of terminal cancer patients’ autonomous DNR decision-making in Taiwan. Methods Using the medical information system database of one public medical center in Taiwan, we identified hospitalized cancer patients who died between Jan. 2017 and Dec. 2018, collected their demographic and clinical course data and records of their statutory DNR document types, letter of intent (DNR-LOI) signed by the patient personally and the consent form signed by their close relatives. Results We identified 1,338 signed DNR documents, 754 (56.35%) being DNR-LOI. Many patients had the first DNR order within their last week of life (40.81%). Signing the DNR-LOI was positively associated with being under the care of a family medicine physician prior to death at last hospitalization and having hospice palliative care and negatively associated with patient age ≥ 65 years, no formal education, having ≥ 3 children, having the first DNR order to death ≤ 29 days, and the last admission in an intensive care unit. Conclusions A substantial proportion of terminal cancer patients did not sign DNR documents by themselves. It indicates they may not know their actual terminal conditions and lose the last chance to grasp time to express their life values and wishes. Medical staff involving cancer patient care may need further education on the legal and ethical issues revolving around patient autonomy and training on communicating end-of-life options with the patients. We suggest proactively discussing DNR decision issues with terminal cancer patients no later than when their estimated survival is close to 1 month.
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Affiliation(s)
- Ru-Yih Chen
- Department of Family Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC.,Department of Business Management, Institute of Health Care Management, National Sun Yat-Sen University, No. 70. Lianhai Rd, Kaohsiung, Taiwan, ROC
| | - Ying-Chun Li
- Department of Business Management, Institute of Health Care Management, National Sun Yat-Sen University, No. 70. Lianhai Rd, Kaohsiung, Taiwan, ROC.
| | - Kuang-Chieh Hsueh
- Department of Family Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
| | - Fu-Wei Wang
- Department of Family Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
| | - Hong-Jhe Chen
- Department of Family Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
| | - Tzu-Ya Huang
- Department of Family Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
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10
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Lim MYH. Patient autonomy in an East-Asian cultural milieu: a critique of the individualism-collectivism model. JOURNAL OF MEDICAL ETHICS 2022:medethics-2022-108123. [PMID: 35672134 DOI: 10.1136/medethics-2022-108123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 05/29/2022] [Indexed: 06/15/2023]
Abstract
The practice of medicine-and especially the patient-doctor relationship-has seen exceptional shifts in ethical standards of care over the past few years, which by and large originate in occidental countries and are then extrapolated worldwide. However, this phenomenon is blind to the fact that an ethical practice of medicine remains hugely dependent on prevailing cultural and societal expectations of the community in which it serves. One model aiming to conceptualise the dichotomous efforts for global standardisation of medical care against differing sociocultural expectations is the individualism-collectivism model, with the 'West' being seen as individualistic and the 'East' being seen as collectivistic. This has been used by many academics to explain differences in approach towards ethical practice on key concepts such as informed consent and patient autonomy. However, I argue that this characterisation is incomplete and lacks nuance into the complexities surrounding cross-cultural ethics in practice, and I propose an alternative model based on the ethics of clinical care in Hong Kong, China. Core ethical principles need not be culture-bound-indeed, their very existence mandates for them to be universal and non-derogable-but instead cultural alignment occurs in the particular implementation of these principles, insofar as they respect the general spirit of contemporary ethical standards.
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Affiliation(s)
- Max Ying Hao Lim
- Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, People's Republic of China
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11
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Zhou S, Ma J, Dong X, Li N, Duan Y, Wang Z, Gao L, Han L, Tu S, Liang Z, Liu F, LaBresh KA, Smith SC, Jin Y, Zheng ZJ. Barriers and enablers in the implementation of a quality improvement program for acute coronary syndromes in hospitals: a qualitative analysis using the consolidated framework for implementation research. Implement Sci 2022; 17:36. [PMID: 35650618 PMCID: PMC9158188 DOI: 10.1186/s13012-022-01207-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 04/27/2022] [Indexed: 11/11/2022] Open
Abstract
Background Ischemic heart disease causes a high disease burden globally and numerous challenges in treatment, particularly in developing countries such as China. The National Chest Pain Centers Program (NCPCP) was launched in China as the first nationwide, hospital-based, comprehensive, continuous quality improvement (QI) program to improve early diagnosis and standardized treatment of acute coronary syndromes (ACS) and improve patients’ clinical outcomes. With implementation and scaling up of the NCPCP, we investigated barriers and enablers in the NCPCP implementation process and provided examples and ideas for overcoming such barriers. Methods We conducted a nationally representative survey in six cities in China. A total of 165 key informant interviewees, including directors and coordinators of chest pain centers (CPCs) in 90 hospitals, participated in semi-structured interviews. The interviews were transcribed verbatim, translated into English, and analyzed in NVivo 12.0. We used the Consolidated Framework for Implementation Research (CFIR) to guide the codes and themes. Results Barriers to NCPCP implementation mainly arose from nine CFIR constructs. Barriers included the complexity of the intervention (complexity), low flexibility of requirements (adaptability), a lack of recognition of chest pain in patients with ACS (patient needs and resources), relatively low government support (external policies and incentives), staff mobility in the emergency department and other related departments (structural characteristics), resistance from related departments (networks and communications), overwhelming tasks for CPC coordinators (compatibility), lack of available resources for regular CPC operations (available resources), and fidelity to and sustainability of intervention implementation (executing). Enablers of intervention implementation were inner motivation for change (intervention sources), evidence strength and quality of intervention, relatively low cost (cost), individual knowledge and beliefs regarding the intervention, pressure from other hospitals (peer pressure), incentives and rewards of the intervention, and involvement of hospital leaders (leadership engagement, engaging). Conclusion Simplifying the intervention to adapt routine tasks for medical staff and optimizing operational mechanisms between the prehospital emergency system and in-hospital treatment system with government support, as well as enhancing emergency awareness among patients with chest pain are critically important to NCPCP implementation. Clarifying and addressing these barriers is key to designing a sustainable QI program for acute cardiovascular diseases in China and similar contexts across developing countries worldwide. Trial registration This study was registered in the Chinese Clinical Trial Registry (ChiCTR 2100043319), registered 10 February 2021. Supplementary Information The online version contains supplementary material available at 10.1186/s13012-022-01207-6.
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Affiliation(s)
- Shuduo Zhou
- Department of Global Health, School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China.,Institute for Global Health and Development, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China
| | - Junxiong Ma
- Department of Global Health, School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China.,Institute for Global Health and Development, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China
| | - Xuejie Dong
- Department of Global Health, School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China.,Institute for Global Health and Development, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China
| | - Na Li
- Department of Global Health, School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China.,Institute for Global Health and Development, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China
| | - Yuqi Duan
- Department of Global Health, School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China.,Institute for Global Health and Development, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China
| | - Zongbin Wang
- Department of Global Health, School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China.,Institute for Global Health and Development, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China
| | - Liqun Gao
- Department of Global Health, School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China.,Institute for Global Health and Development, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China
| | - Lu Han
- Department of Global Health, School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China.,Institute for Global Health and Development, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China
| | - Shu Tu
- Department of Global Health, School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China.,Institute for Global Health and Development, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China
| | - Zhisheng Liang
- Department of Global Health, School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China.,Institute for Global Health and Development, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China
| | - Fangjing Liu
- Department of Global Health, School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China.,Institute for Global Health and Development, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China
| | | | - Sidney C Smith
- Division of Cardiovascular Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Yinzi Jin
- Department of Global Health, School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China. .,Institute for Global Health and Development, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China.
| | - Zhi-Jie Zheng
- Department of Global Health, School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China. .,Institute for Global Health and Development, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China.
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12
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Yu WC, Huang CT, Sheng WH. Application of a pre-emptive question and answer platform to improve the level of satisfaction during family meetings in general medical wards. BMC Health Serv Res 2022; 22:499. [PMID: 35422016 PMCID: PMC9008296 DOI: 10.1186/s12913-022-07929-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 03/31/2022] [Indexed: 12/03/2022] Open
Abstract
Background A successful family meeting is key to family-centered care and may foster communication and improve the level of satisfaction of the family in terms of communication. In this study, we evaluated whether a proactive communication channel could improve the level of satisfaction of family members following a family meeting in a general medical ward setting. Methods We conducted a pre- and post-study to compare the level of satisfaction of a family with a family meeting before (N = 39) and after (N = 29) intervention in two general medical wards of a tertiary-care referral center. The intervention included a pre-emptive question and answer platform and a written response to family-raised queries in addition to a regular setting. Following each family meeting, family members were requested to fill a 10-item survey assessing their levels of satisfaction. Results The characteristics of the family members in terms of demographics, education levels, and previous experiences with family meetings in the pre- and post-intervention groups were similar. The scores in all the items that indicated the level of satisfaction significantly improved after intervention. The overall score for satisfaction increased from 85 (interquartile range, 80–95) to 98 (interquartile range, 93–100; P < 0.001). Conclusions Compared with conventional practice, the inclusion of a proactive communication platform along with a written response to raised queries as a part of family meetings improved the satisfaction levels of the family in terms of the content and process of the meeting in the general ward setting. Further studies are needed to delineate the optimal timing and use of such a communication modality. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07929-z.
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Bhakuni H. Glocalization of bioethics. Glob Bioeth 2022; 33:65-77. [PMID: 35340843 PMCID: PMC8942517 DOI: 10.1080/11287462.2022.2052603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
- Himani Bhakuni
- University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Department of Foundations and Methods of Law, Maastricht University, Maastricht, The Netherlands
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Redinger M. Physician-assisted suicide and euthanasia in India: A call for Asian wisdom. Asian J Psychiatr 2021; 66:102848. [PMID: 34538549 DOI: 10.1016/j.ajp.2021.102848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 09/02/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Michael Redinger
- Western Michigan University Homer Stryker M.D. School of Medicine, 1000 Oakland Drive, Kalamazoo, MI 49048, United States
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Molina-Pérez A, Delgado J, Frunza M, Morgan M, Randhawa G, de Wijdeven JRV, Schicktanz S, Schiks E, Wöhlke S, Rodríguez-Arias D. Should the family have a role in deceased organ donation decision-making? A systematic review of public knowledge and attitudes towards organ procurement policies in Europe. Transplant Rev (Orlando) 2021; 36:100673. [PMID: 34864448 DOI: 10.1016/j.trre.2021.100673] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 11/09/2021] [Accepted: 11/10/2021] [Indexed: 10/19/2022]
Abstract
GOAL To assess public knowledge and attitudes towards the family's role in deceased organ donation in Europe. METHODS A systematic search was conducted in CINHAL, MEDLINE, PAIS Index, Scopus, PsycINFO, and Web of Science on December 15th, 2017. Eligibility criteria were socio-empirical studies conducted in Europe from 2008 to 2017 addressing either knowledge or attitudes by the public towards the consent system, including the involvement of the family in the decision-making process, for post-mortem organ retrieval. Screening and data collection were performed by two or more independent reviewers for each record. RESULTS Of the 1482 results, 467 studies were assessed in full-text form, and 33 were included in this synthesis. When the deceased has not expressed any preference, a majority of the public support the family's role as a surrogate decision-maker. When the deceased expressly consented, the respondents' answers depend on whether they see themselves as potential donors or as a deceased's next-of-kin. Answers also depend on the relationship between the deceased and the decision-maker(s) within the family, and on their ethnic or cultural background. CONCLUSIONS Public views on the authority of the family in organ donation decision-making requiere further research. A common conceptual framework and validated well-designed questionnaires are needed for future studies. The findings should be considered in the development of Government policy and guidance regarding the role of families in deceased organ donation.
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Affiliation(s)
- Alberto Molina-Pérez
- Institute for Advanced Social Studies, Spanish National Research Council, Cordoba, Spain; Public Issues working group, ELPAT-ESOT, Padova, Italy.
| | - Janet Delgado
- Public Issues working group, ELPAT-ESOT, Padova, Italy; Department of Philosophy 1, University of Granada, Granada, Spain
| | - Mihaela Frunza
- Department of Philosophy, Faculty of History and Philosophy, Babes-Bolyai University of Cluj, Cluj, Romania
| | - Myfanwy Morgan
- Institute of Pharmaceutical Science, King's College London, United Kingdom
| | - Gurch Randhawa
- Institute for Health Research, University of Bedfordshire, Luton, England, United Kingdom
| | | | - Silke Schicktanz
- Department of Medical Ethics and History of Medicine, University Medical Center Göttingen, Göttingen, Germany
| | - Eline Schiks
- Department of Policy, Dutch Transplant Foundation, Leiden, the Netherlands
| | - Sabine Wöhlke
- Department of Health Sciences, HAW-Hamburg, Hamburg, Germany
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Lau WYT, Stoner C, Wong GHY, Spector A. New horizons in understanding the experience of Chinese people living with dementia: a positive psychology approach. Age Ageing 2021; 50:1493-1498. [PMID: 34107007 DOI: 10.1093/ageing/afab097] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Indexed: 12/30/2022] Open
Abstract
As the global average age increases, the incidence of dementia is also rising. Given improvements in diagnosis and life expectancies, people now live longer with dementia. Thus, the wellbeing and quality of life among people living with dementia are increasingly important areas for research. Research with Western populations has recently begun to apply positive psychology concepts to understand wellbeing in people with dementia. Positive psychology focuses on positive emotions and traits that allow individuals to flourish and thrive-it highlights the possibility of positive subjective experiences in the face of loss and functional decline, and contrasts the traditional deficit-focused perception of dementia. Despite being a major driver in the global growth of dementia prevalence, there is a dearth of research using such positive concepts to understand people with dementia in non-Western communities. This review contains discussion of research on positive constructs in Chinese older adults, and parallels between traditional Chinese cultural values and positive psychology. On this basis, we propose the applicability of a positive psychology framework to Chinese people with dementia, and that 'harmony' is an important culturally specific concept to consider in this area of research. A positive psychology approach acknowledges that strengths and positive experiences can endure after dementia diagnosis. This not only adds to the under-researched area of lived experience of dementia in Chinese people, but highlights areas that could be the focus of interventions or measured as outcomes. By improving understanding, this approach also has potential to reduce carer burden and stigma around dementia.
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Affiliation(s)
- Wing Yin Tiffany Lau
- Research Department of Clinical, Educational and Health Psychology, University College London, London WC1E 7HB, UK
| | - Charlotte Stoner
- Centre for Chronic Illness and Ageing, School of Human Sciences, University of Greenwich, London SE10 9LS, UK
| | - Gloria Hoi-Yan Wong
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong SAR
| | - Aimee Spector
- Research Department of Clinical, Educational and Health Psychology, University College London, London WC1E 7HB, UK
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Brady SS, Connor JJ, Chaisson N, Sharif Mohamed F, Robinson BBE. Female Genital Cutting and Deinfibulation: Applying the Theory of Planned Behavior to Research and Practice. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:1913-1927. [PMID: 31359211 PMCID: PMC6987000 DOI: 10.1007/s10508-019-1427-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 02/11/2019] [Accepted: 02/15/2019] [Indexed: 05/09/2023]
Abstract
At least 200 million girls and women across the world have experienced female genital cutting (FGC). International migration has grown substantially in recent decades, leading to a need for health care providers in regions of the world that do not practice FGC to become knowledgeable and skilled in their care of women who have undergone the procedure. There are four commonly recognized types of FGC (Types I, II, III, and IV). To adhere to recommendations advanced by the World Health Organization (WHO) and numerous professional organizations, providers should discuss and offer deinfibulation to female patients who have undergone infibulation (Type III FGC), particularly before intercourse and childbirth. Infibulation involves narrowing the vaginal orifice through cutting and appositioning the labia minora and/or labia majora, and creating a covering seal over the vagina with appositioned tissue. The WHO has published a handbook for health care providers that includes guidance in counseling patients about deinfibulation and performing the procedure. Providers may benefit from additional guidance in how to discuss FGC and deinfibulation in a manner that is sensitive to each patient's culture, community, and values. Little research is available to describe decision-making about deinfibulation among women. This article introduces a theoretically informed conceptual model to guide future research and clinical conversations about FGC and deinfibulation with women who have undergone FGC, as well as their partners and families. This conceptual model, based on the Theory of Planned Behavior, may facilitate conversations that lead to shared decision-making between providers and patients.
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Affiliation(s)
- Sonya S Brady
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, 1300 South Second Street, Suite 300, Minneapolis, MN, 55454, USA.
| | - Jennifer J Connor
- Program in Human Sexuality, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Nicole Chaisson
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | | | - Beatrice Bean E Robinson
- Program in Human Sexuality, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
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18
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Iltis A. Strangers at the Altar. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2021; 21:19-22. [PMID: 34036886 DOI: 10.1080/15265161.2021.1915414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
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19
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Zhang H, Tian L, Zhang H, Zhang Z, Wang Y. Chinese Clinical Ethicists Accept Physicians' Benevolent Deception of Patients. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2021; 21:22-24. [PMID: 33945408 DOI: 10.1080/15265161.2021.1906988] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Hui Zhang
- Henan Provincial People's Hospital and the People's Hospital of Zhengzhou University
- School of Nursing and Health, Zhengzhou University
| | - Li Tian
- The First Affiliated Hospital of Zhengzhou University
| | - Hongmei Zhang
- Henan Provincial People's Hospital and the People's Hospital of Zhengzhou University
| | | | - Yuming Wang
- Henan Provincial People's Hospital and the People's Hospital of Zhengzhou University
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Menon S, Entwistle VA, Campbell AV, van Delden JJM. Some Unresolved Ethical Challenges in Healthcare Decision-Making: Navigating Family Involvement. Asian Bioeth Rev 2021; 12:27-36. [PMID: 33717329 PMCID: PMC7747266 DOI: 10.1007/s41649-020-00111-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 02/14/2020] [Accepted: 02/19/2020] [Indexed: 11/05/2022] Open
Abstract
Family involvement in healthcare decision-making for competent patients occurs to varying degrees in many communities around the world. There are different attitudes about who should make treatment decisions, how and why. Legal and professional ethics codes in most jurisdictions reflect and support the idea that competent patients should be enabled to make their own treatment decisions, even if others, including their healthcare professionals, disagree with them. This way of thinking contrasts with some cultural norms that put more emphasis on the family as a decision-making entity, in some circumstances to the exclusion of a competent patient. Possible tensions may arise between various combinations of patient, family members and healthcare professionals, and healthcare professionals must tread a careful path in navigating family involvement in the decision-making process. These tensions may be about differences of opinion about which treatment option is best and/or on who should have a say or influence in the decision-making process. While some relevant cultural, legal and policy considerations vary from community to community, there are ethical issues that healthcare professionals need to grapple with in balancing the laws and professional codes on decision-making and the ethical principle of respecting patients and their autonomy. This paper will highlight and propose that a partial resolution to these issues may lie in relational understandings of autonomy, which in principle justify interventions by healthcare professionals and family that support patients in decision-making.
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Affiliation(s)
- Sumytra Menon
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Vikki A Entwistle
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Alastair V Campbell
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Johannes J M van Delden
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
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21
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Abstract
Critical care clinicians strive to reverse the disease process and are frequently faced with difficult end-of-life (EoL) situations, which include transitions from curative to palliative care, avoidance of disproportionate care, withholding or withdrawing therapy, responding to advance treatment directives, as well as requests for assistance in dying. This article presents a summary of the most common issues encountered by intensivists caring for patients around the end of their life. Topics explored are the practices around limitations of life-sustaining treatment, with specific mention to the thorny subject of assisted dying and euthanasia, as well as the difficulties encountered regarding the adoption of advance care directives in clinical practice and the importance of integrating palliative care in the everyday practice of critical-care physicians. The aim of this article is to enhance understanding around the complexity of EoL decisions, highlight the intricate cultural, religious, and social dimensions around death and dying, and identify areas of potential improvement for individual practice.
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Affiliation(s)
- Victoria Metaxa
- Critical Care Department, King's College Hospital NHS Foundation Trust, London, United Kingdom
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22
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Saeed F, Sardar M, Rasheed K, Naseer R, Epstein RM, Davison SN, Mujtaba M, Fiscella KA. Dialysis Decision Making and Preferences for End-of-Life Care: Perspectives of Pakistani Patients Receiving Maintenance Dialysis. J Pain Symptom Manage 2020; 60:336-345. [PMID: 32201311 PMCID: PMC7375006 DOI: 10.1016/j.jpainsymman.2020.03.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 03/11/2020] [Accepted: 03/12/2020] [Indexed: 02/06/2023]
Abstract
CONTEXT Previous studies from the U.S. and Canada report deficiencies in informed decision making and a need to improve end-of-life (EoL) care in patients undergoing dialysis. However, there is a paucity of literature on these issues in Pakistani dialysis patients, who differ from Western patients in culture, religion, and available health care services. OBJECTIVES To study informed dialysis decision-making and EoL attitudes and beliefs in Pakistani patients receiving dialysis. METHODS We used convenience sampling to collect 522 surveys (90% response rate) from patients in seven different dialysis units in Pakistan. We used an existing dialysis survey tool, translated into Urdu, and backtranslated to English. A facilitator distributed the survey, explained questions, and orally administered it to patients unable to read. RESULTS Less than one-fourth of the respondents (23%) felt informed about their medical condition, and 45% were hopeful that their condition would improve in the future. More than half (54%) wished to know their prognosis, and 80% reported having no prognostic discussion. Almost 63% deemed EoL planning important, but only 5% recalled discussing EoL decisions with a doctor during the last 12 months. Nearly 62% of the patients regretted their decision to start dialysis. Patients' self-reported knowledge of hospice (5%) and palliative care (7.9%) services was very limited, yet 46% preferred a treatment plan focused on comfort and symptom management rather than life extension. CONCLUSION Pakistani patients reported a need for better informed dialysis decision making and EoL care and better access to palliative care services. These findings underscore the need for palliative care training of Pakistani physicians and in other developing countries to help address communication and EoL needs of their dialysis patients.
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Affiliation(s)
- Fahad Saeed
- Division of Nephrology, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA; Division of Palliative Care, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.
| | - Muhammad Sardar
- Department of Medicine, University of Arizona, Tuscan, Arizona, USA
| | - Khalid Rasheed
- Department of Medicine, Shifa medical Center, Islamabad, Pakistan
| | - Raza Naseer
- The Wright Center for Community Health, Scranton, Pennsylvania, USA
| | - Ronald M Epstein
- Division of Palliative Care, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA; Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA; Department of Family Medicine and Center for Communication and Disparities Research, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Sara N Davison
- Division of Nephrology & Immunology, University of Alberta, Edmonton, Alberta, Canada
| | - Muhammad Mujtaba
- Division of Nephrology, Department of Medicine, University of Texas Medical Branch, Galveston, Texas, USA
| | - Kevin A Fiscella
- Department of Family Medicine and Center for Communication and Disparities Research, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
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Gómez-Vírseda C, de Maeseneer Y, Gastmans C. Relational autonomy in end-of-life care ethics: a contextualized approach to real-life complexities. BMC Med Ethics 2020; 21:50. [PMID: 32605569 PMCID: PMC7325052 DOI: 10.1186/s12910-020-00495-1] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 06/23/2020] [Indexed: 12/24/2022] Open
Abstract
Background Respect for autonomy is a paramount principle in end-of-life ethics. Nevertheless, empirical studies show that decision-making, exclusively focused on the individual exercise of autonomy fails to align well with patients’ preferences at the end of life. The need for a more contextualized approach that meets real-life complexities experienced in end-of-life practices has been repeatedly advocated. In this regard, the notion of ‘relational autonomy’ may be a suitable alternative approach. Relational autonomy has even been advanced as a foundational notion of palliative care, shared decision-making, and advance-care planning. However, relational autonomy in end-of-life care is far from being clearly conceptualized or practically operationalized. Main body Here, we develop a relational account of autonomy in end-of-life care, one based on a dialogue between lived reality and conceptual thinking. We first show that the complexities of autonomy as experienced by patients and caregivers in end-of-life practices are inadequately acknowledged. Second, we critically reflect on how engaging a notion of relational autonomy can be an adequate answer to addressing these complexities. Our proposal brings into dialogue different ethical perspectives and incorporates multidimensional, socially embedded, scalar, and temporal aspects of relational theories of autonomy. We start our reflection with a case in end-of-life care, which we use as an illustration throughout our analysis. Conclusion This article develops a relational account of autonomy, which responds to major shortcomings uncovered in the mainstream interpretation of this principle and which can be applied to end-of-life care practices.
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Affiliation(s)
- Carlos Gómez-Vírseda
- Centre for Biomedical Ethics and Law, KU Leuven, Kapucijnenvoer 35/3, 3000, Leuven, Belgium.
| | - Yves de Maeseneer
- Faculty of Theology and Religious Studies (Theological and Comparative Ethics), KU Leuven, Sint-Michielsstraat 4 - box 3101, B-3000, Leuven, Belgium
| | - Chris Gastmans
- Centre for Biomedical Ethics and Law, KU Leuven, Kapucijnenvoer 35 blok d - box 7001, 3000, Leuven, Belgium
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Kaldjian LC. Practising the ethics we teach in international medical education. MEDICAL EDUCATION 2020; 54:384-386. [PMID: 32119149 DOI: 10.1111/medu.14143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 02/25/2020] [Indexed: 06/10/2023]
Affiliation(s)
- Lauris C Kaldjian
- Program in Bioethics and Humanities, Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
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Zivkovic T. Lifelines and End-of-life Decision-making: An Anthropological Analysis of Advance Care Directives in Cross-cultural Contexts. ETHNOS 2019. [DOI: 10.1080/00141844.2019.1696857] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Lee HTS, Chen TR, Yang CL, Chiu TY, Hu WY. Action research study on advance care planning for residents and their families in the long-term care facility. BMC Palliat Care 2019; 18:95. [PMID: 31690289 PMCID: PMC6833237 DOI: 10.1186/s12904-019-0482-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 10/28/2019] [Indexed: 11/10/2022] Open
Abstract
Background Research in Taiwan has indicated that advance care planning is rarely undertaken in long-term care facilities. The purpose of this study was to develop an advance care planning interview guideline and care model to facilitate the process of advance care planning for residents and their families in long-term care facilities. Methods This study follows an action research design. Cycles of planning, action, observation, and reflection were planned and modified based on the results of interviews with residents and their families as well as meetings with staff. To establish the interview guideline and care model through this action research study, residents and their families were interviewed separately. The researcher subsequently held meetings with staff members to evaluate the results and identify problems during each advance care planning process. This information was synthesised and used to modify the care model for implementation with the next resident–family pair. This process was performed a total of ten times. Results This study included residents (N = 10), their families (N = 20), and medical staff (N = 4) at a long-term care facility. The interviews and meetings were audio recorded, transcribed, and subjected to a simple thematic analysis together with the field notes and reflection logs. Four themes emerged from the data related to: opening the conversation with the interview guidelines about the life story of residents; continuing life stories to the quality of remaining years of the residents; gradually changing the topic to the end-of-life care issues; and concluding the conversation by explaining the content of advance directives and hospice care. Conclusions The advance care planning care model was implemented following logical thinking from a Chinese perspective. This consisted of opening, developing, changing, and concluding through the views of Confucianism, Buddhism, and Taoism. The research findings indicate that the model successfully facilitated the process of advance care planning for residents and their families.
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Affiliation(s)
- Hsin-Tzu Sophie Lee
- Department of Nursing, Tzu Chi University of Science and Technology, No. 880, Section 2, Chien-kuo Road, Hualien City, 97005, Taiwan, Republic of China
| | - Ting-Ru Chen
- Department of Nursing, Chang Gung University of Science and Technology, No. 261, Wenhua 1st Road, Guishan District, Taoyuan City, 33303, Taiwan, Republic of China
| | - Chia-Ling Yang
- Mackay Junior College of Medicine, Nursing and Management, No. 92, Shengjing Road, Beitou District, Taipei City, 11260, Taiwan, Republic of China
| | - Tai-Yuan Chiu
- Department of Family Medicine, National Taiwan University, No. 1 Chang-de Street, Zhong Zheng District, Taipei, 10048, Taiwan, Republic of China
| | - Wen-Yu Hu
- Department of Nursing, National Taiwan University, No. 1, Sec. 1, Jen-Ai Road, Zhong Zheng District, Taipei City, 10048, Taiwan, Republic of China.
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Nagai H. Blood ties and trust: a comparative history of policy on family consent in Japan and the United States. Monash Bioeth Rev 2019; 34:226-238. [PMID: 28432652 DOI: 10.1007/s40592-017-0069-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Informed consent honors the autonomous decisions of patients, and family consent places importance on decisions made by their families. However, there is little understanding of the relationship between these two medical decision-making approaches. Both approaches exist in Japan as part of its truth disclosure policy. What is the status of family consent in the United States, from which Japan introduced informed consent? This paper compares the situation in the United States with that in Japan, where family consent has been combined with informed consent. It then explains the history of policy development through which family consent was added to informed consent in the United States. Based on this analysis, the paper suggests that the relationship between informed consent and family consent in the United States was established on the basis of a family model that places more importance on trust-based relationships than it does on blood ties.
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Affiliation(s)
- Hiroyuki Nagai
- Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
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Tsuda S, Nakamura M, Miyachi J, Matsui Y, Takagi M, Ohashi H, Aoki S, Ono H, Ojima T. Decisional Conflict in Home Medical Care in a Family-Oriented Society: Family Members' Perspectives on Surrogate Decision Making from a Multicenter Cohort Study. J Palliat Med 2019; 22:814-822. [DOI: 10.1089/jpm.2018.0493] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Shuji Tsuda
- Department of Community Health and Preventive Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Mieko Nakamura
- Department of Community Health and Preventive Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Junichiro Miyachi
- The Hokkaido Centre for Family Medicine, Sapporo, Japan
- Center for Medical Education, Kyoto University, Kyoto, Japan
| | | | | | | | | | | | - Toshiyuki Ojima
- Department of Community Health and Preventive Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
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Choi IS, Choi EY, Lee IH. Challenges in informed consent decision-making in Korean clinical research: A participant perspective. PLoS One 2019; 14:e0216889. [PMID: 31120918 PMCID: PMC6532870 DOI: 10.1371/journal.pone.0216889] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 04/30/2019] [Indexed: 12/02/2022] Open
Abstract
Objectives This study investigated how the essential elements of informed consent are realised during the consent process and examined the challenges in obtaining genuine informed consent in Korea. Methods Through purposive sampling, we recruited 21 subjects from those participating in anticancer drug research since 2013. We undertook 1:1 in-depth interviews and analysed the data by framework analysis. Results Themes raised throughout the interviews were categorised into ‘disclosure’ and ‘understanding’ of clinical information and ‘decision’. Provider-centred information, both verbal and written, was delivered to each participant. There were few tools that the research staff might evaluate study participants’ level of understanding of the provided information during the clinical trial. Although participants did not understand basic clinical trial concepts as much as desired, they may not seek to solve difficulties through communication with trial researchers. Doubts were raised about whether participants had sufficient capacity and free will to provide informed consent. Conclusion There is a concern that informed consent can fall short of genuine in Korea. To ensure informed consent meets the international standard, greater efforts should be made to establish an explicit standard operational protocol for obtaining informed consent.
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Affiliation(s)
- Im-Soon Choi
- Department of Pharmacy, Kyungpook National University Medical Centre, Daegu, South Korea
| | - Eun Young Choi
- College of Pharmacy, Yeungnam University, Gyeongsan, South Korea
- Department of Pharmacy, Ulsan University Hospital, Ulsan, South Korea
| | - Iyn-Hyang Lee
- College of Pharmacy, Yeungnam University, Gyeongsan, South Korea
- * E-mail:
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Raposo VL. Lost in 'Culturation': medical informed consent in China (from a Western perspective). MEDICINE, HEALTH CARE, AND PHILOSOPHY 2019; 22:17-30. [PMID: 29594889 DOI: 10.1007/s11019-018-9835-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Although Chinese law imposes informed consent for medical treatments, the Chinese understanding of this requirement is very different from the European one, mostly due to the influence of Confucianism. Chinese doctors and relatives are primarily interested in protecting the patient, even from the truth; thus, patients are commonly uninformed of their medical conditions, often at the family's request. The family plays an important role in health care decisions, even substituting their decisions for the patient's. Accordingly, instead of personal informed consent, what actually exists is 'family informed consent'. From a Western perspective, these features of Chinese law and Chinese culture might seem strange, contradicting our understanding of doctor-patient relationship and even the very essence of self-determination and fundamental rights. However, we cannot forget the huge influence of cultural factors in these domains, and that 'Western' informed consent is grounded on the individualistic nature of Western culture. This article will underline the differences between the Western and the Chinese perspectives, clarifying how each of them must be understood in its own cultural environment. But, while still respecting Chinese particularities, this paper advocates that China adopt patient individual informed consent because this is the only solution compatible with human dignity and human rights.
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Affiliation(s)
- Vera Lúcia Raposo
- Faculty of Law, University of Macau, Room 2043, E32, Avenida da Universidade, Taipa, Macau, China.
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Samaranayake UMJE, Mathangasinghe Y, Banagala ASK. Are predominantly western standards and expectations of informed consent in surgery applicable to all? A qualitative study in a tertiary care hospital in Sri Lanka. BMJ Open 2019; 9:e025299. [PMID: 30813111 PMCID: PMC6347869 DOI: 10.1136/bmjopen-2018-025299] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 11/28/2018] [Accepted: 11/28/2018] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To identify the different perceptions on informed surgical consent in a group of Sri Lankan patients. METHODS A qualitative study was conducted in a single surgical unit at a tertiary care hospital from January to May 2018. The protocol conformed to the Declaration of Helsinki. Patients undergoing elective major surgeries were recruited using initial purposive and later theoretical sampling. In-depth interviews were conducted in their native language based on the grounded theory. Initial codes were generated after analysing the transcripts. Constant comparative method was employed during intermediate and advanced coding. Data collection and analyses were conducted simultaneously, until the saturation of the themes. Finally, advanced coding was used for theoretical integrations. RESULTS Thirty patients (male:female=12:18) were assessed. The mean age was 41±9 years. Sinhalese predominated (50.0%, n=15). Majority underwent thyroidectomy (36.7%, n=11). The generated theory categorises the process of obtaining informed consent in four phases: initial interaction phase, reasoning phase, convincing phase and decision-making phase. Giving consent for surgery was a dependent role between patient, family members and the surgeon, as opposed to an individual decision by the patient. Some patients abstained from asking questions from doctors since doctors were 'busy', 'short-tempered' or 'stressed out'. Some found nurses to be more approachable than doctors. Patients admitted that having a bystander while obtaining consent would relieve their stress. They needed doctors to emphasise more on postoperative lifestyle changes and preprocedure counselling at the clinic level. To educate patients about their procedure, some suggested leaflets or booklets to be distributed at the clinic before ward admission. The majority disliked watching educational videos because they were 'scared' to look at surgical dissections and blood. CONCLUSION The informed consent process should include key elements that are non-culture specific along with elements or practices that consider the cultural norms of the society.
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Affiliation(s)
| | - Yasith Mathangasinghe
- Department of Anatomy, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
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Sim SW, Soh TLGB, Radha Krishna LK. Multi-dimensional approach to end-of-life care: The Welfare Model. Nurs Ethics 2018; 26:1955-1967. [PMID: 30318993 DOI: 10.1177/0969733018806705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Appropriate and balanced decision-making is sentinel to goal setting and the provision of appropriate clinical care that are attuned to preserving the best interests of the patient. Current family-led decision-making in family-centric societies such as those in Singapore and other countries in East Asia are believed to compromise these objectives in favor of protecting familial interests. Redressing these skewed clinical practices employing autonomy-based patient-centric approaches however have been found wanting in their failure to contend with wider sociocultural considerations that impact care determinations. Evaluation of a number of alternative decision-making frameworks set out to address the shortcomings of prevailing atomistic and family-centric decision-making models within the confines of end-of-life care prove these alternative frameworks to be little better at protecting the best interests of vulnerable patients. As a result, we propose the Welfare Model that we believe is attentive to the relevant socio-culturally significant considerations of a particular case and better meets the needs of end-of-life care goals of preserving the welfare of patients. Employing a multi-professional team evaluation guided by regnant psychosocial, legal, and clinical standards and the prevailing practical and clinical realities of the particular patient's setting the Welfare Model provides a clinically relevant, culturally sensitive, transparent, and evidence-based approach to care determinations.
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Zivkovic T. Forecasting and foreclosing futures: The temporal dissonance of advance care directives. Soc Sci Med 2018; 215:16-22. [PMID: 30196148 DOI: 10.1016/j.socscimed.2018.08.035] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 08/25/2018] [Accepted: 08/28/2018] [Indexed: 10/28/2022]
Abstract
Advance care directives situate persons as rational and self-determining actors who can make anticipatory plans about their futures. This paper critically examines how people interpret individual and future-oriented approaches to medical decision-making with limited access to information and knowledge, and reduced opportunities to prepare and document their care preferences. Based on ethnographic research with Asian migrant families living in Adelaide, South Australia (August 2015-July 2018), it reveals a discord between planning for a finite future and the contingencies and continuities of social life. It unsettles the detached reasoning that is privileged in end-of-life decision-making and reveals limitations to "do-it-yourself" approaches to advance care directives which, it will be argued, not only forecasts potential futures but also forecloses them. Taking Derrida's critique of death and decision-making as a point of departure, it develops the concept of temporal dissonance as a theoretical framework to articulate the tensions that are constituted in advance care directives. The paper suggests that attention to temporal incongruities may help to shed light on the many complex interpretations of advance care directives and the difficulties of promoting them in diverse contexts.
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Affiliation(s)
- Tanya Zivkovic
- Department of Sociology, Criminology and Gender Studies, School of Social Sciences, Napier Building, University of Adelaide, Adelaide, South Australia, 5005, Australia.
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Greiner AM, Kaldjian LC. Rethinking medical oaths using the Physician Charter and ethical virtues. MEDICAL EDUCATION 2018; 52:826-837. [PMID: 29700846 DOI: 10.1111/medu.13581] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 12/12/2017] [Accepted: 02/08/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Medical oaths express ethical values that are essential to the trust within the patient-physician relationship and medicine's commitment to society. However, the contents of oaths vary between medical schools and therefore raise questions about which ethical values should be included in a medical oath. More than a decade has passed since this variability was last analysed in North America, and since that time the Physician Charter on Medical Professionalism has gained considerable attention, raising the possibility that the Charter may be influencing medical oaths and making them more consistent. METHODS The authors conducted a content analysis of 84 oaths available in 2015 from medical schools in the USA and Canada affiliated with the Association of American Medical Colleges, organising the content into three categories: (i) ethical values, (ii) principles and commitments in the Physician Charter, and (iii) ethical virtues. RESULTS Only five ethical values were expressed in the majority of oaths (confidentiality, obligation to the profession, beneficence, avoiding discrimination, and honour and integrity), and respect for patient autonomy was uncommon. Only three of the Physician Charter's principles and commitments (primacy of patient welfare, social justice and confidentiality) and one virtue (honour and integrity) were reflected in the majority of oaths. CONCLUSIONS Medical oaths in North America appear to be highly variable in content. Greater attention to resources like the Physician Charter can help improve the ethical content and consistency of oaths across different institutions, and throughout their education medical students should be encouraged to discuss and reflect on the principles and virtues they will profess when they graduate.
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Affiliation(s)
- Alexander M Greiner
- Medical Scientist Training Program, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Lauris C Kaldjian
- Program in Bioethics and Humanities, Carver College of Medicine, Iowa City, Iowa, USA
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
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Ting PS, Chen L, Yang WC, Huang TS, Wu CC, Chen YY. Gender and age disparity in the initiation of life-supporting treatments: a population-based cohort study. BMC Med Ethics 2017; 18:62. [PMID: 29141641 PMCID: PMC5688717 DOI: 10.1186/s12910-017-0222-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Accepted: 11/08/2017] [Indexed: 11/17/2022] Open
Abstract
Background The relationships between age and the life-supporting treatments use, and between gender and the life-supporting treatments use are still controversial. Using extracorporeal membrane oxygenation as an example of life-supporting treatments, the objectives of this study were: (1) to examine the relationship between age and the extracorporeal membrane oxygenation use; (2) to examine the relationship between age and the extracorporeal membrane oxygenation use; and (3) to deliberate the ethical and societal implications of age and gender disparities in the initiation of extracorporeal membrane oxygenation. Methods This is a population-based, retrospective cohort study. Taiwan’s extracorporeal membrane oxygenation cases from 2000 to 2010 were collected. The annual incidence rate of extracorporeal membrane oxygenation use adjusting for both age and gender distribution for each year from 2000 to 2010 was derived using the population of 2000 as the reference population. The trend of extracorporeal membrane oxygenation use was examined using time-series linear regression analysis. We conducted joinpoint regression for estimating the trend change of extracorporeal membrane oxygenation use. Results The trends of extracorporeal membrane oxygenation use both for different gender groups, and for different age groups have been significantly increasing over time. Men were more likely to be supported by extracorporeal membrane oxygenation than women. Women’s perspectives toward life and death, and women’s perception of well-being may be associated with the phenomenon. In addition, the patients at the age of 65 or older were more likely to be supported by extracorporeal membrane oxygenation than those younger than 65. Family autonomy/family-determination, and the Confucian tradition of filial piety and respecting elders may account for this phenomenon. Conclusions This study showed gender and age disparities in the initiation of extracorporeal membrane oxygenation use in Taiwan, which may be accounted for by the cultural and societal values in Taiwan. For a healthcare professional who deals with patients’/family members’ medical decision-making to initiate life-supporting treatments, he/she should be sensitive not only to the legality, but also the societal and ethical issues involved.
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Affiliation(s)
- Peng-Sheng Ting
- Department of Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Likwang Chen
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan
| | - Wei-Chih Yang
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan
| | - Tien-Shang Huang
- Department of Medical Education, Cathay General Hospital, Miaoli, Taiwan
| | - Chau-Chung Wu
- Graduate Institute of Medical Education and Bioethics, National Taiwan University College of Medicine, Taipei, Taiwan.,Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Yen-Yuan Chen
- Graduate Institute of Medical Education and Bioethics, National Taiwan University College of Medicine, Taipei, Taiwan. .,Department of Medical Education, National Taiwan University Hospital, Taipei, Taiwan.
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Chattopadhyay S, Myser C, Moxham T, De Vries R. A Question of Social Justice: How Policies of Profit Negate Engagement of Developing World Bioethicists and Undermine Global Bioethics. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2017; 17:3-14. [PMID: 29020562 DOI: 10.1080/15265161.2017.1365185] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
We identify the ways the policies of leading international bioethics journals limit the participation of researchers working in the resource-constrained settings of low- and middle-income countries (LMICs) in the development of the field of bioethics. Lack of access to essential scholarly resources makes it extremely difficult, if not impossible, for many LMIC bioethicists to learn from, meaningfully engage in, and further contribute to the global bioethics discourse. Underrepresentation of LMIC perspectives in leading journals sustains the hegemony of Western bioethics, limits the presentation of diverse moral visions of life, health, and medicine, and undermines aspirations to create a truly "global" bioethics. Limited attention to this problem indicates a lack of empathy and moral imagination on the part of bioethicists in high-income countries, raises questions about the ethics of bioethics, and highlights the urgent need to find ways to remedy this social injustice.
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Yap SS, Chen K, Detering KM, Fraser SA. Exploring the knowledge, attitudes and needs of advance care planning in older Chinese Australians. J Clin Nurs 2017; 27:3298-3306. [PMID: 28544056 DOI: 10.1111/jocn.13886] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2017] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To identify factors that influence the engagement of Chinese Australians with advance care planning. BACKGROUND Despite the benefits of advance care planning, there is a low prevalence of advance care planning in the Chinese Australian community. Reasons for this are often cited as cultural considerations and taboos surrounding future medical planning and death; however, other logistical factors may also be important. DESIGN This qualitative study used a thematic analysis grounded theory approach to explore facilitators and barriers to engagement in advance care planning. METHODS Semistructured interviews were conducted in-language (Mandarin or Cantonese) exploring the views of a purposive sample of 30 community-dwelling older Chinese Australians within Victoria, Australia. RESULTS Three key themes were identified: knowledge of, attitudes towards and needs for undertaking advance care planning amongst the Chinese Australians. There was a low awareness of advance care planning amongst the participants and some confusion regarding the concept. Most participants reported positive attitudes towards advance care planning but acknowledged that others may be uncomfortable discussing death-related topics. Participants would want to know the true status of their health and plan ahead in consultation with family members to reduce the burden on the family and suffering for themselves. Language was identified as the largest barrier to overcome to increase advance care planning awareness. In-language materials and key support networks including GPs, family and Chinese community groups were identified as ideal forums for the promotion of advance care planning. CONCLUSIONS The participants of this study were open to conversations regarding future medical planning and end-of-life care, suggesting the low uptake of advance care planning amongst Chinese Australians is not culturally motivated but may be due a lack of knowledge relating to advance care planning. RELEVANCE TO CLINICAL PRACTICE The results highlight the need to provide access to appropriate in-language advance care planning resources and promotion of advance care planning across the Chinese community.
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Affiliation(s)
- Sok Shin Yap
- Advance Care Planning Australia, Austin Health, Melbourne, Vic., Australia.,Department of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Vic., Australia
| | - Karren Chen
- Advance Care Planning Australia, Austin Health, Melbourne, Vic., Australia
| | - Karen M Detering
- Advance Care Planning Australia, Austin Health, Melbourne, Vic., Australia.,Department of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Vic., Australia
| | - Scott A Fraser
- Advance Care Planning Australia, Austin Health, Melbourne, Vic., Australia.,Department of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Vic., Australia
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Alden DL, Friend J, Lee PY, Lee YK, Trevena L, Ng CJ, Kiatpongsan S, Lim Abdullah K, Tanaka M, Limpongsanurak S. Who Decides: Me or We? Family Involvement in Medical Decision Making in Eastern and Western Countries. Med Decis Making 2017; 38:14-25. [DOI: 10.1177/0272989x17715628] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. Research suggests that desired family involvement (FI) in medical decision making may depend on cultural values. Unfortunately, the field lacks cross-cultural studies that test this assumption. As a result, providers may be guided by incomplete information or cultural biases rather than patient preferences. Methods. Researchers developed 6 culturally relevant disease scenarios varying from low to high medical seriousness. Quota samples of approximately 290 middle-aged urban residents in Australia, China, Malaysia, India, South Korea, Thailand, and the USA completed an online survey that examined desired levels of FI and identified individual difference predictors in each country. All reliability coefficients were acceptable. Regression models met standard assumptions. Results. The strongest finding across all 7 countries was that those who desired higher self-involvement (SI) in medical decision making also wanted lower FI. On the other hand, respondents who valued relational-interdependence tended to want their families involved – a key finding in 5 of 7 countries. In addition, in 4 of 7 countries, respondents who valued social hierarchy desired higher FI. Other antecedents were less consistent. Conclusion. These results suggest that it is important for health providers to avoid East–West cultural stereotypes. There are meaningful numbers of patients in all 7 countries who want to be individually involved and those individuals tend to prefer lower FI. On the other hand, more interdependent patients are likely to want families involved in many of the countries studied. Thus, individual differences within culture appear to be important in predicting whether a patient desires FI. For this reason, avoiding culture-based assumptions about desired FI during medical decision making is central to providing more effective patient centered care.
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Affiliation(s)
- Dana L. Alden
- University of Hawaii, Honolulu, HI, USA (DLA)
- College of St. Benedict and St. John’s University, Collegeville, MN, USA (JF)
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia (PYL)
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia (YKL)
- School of Public Health, The University of Sydney, Sydney, NSW, Australia (LT)
| | - John Friend
- University of Hawaii, Honolulu, HI, USA (DLA)
- College of St. Benedict and St. John’s University, Collegeville, MN, USA (JF)
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia (PYL)
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia (YKL)
- School of Public Health, The University of Sydney, Sydney, NSW, Australia (LT)
| | - Ping Yein Lee
- University of Hawaii, Honolulu, HI, USA (DLA)
- College of St. Benedict and St. John’s University, Collegeville, MN, USA (JF)
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia (PYL)
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia (YKL)
- School of Public Health, The University of Sydney, Sydney, NSW, Australia (LT)
| | - Yew Kong Lee
- University of Hawaii, Honolulu, HI, USA (DLA)
- College of St. Benedict and St. John’s University, Collegeville, MN, USA (JF)
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia (PYL)
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia (YKL)
- School of Public Health, The University of Sydney, Sydney, NSW, Australia (LT)
| | - Lyndal Trevena
- University of Hawaii, Honolulu, HI, USA (DLA)
- College of St. Benedict and St. John’s University, Collegeville, MN, USA (JF)
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia (PYL)
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia (YKL)
- School of Public Health, The University of Sydney, Sydney, NSW, Australia (LT)
| | - Chirk Jenn Ng
- University of Hawaii, Honolulu, HI, USA (DLA)
- College of St. Benedict and St. John’s University, Collegeville, MN, USA (JF)
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia (PYL)
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia (YKL)
- School of Public Health, The University of Sydney, Sydney, NSW, Australia (LT)
| | - Sorapop Kiatpongsan
- University of Hawaii, Honolulu, HI, USA (DLA)
- College of St. Benedict and St. John’s University, Collegeville, MN, USA (JF)
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia (PYL)
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia (YKL)
- School of Public Health, The University of Sydney, Sydney, NSW, Australia (LT)
| | - Khatijah Lim Abdullah
- University of Hawaii, Honolulu, HI, USA (DLA)
- College of St. Benedict and St. John’s University, Collegeville, MN, USA (JF)
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia (PYL)
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia (YKL)
- School of Public Health, The University of Sydney, Sydney, NSW, Australia (LT)
| | - Miho Tanaka
- University of Hawaii, Honolulu, HI, USA (DLA)
- College of St. Benedict and St. John’s University, Collegeville, MN, USA (JF)
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia (PYL)
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia (YKL)
- School of Public Health, The University of Sydney, Sydney, NSW, Australia (LT)
| | - Supanida Limpongsanurak
- University of Hawaii, Honolulu, HI, USA (DLA)
- College of St. Benedict and St. John’s University, Collegeville, MN, USA (JF)
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia (PYL)
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia (YKL)
- School of Public Health, The University of Sydney, Sydney, NSW, Australia (LT)
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Abstract
ABSTRACTObjective:Advanced care plans (ACPs) are designed to convey the wishes of patients with regards to their care in the event of incapacity. There are a number of prerequisites for creation of an effective ACP. First, the patient must be aware of their condition, their prognosis, the likely trajectory of the illness, and the potential treatment options available to them. Second, patient input into ACP must be free of any coercive factors. Third, the patient must be able to remain involved in adapting their ACP as their condition evolves. Continued use of familial determination and collusion within the local healthcare system, however, has raised concerns that the basic requirements for effective ACP cannot be met.Method:To assess the credibility of these concerns, we employed a video vignette approach depicting a family of three adult children discussing whether or not to reveal a cancer diagnosis to their mother. Semistructured interviews with 72 oncology patients and 60 of their caregivers were conducted afterwards to explore the views of the participants on the different positions taken by the children.Results:Collusion, family-centric decision making, adulteration of information provided to patients, and circumnavigation of patient involvement appear to be context-dependent. Patients and families alike believe that patients should be told of their conditions. However, the incidence of collusion and familial determination increases with determinations of a poor prognosis, a poor anticipated response to chemotherapy, and a poor premorbid health status. Financial considerations with respect to care determinations remain secondary considerations.Significance of results:Our data suggest that ACPs can be effectively constructed in family-centric societies so long as healthcare professionals continue to update and educate families on the patient's situation. Collusion and familial intervention in the decision-making process are part of efforts to protect the patient from distress and are neither solely dependent on cultural nor an “all-or-nothing” phenomenon. The response of families are context-dependent and patient-specific, weighing the patient's right to know and prepare and the potential distress it is likely to cause. In most cases, the news is broken gently over time to allow the patient to digest the information and for the family to assess how well they cope with the news. Furthermore, the actions of families are dependent upon their understanding of the situation, highlighting the need for continued engagement with healthcare professionals.
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Specker Sullivan L. Dynamic axes of informed consent in Japan. Soc Sci Med 2016; 174:159-168. [PMID: 28043018 DOI: 10.1016/j.socscimed.2016.12.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 12/18/2016] [Accepted: 12/20/2016] [Indexed: 11/29/2022]
Abstract
Scholarship in cross-cultural bioethics routinely frames Japanese informed consent in contrast to informed consent in North America. This contrastive analysis foregrounds cancer diagnosis disclosure and physician paternalism as unique aspects of Japanese informed consent that deviate from American practices. Drawing on in-depth interviews with 15 Japanese medical professionals obtained during fieldwork in Japan from 2013 to 15, this article complicates the informed consent discourse beyond East-West comparisons premised on Anglo-American ethical frameworks. It expands professional perspectives to include nurses, medical social workers, clinical psychologists, and ethicists and it addresses informed consent for a broad range of conditions in addition to cancer. The results suggest that division of affective labor is an under-theorized dimension of informed consent that is perceived as at odds with principled demands for universal informed consent. These practical tensions are conceptualized as cultural differences, with Japan identified in terms of omakase as practical and supportive and the United States identified in terms of jiko kettei as principled and self-determining. These results have implications for the methodology of cross-cultural bioethics as well as for theories and practices of informed consent in both Japan and the United States. I conclude that responsible cross-cultural work in bioethics must begin from the ground up, incorporating all relevant stakeholder perspectives, attitudes, and experiences.
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Affiliation(s)
- Laura Specker Sullivan
- University of Washington, Box 37, 1414 NE 42nd Street, Seattle, WA 98105-6271, United States; Department of Philosophy, University of Washington, Seattle, WA, United States; University of British Columbia, Canada.
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Lin ML, Huang CT, Chen CH. Reasons for family involvement in elective surgical decision-making in Taiwan: a qualitative study. J Clin Nurs 2016; 26:1969-1977. [DOI: 10.1111/jocn.13600] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Mei-Ling Lin
- Tsaotun Psychiatric Center; Ministry of Health and Welfare; Nantou County Taiwan
- Central Taiwan University of Science and Technology; Taichung Taiwan
| | - Chuen-Teng Huang
- Graduate Institute of Children's English; National Changhua University of Education; Changhua Taiwan
| | - Ching-Huey Chen
- Department of Nursing; Chang Jung Christian University; Tainan City Taiwan
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Fainzang S. From solidarity to autonomy: towards a redefinition of the parameters of the notion of autonomy. THEORETICAL MEDICINE AND BIOETHICS 2016; 37:463-472. [PMID: 27896525 DOI: 10.1007/s11017-016-9385-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Starting from examples of concrete situations in France, I show that autonomy and solidarity can coexist only if the parameters of autonomy are redefined. I show on the one hand that in situations where autonomy is encouraged, solidarity nevertheless remains at the foundation of their practices. On the other hand, in situations largely infused with family solidarity, the individual autonomy may be put in danger. Yet, based on my ethnographic observations regarding clinical encounters and medical secrecy, I show that while solidarity may endanger individual autonomy, it does not necessarily endanger autonomy itself. The social practices observable in France reflect the reality of an autonomy that goes beyond the individual, a reality that involves a collective subject and includes solidarity. The opposition between these two values can then be resolved if the content of the notion of autonomy is understood to be dependent on its cultural context of application and on its social use.
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Affiliation(s)
- Sylvie Fainzang
- Institut National de la Santé et de la Recherche Médicale (INSERM), Cermes3, Site CNRS, 7, rue Guy Môquet, 94801, Villejuif Cedex, France.
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Macioce F. Balancing cultural pluralism and universal bioethical standards: a multiple strategy. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2016; 19:393-402. [PMID: 26860625 DOI: 10.1007/s11019-016-9691-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
If we want to take firm the importance of universal principles in Bioethics, but at the same time we want to take seriously the importance of cultural diversity and pluralism, it is necessary to adopt a multifaceted approach. In the article I argue that a possible way out is a sort of hermeneutic approach, in order to reduce the ambivalence that stems from the dual recognition of cultural diversity and universal value of human rights. Through this approach conflicting principles and traditions can be harmonized within a common framework, at least to some extent. Such an approach, in my perspective, can be implemented as a strategy of interpretation, which can hold together different conceptions and common principles.
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Bein T. Understanding intercultural competence in intensive care medicine. Intensive Care Med 2016; 43:229-231. [PMID: 27379795 DOI: 10.1007/s00134-016-4432-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 06/27/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Thomas Bein
- Department of Anesthesia and Operative Intensive Care, University Hospital Regensburg, 93042, Regensburg, Germany.
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Bein T. [Intercultural competence. Management of foreignness in intensive care medicine]. Anaesthesist 2016; 64:562-8. [PMID: 26231291 DOI: 10.1007/s00101-015-0069-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Living in a multicultural society is characterized by different attitudes caused by a variety of religions and cultures. In intensive care medicine such a variety of cultural aspects with respect to pain, shame, bodiliness, dying and death is of importance in this scenario. AIM To assess the importance of cultural and religious attitudes in the face of foreignness in intensive care medicine and nursing. Notification of misunderstandings and misinterpretations in communication and actions. MATERIAL AND METHODS An analysis of the scientific literature was carried out and typical intercultural conflict burden situations regarding the management of brain death, organ donation and end of life decisions are depicted. RESULTS Specific attitudes are found in various religions or cultures regarding the change of a therapeutic target, the value of the patient's living will and the organization of rituals for dying. Intercultural conflicts are mostly due to misunderstandings, assessment differences, discrimination and differences in values. CONCLUSION Intercultural competence is crucial in intensive care medicine and includes knowledge of social and cultural influences of different attitudes on health and illness, the abstraction from own attitudes and the acceptance of other or foreign attitudes.
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Affiliation(s)
- T Bein
- Klinik für Anästhesiologie, Universitätsklinikum, 93042, Regensburg, Deutschland,
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Lee HTS, Cheng SC, Dai YT, Chang M, Hu WY. Cultural perspectives of older nursing home residents regarding signing their own DNR directives in Eastern Taiwan: a qualitative pilot study. BMC Palliat Care 2016; 15:45. [PMID: 27154213 PMCID: PMC4859998 DOI: 10.1186/s12904-016-0117-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 04/22/2016] [Indexed: 11/29/2022] Open
Abstract
Background Chinese tradition and culture developed from Taoism, Confucianism, and Buddhism and have influenced ethnic Chinese for thousands of years, particularly thoughts on death. Many ethnic Chinese, particularly older people, refrain from discussing death-related concerns, making it difficult to obtain advance directives, including do-not-resuscitate (DNR) directives, signed independently by older people. This study explored the attitudes of older nursing home residents in Taiwan toward signing their own DNR directives. Methods This study adopted purposive sampling and collected data through in-depth interviews. The data were analysed using qualitative inductive content analysis, and the study location was a nursing home in Eastern Taiwan. Results A total of 11participants were recruited from a sample of 12 eligible participants. Most of the older residents in this study refused to make decisions independently regarding DNR directives. Content analysis of the interviews revealed four themes concerning refusing to sign DNR directives independently: not going against nature, accepting the results of cause and effect, viewing the family as a decision-making system, and practising self-effacement. Chinese cultural aspects, including Taoist, Buddhist, and Confucian philosophy, affected the autonomy of the older residents, and they relied on others to make decisions for them. Conclusions Professionals must respect this family-oriented decision-making thinking of older residents because it reflects personal choice. Otherwise, healthcare providers may play a mediating role in coordinating and communicating between older residents and their families regarding EOL-care-related concerns, replacing the traditional practice of holding a family meeting.
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Affiliation(s)
- Hsin-Tzu Sophie Lee
- Department of Nursing, Tzu Chi University of Science and Technology, Hualien City, Taiwan.,Department of Nursing, National Taiwan University, Taipei City, Taiwan
| | - Shu-Chen Cheng
- Department of Nursing, Tzu Chi University of Science and Technology, Hualien City, Taiwan
| | - Yu-Tzu Dai
- Department of Nursing, National Taiwan University, Taipei City, Taiwan
| | - Mei Chang
- Department of Nursing, National Taiwan University, Taipei City, Taiwan
| | - Wen-Yu Hu
- Department of Nursing, National Taiwan University, Taipei City, Taiwan. .,Department of Nursing, College of Medicine, National Taiwan University, No. 1, Sec. 1, Jen-Ai Rd., Zhong zheng Dist., Taipei City, 100, Taiwan, R.O.C..
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Abstract
In spite of ongoing globalisation in many fields, the ethics of radiological protection have long been discussed almost exclusively in terms of 'Western' moral philosophy concepts such as utilitarianism or deontology. A cross-cultural discourse in this field is only just beginning. In 'Principles of Biomedical Ethics', Beauchamp and Childress suggested that there exists a 'common morality' which is 'not relative to cultures or individuals, because it transcends both'. They proposed four cross-culturally valid principles for decision making in medicine: respect for autonomy, non-maleficence, beneficence, and justice. A similar approach is being developed by the International Commission on Radiological Protection Task Group 94 on the ethics of radiological protection. Here, the core values are: human dignity, beneficence/non-maleficence, prudence, and justice. Other values could be added, such as consideration for the interests of society as a whole or the interests of future generations, or procedural values such as transparency and accountability; this paper will include a brief discussion on how they relate to the four basic principles. The main question to be addressed here, however, is whether the proposed core values are indeed part of a 'common morality'. This, as it will be argued, cannot be decided by a global opinion poll, but has to be based on an analysis of the written and oral traditions that have provided ethical orientation throughout history, and are still considered seminal by the majority of people. It turns out that there are indeed many commonalities across cultures, and that the concept of globally shared core values for the radiological protection system is not hopelessly idealistic.
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Affiliation(s)
- F Zölzer
- Department of Radiology, Toxicology, and Civil Protection, Faculty of Health and Social Studies, University of South Bohemia, Emy Destinové 46, 37005 České Budějovice, Czech Republic
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Abstract
"At-own-risk discharges" or "self-discharges" evidences an irretrievable breakdown in the patient-clinician relationship when patients leave care facilities before completion of medical treatment and against medical advice. Dissolution of the therapeutic relationship terminates the physician's duty of care and professional liability with respect to care of the patient. Acquiescence of an at-own-risk discharge by the clinician is seen as respecting patient autonomy. The validity of such requests pivot on the assumptions that the patient is fully informed and competent to invoke an at-own-risk discharge and that care up to the point of the at-own-risk discharge meets prevailing clinical standards. Palliative care's use of a multidisciplinary team approach challenges both these assumptions. First by establishing multiple independent therapeutic relations between professionals in the multidisciplinary team and the patient who persists despite an at-own-risk discharge. These enduring therapeutic relationships negate the suggestion that no duty of care is owed the patient. Second, the continued employ of collusion, familial determinations, and the circumnavigation of direct patient involvement in family-centric societies compromises the patient's decision-making capacity and raises questions as to the patient's decision-making capacity and their ability to assume responsibility for the repercussions of invoking an at-own-risk discharge. With the validity of at-own-risk discharge request in question and the welfare and patient interest at stake, an alternative approach to assessing at-own-risk discharge requests are called for. The welfare model circumnavigates these concerns and preserves the patient's welfare through the employ of a multidisciplinary team guided holistic appraisal of the patient's specific situation that is informed by clinical and institutional standards and evidenced-based practice. The welfare model provides a robust decision-making framework for assessing the validity of at-own-risk discharge requests on a case-by-case basis.
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Affiliation(s)
- Lalit Kumar Radha Krishna
- National University of Singapore, Singapore; Duke-NUS Graduate Medical School, Singapore; National Cancer Centre Singapore, Singapore
| | | | - Ravindran Kanesvaran
- Duke-NUS Graduate Medical School, Singapore; National Cancer Centre Singapore, Singapore
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Intimacy and Family Consent: A Confucian Ideal. THE JOURNAL OF MEDICINE AND PHILOSOPHY 2015; 40:418-36. [DOI: 10.1093/jmp/jhv015] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Jin P. The physician charter on medical professionalism from the Chinese perspective: a comparative analysis. JOURNAL OF MEDICAL ETHICS 2015; 41:511-4. [PMID: 25341734 DOI: 10.1136/medethics-2014-102318] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 10/03/2014] [Indexed: 05/25/2023]
Abstract
The charter of medical professionalism in the new millennium (Charter) has been endorsed worldwide, including by the Chinese Medical Doctor Association from 2005. Six years later, the association drafted a Chinese version of medical professionalism based on the Charter, the Chinese Medical Doctor Declaration (Declaration). This Declaration encompasses six tenets, which have large areas of overlap with the Charter. Meanwhile, certain differences also exist between the universal professionalism that the Charter aims to disseminate and the ideal Chinese professionalism that the Declaration endeavours to bolster. In this paper, we explore the unique aspects of the Declaration in contrast with the Charter to gain a deeper understanding of professionalism in the particular context of China. The Declaration may omit some valuable commitments found in the Charter, but it includes longstanding Confucian and cultural traditions of China, as well as consideration of current social circumstances. The Declaration thus re-establishes the ideal of universal professionalism in light of the Chinese context.
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