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Perceptions of healthcare professionals towards palliative care in internal medicine wards: a cross-sectional survey. BMC Palliat Care 2021; 20:101. [PMID: 34193142 PMCID: PMC8247075 DOI: 10.1186/s12904-021-00787-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 06/04/2021] [Indexed: 11/10/2022] Open
Abstract
Background The extension of palliative care services to meet the needs of patients with chronic non-malignant life-limiting conditions faces misconceptions amongst healthcare professionals. A study of prevailing perceptions of healthcare professionals on this wider palliative care service was thus conducted to identify current obstacles, guide the education of local healthcare professionals and improve service accessibility. Methods A cross-sectional study was carried out at the Singapore General Hospital. An anonymised and close-ended online questionnaire was disseminated to 120 physicians and 500 nurses in the Department of Internal Medicine. The online survey tool focused on participant demographics; perceptions of palliative care and its perceived benefits; roles and indications; and attitudes and behaviours towards palliative care referrals. Results Forty four physicians and 156 nurses suggested that care of terminally ill patients with chronic non-malignant life-limiting conditions are compromised by concerns over the role of palliative care in non-cancer care and lapses in their prognostication and communication skills. Respondents also raised concerns about their ability to confront sociocultural issues and introduce palliative care services to patients and their families. Conclusions Gaps in understanding and the ability of nurses and physicians to communicate end of life issues, introduce palliative care services to patients and their families and confront sociocultural issues suggest the need for a longitudinal training program. With similar concerns likely prevalent in other clinical settings within this island nation, a concerted national education program targeting obstacles surrounding effective palliative care should be considered.
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Martin DE, Muller E. In Defense of Patient Autonomy in Kidney Failure Care When Treatment Choices Are Limited. Semin Nephrol 2021; 41:242-252. [PMID: 34330364 DOI: 10.1016/j.semnephrol.2021.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Respect for patient autonomy is a primary ethical obligation of health care providers. In kidney health care, clinical practice recommendations commonly include strategies to promote shared decision making with patients and their families about treatment options to promote patient autonomy and improve patient outcomes. However, for many people with kidney failure, treatment options may be unavailable or inaccessible. In these circumstances some clinicians may act paternalistically and withhold information from patients because of a fear of causing harm or because clinicians believe that patient autonomy is not a relevant consideration. In this article, we reflect on the concept of autonomy in the context of clinical decision making in kidney failure care, with particular attention to resource-constrained settings and the disclosure of information to patients for whom treatment may be inaccessible. We examine and address key concerns that patient autonomy may be impossible, irrelevant, or harmful in the context of limited treatment choices, and discuss factors that may influence paternalistic practices in such settings. We conclude that respect for autonomy is intrinsically and instrumentally valuable, and argue that in neglecting patient autonomy in resource-constrained settings, clinicians may exacerbate and entrench the structural inequalities and health inequities they are committed to addressing.
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Affiliation(s)
| | - Elmi Muller
- Department of Surgery, University of Cape Town, Cape Town, South Africa
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Li BY. Co-Composing an Aesthetic Self Through Play: Towards a Transformative Framework for Dementia Care. THE GERONTOLOGIST 2021; 62:464-474. [PMID: 33605400 DOI: 10.1093/geront/gnab021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Aging and deterioration mark a new phase in many older adults' life, highlighting the importance of creativity and imagination. This article introduces the implementation of an innovative program, Play Intervention for Dementia (PID), at a nursing home in Hong Kong, with emphasis on its contribution to the conceptual framework for understanding selfhood of older adults with dementia. RESEARCH DESIGN AND METHODS As a community-based participatory action research (CBPAR) project, this study democratized knowledge production by integrating voices of practitioners with diverse backgrounds through video-based methods. RESULTS Play, as an activity replete with free expressions and impulsive interactions, is an ideal realm for exploring and establishing selfhood with older adults with dementia. It has been found that "aesthetic self", an alternative self emerging from immediate aesthetic experience and carrying transformative power within the caring relationship, is a necessary element of self-construction in life with dementia. DISCUSSION AND IMPLICATIONS Integrating theories and practice, this framework provides a new lens for understanding and responding to selfhood, disease, and life.
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Affiliation(s)
- Bing Yu Li
- Department of Sociology, Law School, Shenzhen University, Shenzhen, China
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4
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Foo CD, Tan YL, Shrestha P, Eh KX, Ang IYH, Nurjono M, Toh SA, Shiraz F. Exploring the dimensions of patient experience for community-based care programmes in a multi-ethnic Asian context. PLoS One 2020; 15:e0242610. [PMID: 33237953 PMCID: PMC7688169 DOI: 10.1371/journal.pone.0242610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 11/06/2020] [Indexed: 11/19/2022] Open
Abstract
Introduction The aim of this study is to explore patients’ experiences with community-based care programmes (CCPs) and develop dimensions of patient experience salient to community-based care in Singapore. Most countries like Singapore are transforming its healthcare system from a hospital-centric model to a person-centered community-based care model to better manage the increasing chronic disease burden resulting from an ageing population. It is thus critical to understand the impact of hospital to community transitions from the patients’ perspective. The exploration of patient experience will guide the development of an instrument for the evaluation of CCPs for quality improvement purposes. Methods A qualitative exploratory study was conducted where face-to-face in-depth interviews were conducted using a purposive sampling method with patients enrolled in CCPs. In total, 64 participants aged between 41 to 94 years were recruited. A deductive framework was developed using the Picker Patient Experience instrument to guide our analysis. Inductive coding was also conducted which resulted in emergence of new themes. Results Our findings highlighted eight key themes of patient experience: i) ensuring care continuity, ii) involvement of family, iii) access to emotional support, vi) ensuring physical comfort, v) coordination of services between providers, vi) providing patient education, vii) importance of respect for patients, and viii) healthcare financing. Conclusion Our results demonstrated that patient experience is multi-faceted, and dimensions of patient experience vary according to healthcare settings. As most patient experience frameworks were developed based on a single care setting in western populations, our findings can inform the development of a culturally relevant instrument to measure patient experience of community-based care for a multi-ethnic Asian context.
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Affiliation(s)
- Chuan De Foo
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- * E-mail:
| | - Yan Lin Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Pami Shrestha
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- Singapore Population Health Improvement Centre (SPHERiC), National University Health System, Singapore, Singapore
| | - Ke Xin Eh
- Singapore Population Health Improvement Centre (SPHERiC), National University Health System, Singapore, Singapore
- Regional Health System Office, National University Health System, Singapore, Singapore
| | - Ian Yi Han Ang
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- Regional Health System Office, National University Health System, Singapore, Singapore
| | - Milawaty Nurjono
- Centre for Health Services and Policy Research (CHSPR), Saw Swee Hock School of Public Health National University of Singapore, Singapore, Singapore
- Health Services Research, Changi General Hospital, Singapore Health Services, Singapore, Singapore
| | - Sue-Anne Toh
- Singapore Population Health Improvement Centre (SPHERiC), National University Health System, Singapore, Singapore
- Regional Health System Office, National University Health System, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Farah Shiraz
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- Singapore Population Health Improvement Centre (SPHERiC), National University Health System, Singapore, Singapore
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5
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Ngiam LXL, Ong YT, Ng JX, Kuek JTY, Chia JL, Chan NPX, Ho CY, Abdurrahman ABHM, Kamal NHA, Cheong CWS, Ng CH, Tan XH, Tan LHE, Chin AMC, Mason S, Jumat MR, Chiam M, Krishna LKR. Impact of Caring for Terminally Ill Children on Physicians: A Systematic Scoping Review. Am J Hosp Palliat Care 2020; 38:396-418. [PMID: 32815393 DOI: 10.1177/1049909120950301] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Caring for terminally ill children influences nurses' and allied health provider's quality of life, ability to provide personalized, dignified and empathetic care and even their concepts of personhood. In the absence of data this review utilizes the Ring Theory of Personhood (RToP) to evaluate how a physician's concept of personhood is affected caring for terminally ill children in order to better support them holistically. METHODS Using PRISMA Guidelines, 14 researchers carried out independent searches of PubMed, CINAHL, PsycINFO, Cochrane Library and gray literature databases for articles published between 2000 to 2019. Concurrent and independent employment of content and thematic analysis (Split Approach) was used to enhance the trustworthiness of the analysis. RESULTS 13,424 titles and abstracts were retrieved, 188 full texts were evaluated, and 39 articles were included and analyzed. Identical categories and themes identified using the Split Approach suggest that caring for dying children in PPC impacts the physician's professional identity, clinical decision making, personal well-being and relationships. The data also suggests that the magnitude of these effects depends on the presence of protective and risk factors. CONCLUSION Aside from providing a novel insight into the upon the physician, this review proffers a unique approach to accounting for the presence, magnitude and influence of incoming catalysts, resultant conflicts, and protective and risk factors upon the physician's personhood. Further studies into the changes in personhood are required. Design of a personalized assessment tool based on the RToP will help direct timely, appropriate and personalized support to these physicians.
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Affiliation(s)
- Lisa Xin Ling Ngiam
- 63751Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Yun Ting Ong
- 63751Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Jun Xuan Ng
- 63751Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Joshua Tze Yin Kuek
- 63751Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Jeng Long Chia
- 63751Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Natalie Pei Xin Chan
- 63751Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Chong Yao Ho
- 63751Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Ahmad Bin Hanifah Marican Abdurrahman
- 63751Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Nur Haidah Ahmad Kamal
- 63751Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Clarissa Wei Shuen Cheong
- 63751Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Cheng Han Ng
- 63751Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Xiu Hui Tan
- 63751Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Lorraine Hui En Tan
- 63751Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | | | - Stephen Mason
- Palliative Care Institute Liverpool, Academic Palliative & End of Life Care Centre, University of Liverpool, United Kingdom
| | | | - Min Chiam
- Division of Cancer Education, 68751National Cancer Centre Singapore, Singapore
| | - Lalit Kumar Radha Krishna
- 63751Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore.,Palliative Care Institute Liverpool, Academic Palliative & End of Life Care Centre, University of Liverpool, United Kingdom.,Duke-NUS Medical School, 63751National University of Singapore, Singapore.,Division of Cancer Education, 68751National Cancer Centre Singapore, Singapore.,Centre of Biomedical Ethics, 37580National University of Singapore, Singapore.,PalC, The Palliative Care Centre for Excellence in Research and Education, Singapore
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La IS, Lee MC, Hinderer KA, Chi I, Liu R, Liu M, Fu Y. Palliative Care for the Asian American Adult Population: A Scoping Review. Am J Hosp Palliat Care 2020; 38:658-670. [PMID: 32489147 DOI: 10.1177/1049909120928063] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The Asian American (AA) population is rapidly becoming one of the largest racial/ethnic groups in the United States. Despite this growth and advances in palliative care (PC) programs in the United States, the scope and nature of the literature regarding PC for AAs remains unclear. This review provides an overview of existing research on PC for AAs, identifies gaps in the research with recommendations for future research and delineates practice implications. METHODS A scoping review of studies published in English was conducted. Electronic Databases (PubMed, Embase, CINAHL, and PsycINFO databases) were searched up to December 2019. No starting date limit was set. Arksey and O'Malley's methodological framework was followed for scoping reviews. RESULTS Of 2390 publications initially identified, 42 studies met our inclusion criteria for this review. Southeast AA subgroups remain understudied compared to East and South AAs. Most studies were descriptive; a few (n = 3) evaluated effectiveness of PC interventions for AAs. Research synthesized in this review addresses the following topics and includes considerations in PC related to care recipients and their relatives: treatment choice discussions (73%), coordination of care with health care providers (26%), symptom management (14%), and emotional support (10%). This review identified various factors around PC for AAs, specifically the influence of cultural aspects, including levels of acculturation, traditional norms and values, and religious beliefs. CONCLUSION A culturally inclusive approach is vital to providing appropriate and accessible PC for AAs. Further research is needed concerning core PC components and effective interventions across diverse AA subgroups.
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Affiliation(s)
- In Seo La
- 16112University of Maryland School of Nursing, Baltimore, MD, USA
| | - Mei Ching Lee
- 16112University of Maryland School of Nursing, Baltimore, MD, USA
| | | | - Iris Chi
- 115162Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Ruotong Liu
- 115162Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Mandong Liu
- 115162Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Yunting Fu
- Health Sciences and Human Services Library, 12265University of Maryland, Baltimore, MD, USA
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Liew KK. Suturing the Nation in South Korean Historical Television Medical Dramas. THE JOURNAL OF MEDICAL HUMANITIES 2020; 41:193-205. [PMID: 31848841 DOI: 10.1007/s10912-019-09586-6] [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: 06/10/2023]
Abstract
Using the 2000-2010 South Korean historical medical dramas Heo Jun (The Way of Medicine), Dae Jang Geum (Jewel in the Palace), and Jejoongwon (The Hospital) as case studies, this article examines televisual reimaginations of Korean medical modernity as (re)interpretative popular culture texts. Particularly in the areas of the anatomical sciences and surgery, modern medicine's emancipatory potentials in these productions are set semi-fictitiously in pre-modern Joseon historical contexts. Dramaturgically challenging entrenched social hierarchies and ossified cultural taboos of Institutionalized Confucianism, these dramas' progressive physician-protagonists emphasize the universality and impartiality of medical knowledge in what is herein termed as Generative Confucianism.
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Affiliation(s)
- Kai Khiun Liew
- Wee Kim Wee School of Communication and Information, Nanyang Technological University, 31 Nanyang Link, WKWSCI Building, Singapore, 637718, Singapore.
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8
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Han E, Haldane V, Koh JJK, Quek RYC, Ozdemir S, Finkelstein EA, Jafar TH, Choong H, Gan S, Lim LWW, Shiraz F, Legido‐Quigley H. Perspectives on decision making amongst older people with end-stage renal disease and caregivers in Singapore: A qualitative study. Health Expect 2019; 22:1100-1110. [PMID: 31418984 PMCID: PMC6803400 DOI: 10.1111/hex.12943] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 07/08/2019] [Accepted: 07/09/2019] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND End-stage renal disease (ESRD) is increasing both globally and in Asia. Singapore has the fifth highest incidence of ESRD worldwide, a trend that is predicted to rise. Older patients with ESRD are faced with a choice of haemodialysis, peritoneal dialysis or conservative management, all of which have their risks and benefits. OBJECTIVE This study seeks to explore perspectives on decision making amongst older (≥70) Singaporean ESRD patients and their caregivers to undergo (or not to undergo) dialysis. DESIGN Qualitative study design using semi-structured interviews. SETTING AND PARTICIPANTS Twenty-three participants were recruited from the largest tertiary hospital in Singapore: seven peritoneal dialysis patients, five haemodialysis patients, four patients on conservative management and seven caregivers. RESULTS While some patients believed that they had made an independent treatment decision, others reported feeling like they had no choice in the matter or that they were strongly persuaded by their doctors and/or family members to undergo dialysis. Patients reported decision-making factors including loss of autonomy in daily life, financial burden (on themselves or on their families), caregiving burden, alternative medicine, symptoms and disease progression. Caregivers also reported concerns about financial and caregiving burden. DISCUSSION AND CONCLUSION This study has identified several factors that should be considered in the design and implementation of decision aids to help older ESRD patients in Singapore make informed treatment decisions, including patients' and caregivers' decision-making factors as well as the relational dynamics between patients, caregivers and doctors.
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Affiliation(s)
- Emeline Han
- Saw Swee Hock School of Public HealthNational University of SingaporeSingaporeSingapore
| | - Victoria Haldane
- Saw Swee Hock School of Public HealthNational University of SingaporeSingaporeSingapore
| | - Joel Jun Kai Koh
- Saw Swee Hock School of Public HealthNational University of SingaporeSingaporeSingapore
| | - Rina Yu Chin Quek
- Saw Swee Hock School of Public HealthNational University of SingaporeSingaporeSingapore
| | | | | | | | - Hui‐Lin Choong
- Department of Renal MedicineSingapore General HospitalSingaporeSingapore
| | - Sheryl Gan
- Department of Renal MedicineSingapore General HospitalSingaporeSingapore
| | - Lydia W. W. Lim
- Department of Renal MedicineSingapore General HospitalSingaporeSingapore
| | - Farah Shiraz
- Saw Swee Hock School of Public HealthNational University of SingaporeSingaporeSingapore
| | - Helena Legido‐Quigley
- Saw Swee Hock School of Public HealthNational University of SingaporeSingaporeSingapore
- London School of Hygiene and Tropical MedicineLondonUK
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Payne S, Chapman A, Holloway M, Seymour JE, Chau R. Chinese Community Views: Promoting Cultural Competence in Palliative Care. J Palliat Care 2019. [DOI: 10.1177/082585970502100207] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Sheila Payne
- Palliative and End-of-Life Care Research Group, University of Sheffield
| | - Alice Chapman
- Palliative and End-of-Life Care Research Group, University of Sheffield
| | | | - Jane E. Seymour
- Palliative and End-of-Life Care Research Group, University of Sheffield
| | - Ruby Chau
- Department of Sociological Studies, University of Sheffield, Sheffield, UK
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10
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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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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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12
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Wang R, Langhammer B. Predictors of quality of life for chronic stroke survivors in relation to cultural differences: a literature review. Scand J Caring Sci 2017; 32:502-514. [DOI: 10.1111/scs.12533] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Accepted: 09/05/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Rongrong Wang
- Department of Physiotherapy; Faculty of Health; Oslo and Akershus University College; Oslo Norway
- Neurorehabilitation Department; China Rehabilitation Research Center; Beijing China
| | - Birgitta Langhammer
- Department of Physiotherapy; Faculty of Health; Oslo and Akershus University College; Oslo Norway
- Sunnaas Rehabilitation Hospital; Oslo Norway
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Helmich E, Yeh HM, Yeh CC, de Vries J, Fu-Chang Tsai D, Dornan T. Emotional Learning and Identity Development in Medicine: A Cross-Cultural Qualitative Study Comparing Taiwanese and Dutch Medical Undergraduates. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2017; 92:853-859. [PMID: 28353499 DOI: 10.1097/acm.0000000000001658] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
PURPOSE Current knowledge about the interplay between emotions and professional identity formation is limited and largely based on research in Western settings. This study aimed to broaden understandings of professional identity formation cross-culturally. METHOD In fall 2014, the authors purposively sampled 22 clinical students from Taiwan and the Netherlands and asked them to keep audio diaries, narrating emotional experiences during clerkships using three prompts: What happened? What did you feel/think/do? How does this interplay with your development as a doctor? Dutch audio diaries were supplemented with follow-up interviews. The authors analyzed participants' narratives using a critical discourse analysis informed by Figured Worlds theory and Bakhtin's concept of dialogism, according to which people's spoken words create identities in imagined future worlds. RESULTS Participants talked vividly, but differently, about their experiences. Dutch participants' emotions related to individual achievement and competence. Taiwanese participants' rich, emotional language reflected on becoming both a good person and a good doctor. These discourses constructed doctors' and patients' autonomy in culturally specific ways. The Dutch construct centered on "hands-on" participation, which developed the identity of a technically skilled doctor, but did not address patients' self-determination. The Taiwanese construct located physicians' autonomy within moral values more than practical proficiency, and gave patients agency to influence doctor-patient relationships. CONCLUSIONS Participants' cultural constructs of physician and patient autonomy led them to construct different professional identities within different imagined worlds. The contrasting discourses show how medical students learn about different meanings of becoming doctors in culturally specific contexts.
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Affiliation(s)
- Esther Helmich
- E. Helmich is senior researcher, Center for Education Development and Research in Health Professions, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.H.-M. Yeh is assistant professor, Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan.C.-C. Yeh is attending physician, Department of Medical Education/Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan.J. de Vries is a PhD student, Center for Evidence-Based Education, Academic Medical Center/University of Amsterdam, Amsterdam, the Netherlands.D.F.-C. Tsai is professor, Research Institute of Medical Education & Bioethics, National Taiwan University College of Medicine, and attending physician, Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan.T. Dornan is professor, School of Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast, United Kingdom
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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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Mak WWS, Ng ISW, Wong CCY, Law RW. Resilience Style Questionnaire: Development and Validation Among College Students and Cardiac Patients in Hong Kong. Assessment 2016; 26:706-725. [PMID: 28006974 DOI: 10.1177/1073191116683798] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The present research aims to develop and validate a measure of resilience that reflects the influence of Confucian philosophies and Chinese cultural lay beliefs. Based on a representative sample of 1,419 college students from universities and a clinical sample of 214 cardiac patients in Hong Kong, reliability, construct validity, and criterion validity of the Resilience Style Questionnaire (RSQ) were examined. A two-factor structure of the RSQ was explored and validated in both samples. Results showed that the two factors of the RSQ (i.e., perseverance and optimistic approach to life) were significantly associated with a variety of mental health indicators in both samples. Furthermore, the RSQ explained additional variances above and beyond those explained by the Ego-Resiliency Scale, the Sense of Coherence Scale (SOC), and the Connor-Davidson Resilience Scale in multiple mental health indicators among college students and cardiac patients. These findings showed that the RSQ is a reliable and valid tool in assessing resilience among Chinese and other groups influenced by Confucianism.
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Affiliation(s)
| | - Ivy S W Ng
- 1 The Chinese University of Hong Kong, Hong Kong, China
| | | | - Rita W Law
- 1 The Chinese University of Hong Kong, Hong Kong, China
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O’Connor D, Phinney A, Smith A, Small J, Purves B, Perry J, Drance E, Donnelly M, Chaudhury H, Beattie L. Personhood in dementia care. DEMENTIA 2016. [DOI: 10.1177/1471301207075648] [Citation(s) in RCA: 127] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Dementia has been understood primarily as a biomedical phenomenon with a trajectory of irrevocable decline related to neurodegenerative changes. However, growing evidence suggests that the performance and behaviour of persons with dementia are not exclusively determined by neuropathology but are also influenced by personal histories, social interactions and social contexts. This evidence shifts attention from the disease process to the need for a more in-depth understanding of the place of personhood in dementia care. Despite its intuitive appeal however, there is limited empirical research grounding this approach to care. This article articulates a framework for organizing research in this area that is based on a critical review and synthesis of research. It encompasses three interrelated and intersecting domains of inquiry: the subjective experience of the person with dementia, the immediate interactional environment and the broader socio-cultural context. Each domain encapsulates a unique but interrelated dimension of a person-centred approach to dementia care.
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Soh TLGB, Krishna LKR, Sim SW, Yee ACP. Distancing sedation in end-of-life care from physician-assisted suicide and euthanasia. Singapore Med J 2016; 57:220-7. [PMID: 27211055 DOI: 10.11622/smedj.2016086] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Lipuma equates continuous sedation until death (CSD) to physician-assisted suicide/euthanasia (PAS/E) based on the premise that iatrogenic unconsciousness negates social function and, thus, personhood, leaving a patient effectively 'dead'. Others have extrapolated upon this position further, to suggest that any use of sedation and/or opioids at the end of life would be analogous to CSD and thus tantamount to PAS/E. These posits sit diametrically opposite to standard end-of-life care practices. This paper will refute Lipuma's position and the posits borne from it. We first show that prevailing end-of-life care guidelines require proportional and monitored use of sedatives and/or opioids to attenuate fears that the use of such treatment could hasten death. These guidelines also classify CSD as a last resort treatment, employed only when symptoms prove intractable, and not amenable to all standard treatment options. Furthermore, CSD is applied only when deemed appropriate by a multidisciplinary palliative medicine team. We also show that empirical data based on local views of personhood will discount concerns that iatrogenic unconsciousness is tantamount to a loss of personhood and death.
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Affiliation(s)
- Tze Ling Gwendoline Beatrice Soh
- Division of Palliative Medicine, National Cancer Centre, Singapore.,Duke-NUS Medical School, National University of Singapore, Singapore
| | - Lalit Kumar Radha Krishna
- Division of Palliative Medicine, National Cancer Centre, Singapore.,Duke-NUS Medical School, National University of Singapore, Singapore.,Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Shin Wei Sim
- Division of Palliative Medicine, National Cancer Centre, Singapore
| | - Alethea Chung Peng Yee
- Division of Palliative Medicine, National Cancer Centre, Singapore.,Duke-NUS Medical School, National University of Singapore, Singapore
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18
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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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Yang HF, Cong JY, Zang XY, Jiang N, Zhao Y. A study on knowledge, attitudes and health behaviours regarding Alzheimer's disease among community residents in Tianjin, China. J Psychiatr Ment Health Nurs 2015; 22:706-14. [PMID: 26282709 DOI: 10.1111/jpm.12259] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/02/2015] [Indexed: 12/22/2022]
Abstract
ACCESSIBLE SUMMARY What is known on the subject? Several studies have measured the general public's knowledge and attitudes towards Alzheimer's disease; however, much of this work is based on western samples. Due to cultural differences, the western findings may be difficult to generalize to the Chinese general public. In addition, the few studies conducted in China were often restricted to a relatively narrow range of knowledge and attitudes. What this paper adds to existing knowledge? The general public had little knowledge of Alzheimer's disease, especially on the causes, symptoms and risk factors. In terms of attitudes, although the general public held positive attitudes towards persons with Alzheimer's disease, most of them were not sure whether or not to share a diagnosis of Alzheimer's disease with the patient. In daily life, only a low proportion of people kept mentally active. What are the implications for practice? A popularization of a wide range of knowledge about Alzheimer's disease needs to be undertaken, especially focusing on persons with low educational level and emphasizing the causes, symptoms and risk factors. Besides, there is a significant need to draw up evidence-based dietary and lifestyle guidelines for Alzheimer's disease risk reduction. Moreover, health promotion agencies should identify priority groups for Alzheimer's disease risk reduction initiatives, especially those with lower income, a lower level of knowledge on Alzheimer's disease and with chronic diseases. AIM The purpose of this descriptive correlational cross-sectional study was to assess the current level of knowledge, attitudes and health behaviours regarding Alzheimer's disease among community residents in Tianjin, China and to identify factors related to these attributes. METHOD A convenience sample of 140 community-dwelling adults aged 20-75 years was selected to complete a researcher-designed questionnaire about Alzheimer's disease-related knowledge, attitudes and health behaviours. RESULTS The findings revealed that 15.7% of the participants knew the risk factors for Alzheimer's disease. With regard to attitude, 138 participants (98.6%) believed that people with Alzheimer's disease should not be discriminated against, and 55.7% were not sure whether to share a diagnosis of Alzheimer's disease with the patient. In daily life, 28.6% of the participants pursued their interests and hobbies. A lower level of health behaviours was associated with lower income, presence of chronic diseases and a lower level of knowledge about Alzheimer's disease. DISCUSSION These findings provide a strong case for population-level risk reduction initiatives to be undertaken, especially among people with lower income, a lower level of knowledge on Alzheimer's disease and with chronic diseases.
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Affiliation(s)
- H-F Yang
- School of Nursing, Tianjin Medicial University, Tianjin, China
| | - J-Y Cong
- School of Nursing, Tianjin Medicial University, Tianjin, China
| | - X-Y Zang
- School of Nursing, Tianjin Medicial University, Tianjin, China
| | - N Jiang
- School of Nursing, Tianjin Medicial University, Tianjin, China
| | - Y Zhao
- School of Nursing, Tianjin Medicial University, Tianjin, China
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Huang CC, Huang CC, Yang YY, Lin SJ, Chen JW. The influence of gender on the communication skills assessment of medical students. Eur J Intern Med 2015; 26:670-4. [PMID: 26160772 DOI: 10.1016/j.ejim.2015.06.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 05/12/2015] [Accepted: 06/27/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND Opinions on the interaction between the genders of standardized patients and examinees are controversial. Our study sought to determine the influence of gender on communication skills assessment in Eastern country. METHODS We recruited year 5 medical students from a medical college in Taiwan. They were assigned to obtain informed consent from either male or female age-matched standardized patients. Their performance was rated by standardized checklist rating scores and global rating scores. Either male or female examiners rated their performance. RESULTS A total of 253 medical students (166 male students and 87 female students) were recruited. The checklist rating scores for students interacting with male standardized patients were significantly lower than the scores for interactions with female standardized patients (male examiners, P=0.006; female examiners, P=0.001). For male students, the checklist rating scores were significantly lower for male standardized patients than for female standardized patients (male examiners, P=0.006; female examiners, P=0.008). For male standardized patients, male students had significantly lower checklist rating scores than female students when rated by male examiners (P=0.044). The global rating scores were similar except when female students interacted with male and female SPs and when rated by female examiners (P=0.004). CONCLUSION The gender of standardized patients influences communication skills assessment. In terms of checklist rating scores, female standardized patients seem preferable to minimize potential gender effects. In the best interest of students, global rating score may be preferable to checklist rating score, especially for male examinees.
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Affiliation(s)
- Chin-Chou Huang
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.; Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.; Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C.; Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan, R.O.C.; Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan, R.O.C
| | - Chia-Chang Huang
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.; Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C
| | - Ying-Ying Yang
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.; Division of General Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.; Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C
| | - Shing-Jong Lin
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.; Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.; Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan, R.O.C.; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C
| | - Jaw-Wen Chen
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.; Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.; Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan, R.O.C.; Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan, R.O.C..
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Lee GL, Fan GKT, Chan SWC. Validation of Chinese and English versions of the Holistic Well-being Scale in patients with cancer. Support Care Cancer 2015; 23:3563-71. [DOI: 10.1007/s00520-015-2736-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 04/06/2015] [Indexed: 09/29/2022]
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Pratt B, Van C, Cong Y, Rashid H, Kumar N, Ahmad A, Upshur R, Loff B. Perspectives from South and East Asia on clinical and research ethics: a literature review. J Empir Res Hum Res Ethics 2014; 9:52-67. [PMID: 24782072 DOI: 10.1525/jer.2014.9.2.52] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A review was conducted of English-language peer-reviewed and gray literature on health and ethics written by authors from Bangladesh, China, India, and Pakistan. This was supplemented by the knowledge of co-authors who are involved in bioethics capacity building in these countries. Of the identified literature that focused on the application of Western principles, it largely discussed informed consent and revealed norms in clinical decision-making that include physician paternalism, family involvement in decision-making, and reluctance to provide information that might upset patients. It appears that Western ethical principles may be interpreted and applied in unexpected ways. The literature further indicates that, although there is some consistency with Western ideas, Islamic, Confucian, and Indian religious and philosophical traditions contain concepts not reflected in international guidance. Findings suggest scholars from these countries seek to enter into a bioethics dialogue with the potential to enrich and inform "international" frameworks.
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Affiliation(s)
- Bridget Pratt
- Johns Hopkins University (USA) University of Melbourne (Australia)
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Abstract
OBJECTIVE The manner in which personhood or "what makes you who you are" is conceived is key to the provision of patient-centered care and maintenance of the dignity and quality of life of terminally ill patients. However, there is little agreement on how this pivotal concept ought to be defined. Some have argued in favor of an innate concept of personhood, while others see an individual as a reflection of their familial identity or their conscious function, and all share a common position that personhood is unchanging, and hinges upon the central theme of their respective concepts. The present paper aims to explore a more clinically influenced perspective of personhood. METHOD We report the case of a 42-year-old Malay Singaporean who had been a caregiver for her husband throughout his cancer and then became a cancer patient herself after his passing. This case explores her changing and multifaceted conceptions of personhood throughout her life and illness, and discussions about end-of-life care. RESULTS The patient reports a concept of personhood that encompasses the innate, individual, relational, and societal aspects, which are interlinked and vary in terms of depth and conviction according to the various times in her life and illness. SIGNIFICANCE OF RESULTS Our findings support the ring theory of personhood, which provides a clinically supported model of the conception of personhood that is context dependent and encompasses the four abovementioned aspects.
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24
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Krishna LKR, Watkinson DS, Beng NL. Limits to relational autonomy--the Singaporean experience. Nurs Ethics 2014; 22:331-40. [PMID: 24913544 DOI: 10.1177/0969733014533239] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Recognition that the Principle of Respect for Autonomy fails to work in family-centric societies such as Singapore has recently led to the promotion of relational autonomy as a suitable framework within which to place healthcare decision making. However, empirical data, relating to patient and family opinions and the practices of healthcare professionals in Confucian-inspired Singapore, demonstrate clear limitations on the ability of a relational autonomy framework to provide the anticipated compromise between prevailing family decision-making norms and adopted Western led atomistic concepts of autonomy. Evidence suggests that despite a growing infusion of Western influence, there is still little to indicate any major shift to individual decision making, particularly in light of the way society and healthcare are structured. Similarly, the lack of employing a shared decision-making model and data that discredit the notion that the complex psychosocial and cultural factors that affect the decision making may be considered "content neutral" not only prevents the application of relational autonomy but questions the viability of the values behind the Principle of Respect for Autonomy. Taking into account local data and drawing upon a wider concept of personhood that extends beyond prevailing family-centric ideals along with the complex interests that are focused upon the preservation of the unique nature of personhood that arises from the Ring Theory of Personhood, we propose and "operationalize" the employing of an authoritative welfare-based approach, within the confines of best interest decision making, to better meet the current care needs within Singapore.
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Radha Krishna LK. Accounting for personhood in palliative sedation: the Ring Theory of Personhood. MEDICAL HUMANITIES 2014; 40:17-21. [PMID: 24072720 DOI: 10.1136/medhum-2013-010368] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Application of sedation at the end of life has been fraught with ethical and clinical concerns, primarily focused on its potential to hasten death. However, in the face of clinical data that assuage most of these concerns, a new threat to this treatment of last resort has arisen. Concern now pivots on its effects on the personhood of the patient, underpinned by the manner in which personhood has been conceptualised. For many authors, it is consciousness that is seen to be the seat of personhood, thus its loss is seen to rob a patient of their moral and ethical worth, leaving them in a state that cannot ethically be differentiated from death. Here I proffer a clinically based alternative to this view, the Ring Theory of Personhood, which dispels these concerns about sedation at the end of life. The Ring Theory envisages personhood as a coadunation of three domains of concern: the innate, the individual and the relational elements of personhood. The innate element of personhood is held to be present among all humans by virtue of their links with the Divine and or their human characteristics. The individual elements of personhood pivot on the presence of consciousness-dependent features such as self-awareness, self-determination and personality traits. The relational component of personhood envisages an individual as being 'socially embedded' replete with social and familial ties. It is these three equally important inter-related domains that define personhood.
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Krishna LKR, Alsuwaigh R, Miti PT, Wei SS, Ling KH, Manoharan D. The influence of the family in conceptions of personhood in the palliative care setting in Singapore and its influence upon decision making. Am J Hosp Palliat Care 2013; 31:645-54. [PMID: 23946254 DOI: 10.1177/1049909113500136] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Conceptions of personhood are critical to the preservation of dignity and quality of life key to a good death and pivotal to the provision of patient centred care. Increasingly there is speculation that this role may be wider still. It has been posited that it is Confucian inspired conceptions of personhood replete with its `dualistic' view of personhood that sees family members as part of the individual's personhood that predispose to the prevailing practices of collusion and the trumping of patient autonomy. In a nation where family centric decision making still dominates end of life decision making, the need to appropriately conceptualise local conceptions of personhood are clear. To this end a mixed methods study of 30 Singaporean oncology and palliative care patients was undertaken. Data accrued revealed local conceptions of personhood to be evolving ideas that are determined by four equally important closely related dimensions. Here Innate Personhood which represents the belief that all persons irrespective of their clinical condition and level of development are deserving of personhood, Individual Personhood which relates to consciousness related faculties, Relational Personhood which relates to the social and familial connections important to the person and Societal Personhood which relates to the roles played in society; combine to proffer the Ring Theory of Personhood. This concept provides a better means of providing for the specific needs of patients with life threatening illnesses whilst providing a unique insight into the role families play in the manner local patients conceive themselves to be.
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Affiliation(s)
| | - Rayan Alsuwaigh
- Yong Loo Lin School of Medicine, University of Singapore, Singapore
| | | | - Sim Shin Wei
- Yong Loo Lin School of Medicine, University of Singapore, Singapore
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Abstract
Religious traditions of medical ethics tend to differ from more secular approaches by stressing limitations on autonomous decision-making, by more positively valuing the experience of suffering, and by drawing on beliefs and values that go beyond empiric verification. I trace the impact of these differences for some of the world's great religious traditions with respect to four issues: (1) religious conscientious objection to medical treatments; (2) end-of life decision-making, including euthanasia, physician-assisted suicide, and the withholding or withdrawing of life-sustaining treatments; (3) definitions of moral personhood (defining life's beginning and end); and (4) human sexuality.
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Affiliation(s)
- Ronald M Green
- Department of Religion, Dartmouth College, Hanover, NH, USA.
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Lin ML, Pang MCS, Chen CH. Family as a whole: elective surgery patients’ perception of the meaning of family involvement in decision making. J Clin Nurs 2012; 22:271-8. [DOI: 10.1111/j.1365-2702.2012.04194.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Rater evaluations for psychiatric instruments and cultural differences: the positive and negative syndrome scale in China and the United States. J Nerv Ment Dis 2012; 200:814-20. [PMID: 22922237 PMCID: PMC3885177 DOI: 10.1097/nmd.0b013e318266bcaa] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This article compares Positive and Negative Syndrome Scale (PANSS) data from Chinese and American inpatients with chronic schizophrenia to show how differences in item ratings may reflect cultural attitudes of raters. The Chinese sample (N = 504) came from Beijing Huilongguan Hospital. The American sample came from 268 PANSS assessments of Clinical Antipsychotic Trials of Intervention Effectiveness subjects hospitalized for 15 days or more to optimize equivalence of the samples. When controlling for age and sex, the Chinese sample scored significantly lower for total score by 25% (p < 0.0001), for the positive subscale by 35% (p < 0.0001), and on the general subscale by 32% (p < 0.0001) but not significantly different on the negative subscale score (+0.26%; p = 0.76). However, the Chinese sample scored 26% higher on the item on poor rapport (p < 0.0001), 10.2% higher on passive social withdrawal (p = 0.003), and most notably 46% higher on the item on lack of judgment and insight (p < 0.0001). These results remain broadly consistent across sex subgroup analyses. Differences seem to be best explained by both cultural differences in patient clinical presentations and varying American and Chinese cultural values affecting rater judgment.
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30
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Lin ML, Kan WM, Chen CH. Patients' perceptions and expectations of family participation in the informed consent process of elective surgery in taiwan. Asian Nurs Res (Korean Soc Nurs Sci) 2012; 6:55-9. [PMID: 25030828 DOI: 10.1016/j.anr.2012.05.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2011] [Revised: 03/18/2012] [Accepted: 03/27/2012] [Indexed: 10/28/2022] Open
Abstract
PURPOSE This study investigated patients' perceptions and expectations of their families' participation in the informed consent process of elective surgery. METHODS This is a survey study. Anonymous questionnaires that were mailed to potential participants included a demographic data sheet and a scale, measuring patients' perceptions of themselves and their families' participation level in the informed consent process. A convenience sample of patients who had undergone surgery and had been discharged within 4 months from a medical center in southern Taiwan (n = 1,737) were recruited. RESULTS One hundred and forty-five recipients replied, gaining a response rate of 10.0%, and 120 provided complete data. The mean age of the participants was 56.0 years (range 20-85, SD = 14.98), and more than half were female (54.2%). Twenty-one participants (17.5%) perceived having less family participation than their own participation in the surgery informed consent process, and 40% expected more family participation in the process. The mean scores of the self-rated participation level was significantly higher than that of the families (p < .001). Patients' expectations of family participation were significantly higher than their perceptions of family participation (p < .001). Eleven patients (9.2%) reported having more family participation than they expected. Participants received the most information about the disease during the informed consent process and the least information about alternatives to surgery. Age, gender, number of previous surgeries and admissions influenced the study participants' perceived level of participation in the informed consent process. CONCLUSION This preliminary study demonstrates that patients' perceptions and expectations for family participation in the surgical informed consent process vary. Healthcare providers should be aware of patients' expectation to appropriately invite their family into the informed consent process.
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Affiliation(s)
- Mei-Ling Lin
- Institute of Allied Health Sciences, National Cheng Kung University, Tainan, Taiwan
| | - Wai-Ming Kan
- Department of Pharmacology, National Cheng Kung University, Tainan, Taiwan
| | - Ching-Huey Chen
- Department of Nursing and Institute of Allied Health Sciences, National Cheng Kung University, Tainan, Taiwan
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31
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Abstract
Familialism is a significant mindset within Singaporean culture. Its effects through the practice of familial determination and filial piety, which calls for a family centric approach to care determination over and above individual autonomy, affect many elements of local care provision. However, given the complex psychosocial, political and cultural elements involved, the applicability and viability of this model as well as that of a physician-led practice is increasingly open to conjecture. This article will investigate some of these concerns before proffering a decision-making process based upon a multidisciplinary team approach. It will be shown that such a multidimensional and multiprofessional approach is more in keeping with the inclusive and patient-centred ethos of palliative care than prevailing practices. It will be shown that such an approach will also be better placed to deliver holistic, coherent and sensitive end-of-life care that palliative care espouses.
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Aggarwal NK, Tao H, Xu K, Stefanovics E, Zhening L, Rosenheck RA. Comparing the PANSS in Chinese and American inpatients: cross-cultural psychiatric analyses of instrument translation and implementation. Schizophr Res 2011; 132:146-52. [PMID: 21885258 DOI: 10.1016/j.schres.2011.08.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2011] [Revised: 08/02/2011] [Accepted: 08/08/2011] [Indexed: 10/17/2022]
Abstract
This article compares data from the Positive and Negative Syndrome Scale (PANSS) collected from Chinese and American inpatients diagnosed with schizophrenia to show how patterned differences in item ratings may reflect cultural attitudes of the raters. The Chinese sample (N=553) was based on consecutive admissions to four academic hospitals in Changsha, China. Only patients ill for 3 or more years were included in the analysis to match the chronically ill sample represented in the US CATIE sample. A total of 261 PANSS assessments were completed during a month when CATIE subjects had been hospitalized for 15 days or more to optimize equivalence of the US and Chinese samples. Controlling for age and gender, the total PANSS and the three sub-scores were all significantly lower in the Chinese than in the US CATIE sample by 5-8% (all p<.05). However, on 9 items, the Chinese sample scored 10-30% higher than the US sample (all p<.05) and on 5 items they scored over 20% higher (all p<.0001). These items rated increased hostility, poorer attention, lack of judgment and insight, disturbance of volition, and poorer impulse control. We ascribe these differences to cultural variations in the ways individuals relate to others in their social environment within Chinese and American societies.
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Affiliation(s)
- Neil Krishan Aggarwal
- Department of Psychiatry, Yale University, 300 George Street, Suite 901, New Haven, CT 06511, United States.
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Huang YP, Kellett U, St John W. Being concerned: caregiving for Taiwanese mothers of a child with cerebral palsy. J Clin Nurs 2011; 21:189-97. [DOI: 10.1111/j.1365-2702.2011.03741.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Abstract
The use of Nasogastric (NG) feeding in the provision of artificial nutrition and hydration at the end of life has, for the most part, been regarded as futile by the medical community. This position has been led chiefly by prevailing medical data. In Singapore, however, there has been an increase in its utilization supported primarily by social, religious and cultural factors expressly to prolong life of the terminally ill patient. Here this article will seek to review the ethical and clinical impact of this treatment and provide some understanding for such decisions in the light of the Duty of Palliative Care [DoPC]. Complemented by virtue ethics theory, the DoPC highlights and seeks to realize the individual case specific goals of care that maximize comfort and quality of life of the patient in the face of rapid attenuation of treatment options and the eminence of the final outcome by considering each of these factors individually in order to provide the best outcome for the patient and the family.
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Ho ZJM, Radha Krishna LK, Yee CPA. Chinese familial tradition and Western influence: a case study in Singapore on decision making at the end of life. J Pain Symptom Manage 2010; 40:932-7. [PMID: 21145471 DOI: 10.1016/j.jpainsymman.2010.06.010] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2010] [Revised: 06/22/2010] [Accepted: 07/08/2010] [Indexed: 10/18/2022]
Abstract
Decision making for an incompetent patient at the end of life is difficult for both family members and physicians alike. Often, palliative care teams are tasked with weaving through opinions, emotions, and goals in search for an amenable solution. Occasionally, these situations get challenging. We present the case of an elderly Chinese Singaporean with metastatic cancer, whose family and physicians had conflicting goals of care. The former was adamant on treating the patient's disease with an untested drug, whereas the latter aimed to treat his symptoms with more conventional medication. Drug-drug interactions prevented treatment with both. Beginning with a discussion of the patient's best interest, we delve into the Singaporean context to show how culture affects medical decision making. Confucianism and filial piety are the values on which this family's workings were based. In an analysis of what this entails, we attempt to explain the significant and assertive family involvement in the decision-making process and their insistence on using novel medications, having exhausted conventional interventions. Within this mix were Western influences, too. Through the Internet, family members have become more informed and empowered in decision making, wresting the traditional paternalistic role of physicians in favor of "patient autonomy." An understanding of such dynamic facets will help better tailor culturally appropriate approaches to such complex situations.
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Kang Y, Moyle W, Venturato L. Korean nurses’ attitudes towards older people with dementia in acute care settings. Int J Older People Nurs 2010; 6:143-52. [DOI: 10.1111/j.1748-3743.2010.00254.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Yoon JD, Rasinski KA, Curlin FA. Moral controversy, directive counsel, and the doctor's role: findings from a national survey of obstetrician-gynecologists. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2010; 85:1475-1481. [PMID: 20736675 PMCID: PMC3634119 DOI: 10.1097/acm.0b013e3181eabacc] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
PURPOSE To explore physicians' attitudes toward providing directive counsel when dealing with morally controversial medical decisions, and to examine associations between physicians' opinions and their demographic and religious characteristics. METHOD In 2008-2009, the authors mailed a survey to a stratified, random sample of 1,800 U.S. obstetrician-gynecologists. They asked participants whether, when dealing with either typical or morally controversial medical decisions, "a physician should encourage patients to make the decision that the physician believes is best." RESULTS Among eligible physicians, the response rate was 66%. Fifty-four percent of respondents rejected the use of directive counsel for typical medical decisions; 78% did so for morally controversial medical decisions. Physicians were less likely to refrain from directive counsel for typical medical decisions if they were older and foreign-born but more likely to refrain from directive counsel if they were more theologically pluralistic. Theological pluralism was the only characteristic significantly associated with refraining from directive counsel for morally controversial medical decisions. CONCLUSIONS Providing nondirective counsel to their patients appears to have become the norm among certain obstetrician-gynecologists in the United States, particularly when dealing with morally controversial medical decisions. These physicians tend to be female, younger, U.S.-born, and more theologically pluralistic. Shifts toward refraining from directive counsel seem to relate to shifts in physicians' demographic, cultural, and religious characteristics.
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Affiliation(s)
- John D Yoon
- Section of Hospital Medicine, Department of Medicine, Maclean Center for Clinical Medical Ethics, University of Chicago, Chicago, Illinois 60637, USA.
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38
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Bipolar disorder and medical adherence: A Chinese perspective. Asian J Psychiatr 2010; 3:7-11. [PMID: 23051130 DOI: 10.1016/j.ajp.2009.11.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2009] [Revised: 07/27/2009] [Accepted: 11/30/2009] [Indexed: 12/11/2022]
Abstract
BACKGROUND The aim of this study was to explore the perspectives of New Zealand Chinese with bipolar disorder in regards to medication adherence. METHOD Nine New Zealand Chinese with bipolar disorder (BD) type I or II who had reasonable performance in role functioning were interviewed and data analysis was guided by an inductive approach. RESULTS Relationships with doctors had the most impact on the participants' attitudes towards medication. The majority of the participants in this study went to see Chinese psychiatrists and were professionally linked with Chinese social workers. Meetings with health professionals have been described by the participants as forms of interpersonal interactions. With a deep feeling of trust and respect towards their doctors, the participants felt more positive towards using prescribed medication. In contrast, when the participants experienced feelings of neglect by their doctors they felt less satisfaction towards the treatment. However, when the participants saw Western health professionals, their attitudes towards medication were more related to perceived efficacy of treatment. CONCLUSIONS There is a strong need for facilitating the connection between health professionals and clients. Furthermore, it would be useful for educating Chinese clients on how medication works, their side effects, and interaction with other drugs.
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Speraw S. "Talk to me--I'm human": the story of a girl, her personhood, and the failures of health care. QUALITATIVE HEALTH RESEARCH 2009; 19:732-743. [PMID: 19325023 DOI: 10.1177/1049732309334517] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Perspectives on the concept of personhood and its relationship to health care delivery are considered in the context of the life of an adolescent with multiple disabilities. One phenomenological interview lasting 3 hours illuminated life-long experiences of suffering, healing, and the quest to be treated as human, as perceived by a 16-year-old girl disfigured by multiple cancer treatments. Age-appropriate development is the ground of her existence, whereas the quality of relationships with care providers and the extent to which they demonstrate regard for her value as a person are figural. Health care providers have often failed to interact with her in ways supporting dignity and growth, treating her with "care" that is antithetical to the aims of their professions. The case has relevance for health care education and practice, challenging professionals to examine their views on personhood and self-care agency, and the ways in which those views impact the care they provide.
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Affiliation(s)
- Susan Speraw
- The University of Tennessee-Knoxville, Knoxville, Tennessee, USA.
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40
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Chiu H, Tsoh J. Commentary on 'Dementia: an anthropological perspective' by Mahnaz Hashmi. Int J Geriatr Psychiatry 2009; 24:325-7. [PMID: 19170047 DOI: 10.1002/gps.2184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Helen Chiu
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong (CUHK)
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Matsui M, Braun KL, Karel H. Comparison of End-of-Life Preferences Between Japanese Elders in the United States and Japan. J Transcult Nurs 2008; 19:167-74. [DOI: 10.1177/1043659607312969] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Significant attention is being paid to end-of-life preferences and their cultural variations. This study compares end-of-life preferences between older Japanese residing in Japan and the United States. A self-administered questionnaire was provided to elders affiliated with senior centers and clubs. Japanese Americans preferred to make decisions themselves about withholding life-sustaining treatments, whereas Japanese in Japan preferred to rely on physicians and family members. The U.S. sample showed more positive attitudes toward and higher completion rates of advance directives than the Japanese sample. Results suggest that end-of-life preferences differ between Japanese elders in the two countries and that preferences are influenced by contextual factors in one's country of residence. Practitioners need to be aware of both within-group and across-group diversity in end-of-life preferences, taking into account acculturation changes.
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43
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Affiliation(s)
- Daniel Fu-Chang Tsai
- Department of Social Medicine and Family Medicine, National Taiwan University College of Medicine, Taipei, Taiwan.
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Chiang HH, Lu ZY, Wear SE. To have or to be: ways of caregiving identified during recovery from the earthquake disaster in Taiwan. JOURNAL OF MEDICAL ETHICS 2005; 31:154-8. [PMID: 15738436 PMCID: PMC1734110 DOI: 10.1136/jme.2003.004101] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
The aim of this article is to report the results of therapy sessions conducted with survivors of an earthquake that struck Luku Township in Nantou County, central Taiwan, in September 1999. The sessions explored survivors' feelings, interactions, and interpretations of the crisis, as well as their roles in post-earthquake relief efforts. The participants were teachers and administrators from four primary schools. The results indicated three distinct forms of caring, namely: encumbered caring, connected caring, and reflected caring. The findings were used to construct a framework for caregiver self-monitoring. They also suggest that therapy groups provide an inner space that self-regulates the frustrations arising from this type of experience, for both caregivers and survivors. The intrasubjective and intersubjective dialogues within the groups are essentially reflective practices for improving services and generating new knowledge about medical ethics.
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Affiliation(s)
- H-H Chiang
- Faculty of Nursing, National Yang-Ming University, No. 155, Li-Nong St Sec. 2, Pai Tou, Taipei, Taiwan 112.
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45
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Abstract
This paper examines whether the modern bioethical principles of respect for autonomy, beneficence, non-maleficence, and justice proposed by Beauchamp and Childress are existent in, compatible with, or acceptable to the leading Chinese moral philosophy-the ethics of Confucius. The author concludes that the moral values which the four prima facie principles uphold are expressly identifiable in Confucius' teachings. However, Confucius' emphasis on the filial piety, family values, the "love of gradation", altruism of people, and the "role specified relation oriented ethics" will inevitably influence the "specification" and application of these bioethical principles and hence tend to grant "beneficence" a favourable position that diminishes the respect for individual rights and autonomy. In contrast, the centrality of respect for autonomy and its stance of "first among equals" are more and more stressed in Western liberal viewpoints. Nevertheless, if the Confucian "doctrine of Mean" (chung-yung) and a balanced "two dimensional personhood" approach are properly employed, this will require both theorists and clinicians, who are facing medical ethical dilemmas, of searching to attain due mean out of competing moral principles thus preventing "giving beneficence a priority" or "asserting autonomy must triumph".
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Affiliation(s)
- D F-C Tsai
- Department of Social Medicine, College of Medicine, National Taiwan University Hospital, No 1, Section 1, Jen-Ai Road, Taipei 100, Taiwan.
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46
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Doran M. The presence of family during brain stem death testing. Intensive Crit Care Nurs 2004; 20:87-92. [PMID: 15072776 DOI: 10.1016/j.iccn.2003.10.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2003] [Indexed: 10/26/2022]
Abstract
It is established practice in intensive care units (ICU) for relatives to be excluded from brain stem death testing. However, times are changing and this is evident in other areas of health care, where fathers are now present during childbirth and relatives may be given the choice of being present during cardiopulmonary resuscitation (CPR). In Part One of this serial, it was suggested that with relatives now being present during resuscitation it will only be a matter of time before requests to witness brain stem death testing are made. This article will focus on the barriers that inhibit the presence of family during brain stem death testing. A strategy that aims to facilitate their presence will then be proposed.
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Affiliation(s)
- Majella Doran
- Altnagelvin Hospital, Glenshane Road, Londonderry, Northern Ireland.
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47
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Abstract
Prior to 1959, cardiac and respiratory cessation was universally and unambiguously accepted as confirming the death of a person [M. Morioka, J. Clin. Nurs. 10 (2001) 132; Reconsidering brain death: a lesson from Japan's fifteen years of experience, 2001, http://proquest.umi.com/pqdweb]. However, with the rapid pace of modern technology and resuscitation techniques, the boundaries between life and death have become blurred [J. Bothamley, Organ donation: brain stem death, 2000, http://proquest.umi.com/pqdweb; Re-examining death: against a higher brain criterion, 1999, http://proquest.umi.com/pqdweb]. As a result, a redefinition of death, "brain death" has emerged [M. Brazier, Medicine, Patients and the Law, New ed., Penquin Books, London, 1992]. Most families faced with the brain stem death of a relative find the concept difficult to understand and have trouble in accepting that their relative is actually dead. In Part One of this two part series, the needs of families who are facing the brain stem death of a family member will be examined and explanations offered as to why families find the concept difficult to grasp. In addition, it will also advocate that family members are given the choice to be or not to be present during brain stem death testing. It is suggested that the presence of family members during brain stem death testing not only helps families to accept this concept of death but also promotes the grieving process. In Part Two, the barriers that inhibit family involvement and presence will be explored and methods for involving family proposed.
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Affiliation(s)
- Majella Doran
- Altnagelvin Hospital, Glenshane Road, Londonderry, Northern Ireland, UK.
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48
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Pang SMC, Sawada A, Konishi E, Olsen DP, Yu PLH, Chan MF, Mayumi N. A comparative study of Chinese, American and Japanese nurses' perceptions of ethical role responsibilities. Nurs Ethics 2003; 10:295-311. [PMID: 12762463 DOI: 10.1191/0969733003ne607oa] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This article reports a survey of nurses in different cultural settings to reveal their perceptions of ethical role responsibilities relevant to nursing practice. Drawing on the Confucian theory of ethics, the first section attempts to understand nursing ethics in the context of multiple role relationships. The second section reports the administration of the Role Responsibilities Questionnaire (RRQ) to a sample of nurses in China (n = 413), the USA (n = 163), and Japan (n = 667). Multidimensional preference analysis revealed the patterns of rankings given by the nurses to the statements they considered as important ethical responsibilities. The Chinese nurses were more virtue based in their perception of ethical responsibilities, the American nurses were more principle based, and the Japanese nurses were more care based. The findings indicate that the RRQ is a sensitive instrument for outlining the embedded sociocultural factors that influence nurses' perceptions of ethical responsibilities in the realities of nursing practice. This study could be important in the fostering of partnerships in international nursing ethics.
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Affiliation(s)
- Samantha Mei-che Pang
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, China.
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49
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Abstract
The introduction of ethical regulations in medicine in China might seem at odds with the country's social and moral reality. Chinese bioethicists find themselves torn between the necessity to re-create a fully-fledged modern health-care system and aspirations to become global players in the biomedical sciences. The result is a top-down approach in medical ethics, created on behalf of the people. Despite its introduction, there are concerns about whether China is prepared to embrace the standards it claims to have adopted.
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Affiliation(s)
- Ole Döring
- Chinese History and Philosophy Department, Faculty for East Asian Studies, Ruhr-University Bochum, D-44780 Bochum.
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50
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Abstract
OBJECTIVE To explore general practitioners' (GP's) views on their obligations with respect to diagnosing infections and prescribing antibiotics. METHODS The GP's reflections and prioritization were studied by means of interviews and observations. We analysed how their prioritization complied with an ethical guidance that ranked patient autonomy and welfare highest, then competence obligations and obligations to society, followed by fraternal obligations. RESULTS Balancing of pros and cons was prominent in our informants' decision making but often resulted in decisions that deviated from the ethical guidance. The ranking varied much between the GPs. The highest priorities in the GPs' practice were related to the patient's everyday life (sometimes autonomy, sometimes beneficence in a broad sense), doctor-patient relationship (communication competence), the patient's perceived importance on the job market (society) and relationship with colleagues (fraternal). Perceived lack of resources and uncertainty with respect to both diagnostic and treatment decisions frequently influenced decision making.
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Affiliation(s)
- I Björnsdóttir
- The Pharmaceutical Society of Iceland, Holtaseli 36, IS-109 Reykjavík, Iceland.
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