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Lepizzera J, Caux C, Leibing A, Gauvin-Lepage J. « C’est en fait un peu difficile de mourir aujourd’hui » : perceptions d’infirmières au regard de l’aide médicale à mourir pour des adolescents en fin de vie au Québec. CANADIAN JOURNAL OF BIOETHICS 2021. [DOI: 10.7202/1084451ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
L’entrée en vigueur de l’aide médicale à mourir (AMM) au Québec et au Canada pose la question de l’élargissement de cette prestation à des mineurs. La présence soutenue des infirmières au chevet du patient les amène à recevoir des demandes liées à l’AMM. Le but de cette étude est d’explorer les perceptions d’infirmières oeuvrant en service d’oncologie pédiatrique au regard de la possibilité pour des adolescents de plus de 14 ans, de demander l’AMM. Six infirmières oeuvrant en soins oncologiques ou palliatifs pédiatriques ou étant en contact direct avec des adolescents en fin de vie dans le cadre de leur travail d’infirmières ont participé à une entrevue individuelle semi-dirigée. Les résultats de cette recherche mettent en exergue que : 1) les infirmières reconnaissent leur rôle de soutien dans les soins du patient en fin de vie ; 2) la plupart ont une opinion professionnelle en faveur de l’AMM pour les adultes et distinguent celle-ci de leur opinion personnelle ; 3) elles apprécient les discussions autour de l’AMM et sont préoccupées par l’établissement des critères l’encadrant ; et 4) une longue expérience comme infirmière engendre plus de préoccupations sur l’élargissement de l’AMM, mais en même temps rend les infirmières plus à l’aise de fournir des informations à ce sujet. Au vu de ces constats, les établissements universitaires et de santé pédiatrique doivent reconnaître et évaluer la nécessité d’une formation des infirmières sur l’AMM afin de les outiller davantage face à de telles situations et ainsi, mieux répondre aux besoins de leurs patients.
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Affiliation(s)
- Justine Lepizzera
- Faculté des sciences infirmières, Université de Montréal, Montréal, Canada
| | - Chantal Caux
- Faculté des sciences infirmières, Université de Montréal, Montréal, Canada
| | - Annette Leibing
- Faculté des sciences infirmières, Université de Montréal, Montréal, Canada
| | - Jérôme Gauvin-Lepage
- Faculté des sciences infirmières, Université de Montréal, Montréal, Canada
- Centre de recherche du CHU, Sainte-Justine, Montréal, Canada
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Cherry MJ, Fan R, Evans KK. Family-Based Consent to Organ Transplantation: A Cross-Cultural Exploration. THE JOURNAL OF MEDICINE AND PHILOSOPHY 2019. [DOI: 10.1093/jmp/jhz018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Abstract
This special thematic issue of The Journal of Medicine and Philosophy brings together a cross-cultural set of scholars from Asia, Europe, and North America critically to explore foundational questions of familial authority and the implications of such findings for organ procurement policies designed to increase access to transplantation. The substantial disparity between the available supply of human organs and demand for organ transplantation creates significant pressure to manipulate public policy to increase organ procurement. As the articles in this issue explore, however, even if well intentioned, the desire to maximize organ procurement does not justify undermining foundational elements of human flourishing, such as the family. While defending at times quite different understandings of autonomy, informed consent, and familial authority, each author makes clear that a principled appreciation of the family is necessary. Otherwise, health care practice will treat the family in a cynical and instrumental fashion unlikely to support social or individual good.
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Affiliation(s)
| | - Ruiping Fan
- City University of Hong Kong, Kowloon, Hong Kong, PR China
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Smith LE, Maybach AM, Feldman A, Darling A, Akard TF, Gilmer MJ. Parent and Child Preferences and Styles of Communication About Cancer Diagnoses and Treatment. J Pediatr Oncol Nurs 2019; 36:390-401. [DOI: 10.1177/1043454219859235] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Communication challenges frequently occur among families and health care providers of children with life-threatening conditions. These obstacles compound concerns related to children’s diagnoses and treatment, the family’s quality of life, and delivery of care. Developmentally appropriate and validated methods of addressing the communication preferences of families with chronically ill children are limited. This study used six focus groups to determine child and parent preferences and styles of communication centering on new diagnoses and changes in prognosis. Hypothetical situations were used to minimize feelings of self-consciousness among school-aged and adolescent participants. Qualitative analyses (interrater reliability 75%) of child and parent responses revealed 3 categories and 11 subcategories or themes. The category of Characteristics of Communication Exchange included (1) how to tell, (2) who should tell, (3) when to tell, (4) who should be included, and (5) what to tell. The Knowledge and Understanding category included themes of (1) side effects of treatment, (2) what children understand, and (3) questions when being diagnosed. The category of Feelings and Emotions included themes of (1) feelings about changes in prognosis, (2) children’s feelings on being informed, and (3) coping and emotional regulation. Results reveal a need for developmentally appropriate, evidence-based education to inform parents on how, what, and when to communicate information concerning their child’s disease, as well as instructions around facilitating those discussions. Moreover, a need for professional education and training programs for providers is demonstrated by some parental dissatisfaction with bedside manner and disclosure of information. The data collected from this study lay a foundation for future research in communication as a principal factor in quality of life for pediatric patients and their families.
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Affiliation(s)
| | | | - Amanda Feldman
- Vanderbilt University, Nashville, TN, USA
- James Madison University, Nashville, TN, USA
| | - Austin Darling
- Vanderbilt University, Nashville, TN, USA
- Southern Illinois University Edwardsville, Nashville, TN, USA
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Ruhe KM, De Clercq E, Wangmo T, Elger BS. Relational Capacity: Broadening the Notion of Decision-Making Capacity in Paediatric Healthcare. JOURNAL OF BIOETHICAL INQUIRY 2016; 13:515-524. [PMID: 27365104 DOI: 10.1007/s11673-016-9735-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 04/28/2016] [Indexed: 06/06/2023]
Abstract
Problems arise when applying the current procedural conceptualization of decision-making capacity to paediatric healthcare: Its emphasis on content-neutrality and rational cognition as well as its implicit assumption that capacity is an ability that resides within a person jeopardizes children's position in decision-making. The purpose of the paper is to challenge this dominant account of capacity and provide an alternative for how capacity should be understood in paediatric care. First, the influence of developmental psychologist Jean Piaget upon the notion of capacity is discussed, followed by an examination of Vygostky's contextualist view on children's development, which emphasizes social interactions and learning for decision-making capacity. In drawing parallels between autonomy and capacity, substantive approaches to relational autonomy are presented that underline the importance of the content of a decision. The authors then provide a relational reconceptualization of capacity that leads the focus away from the individual to include important social others such as parents and physicians. Within this new approach, the outcome of adults' decision-making processes is accepted as a guiding factor for a good decision for the child. If the child makes a choice that is not approved by adults, the new conceptualization emphasizes mutual exchange and engagement by both parties.
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Affiliation(s)
- Katharina M Ruhe
- Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, 4056, Basel, Switzerland
| | - Eva De Clercq
- Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, 4056, Basel, Switzerland.
| | - Tenzin Wangmo
- Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, 4056, Basel, Switzerland
| | - Bernice S Elger
- Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, 4056, Basel, Switzerland
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Overcoming Barriers, 1 Child at a Time. J Hosp Palliat Nurs 2016. [DOI: 10.1097/njh.0000000000000275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bester M, Havenga Y, Ligthelm Z. Practices employed by South African healthcare providers to obtain consent for treatment from children. Nurs Ethics 2016; 25:640-652. [PMID: 27521244 DOI: 10.1177/0969733016660878] [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: 11/17/2022]
Abstract
BACKGROUND The ability to consent promotes children's access to health services. Healthcare providers should assess and arrive at a clinical judgement about the child's maturity and mental capacity to obtain valid consent. RESEARCH OBJECTIVE The objective of the study was to determine practices employed by South African healthcare providers to obtain consent for treatment from children. RESEARCH DESIGN A qualitative, explorative, descriptive research design was used and the study was contextual. Participants and research context: In all, 24 healthcare providers (professional nurses and medical practitioners) were purposively sampled from a hospital and primary health clinics. Semi-structured interviews were used. Ethical consideration: Ethical approval was obtained from the Institutional Review Board and gatekeepers. Written informed consent was obtained from each participant. FINDINGS Healthcare providers' current practices in obtaining consent from children revealed inconsistency in implementation as well as the yardstick used to determine children's mental capacity. Building trust with children, sharing information and assessment were interlinked in obtaining consent. DISCUSSION The inconsistent practice has implications for children's access to healthcare services. CONCLUSION Inconsistent practices in the implementation of consent laws have the potential to violate children's rights to bodily and psychological integrity, access to health services and having their opinions heard and be taken into consideration. Through uncovering the current perceptions and practices and a literature review, guidelines intended for use by the Department of Health could be developed.
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De Clercq E, Badarau DO, Ruhe KM, Wangmo T. Body matters: rethinking the ethical acceptability of non-beneficial clinical research with children. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2015; 18:421-431. [PMID: 25433817 DOI: 10.1007/s11019-014-9616-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The involvement of children in non-beneficial clinical research is extremely important for improving pediatric care, but its ethical acceptability is still disputed. Therefore, various pro-research justifications have been proposed throughout the years. The present essay aims at contributing to the on-going discussion surrounding children's participation in non-beneficial clinical research. Building on Wendler's 'contribution to a valuable project' justification, but going beyond a risk/benefit analysis, it articulates a pro-research argument which appeals to a phenomenological view on the body and vulnerability. It is claimed that children's bodies are not mere physical objects, but body-subjects due to which children, as persons, can contribute to research that may hold no direct clinical benefit to them even before they can give informed consent.
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Affiliation(s)
- Eva De Clercq
- Institute for Biomedical Ethics, University of Basel, Bernoullistr 28, 4056, Basel, Switzerland,
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Cherry MJ. Re-Thinking the Role of the Family in Medical Decision-Making. THE JOURNAL OF MEDICINE AND PHILOSOPHY 2015; 40:451-72. [DOI: 10.1093/jmp/jhv011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Cherry MJ. Ignoring the Data and Endangering Children: Why the Mature Minor Standard for Medical Decision Making Must Be Abandoned. THE JOURNAL OF MEDICINE AND PHILOSOPHY 2013; 38:315-31. [DOI: 10.1093/jmp/jht014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
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Stayer D. Pediatric palliative care: a conceptual analysis for pediatric nursing practice. J Pediatr Nurs 2012; 27:350-6. [PMID: 22703682 DOI: 10.1016/j.pedn.2011.04.031] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2010] [Revised: 04/23/2011] [Accepted: 04/30/2011] [Indexed: 11/16/2022]
Abstract
Although there have been significant advances in medical technology, thousands of children continue to die annually. Pediatric palliative care is a relatively new field and has not been well defined in the literature. Therefore, the purposes of this article were to provide a concept analysis of pediatric palliative care that presents pediatric nurses with fundamental information regarding this concept and to increase their ability to understand, identify, provide, and subsequently meet and enhance the needs of those children with a life-limiting illness and their families. With this enhanced understanding of pediatric palliative care, pediatric nurses will continue to improve and provide quality, safe nursing care for this vulnerable population of children with life-limiting illnesses.
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Lago PM, Nilson C, Piva JP, Halal MG, Carvalho Abib GMD, Garcia PCR, Vieira AC. Nurses’ participation in the end-of-life — process in two paediatric intensive care units in Brazil. Int J Palliat Nurs 2011; 17:264, 267-70. [DOI: 10.12968/ijpn.2011.17.6.264] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Patrícia M Lago
- Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Brazil
| | - Cristine Nilson
- Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Brazil
| | - Jefferson Pedro Piva
- Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Brazil
| | - Michel Georges Halal
- Fellow, Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Brazil
| | | | - Pedro Celiny R Garcia
- Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Brazil
| | - Ana Cláudia Vieira
- Hospital São Lucas, Pontificia Universidade Catolica do Rio Grande do Sul, Brazil
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