Nurse leaders’ role in medical assistance in dying: A relational ethics approach

Thiele, Tracy; Dunsford, Jennifer

doi:10.1177/0969733017730684

Cited by 19 publications

(33 citation statements)

References 11 publications

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“…Second, decision-making was described as not being an exclusively rational act [28, 42, 45, 52, 54, 55, 63, 65, 68, 69]. Relational theorists have highlighted the importance of emotions, imagination, and non-verbal communication, as essential elements of human decision-making [27, 28, 32, 45, 48, 52, 54, 68, 69, 73].…”

Section: Resultsmentioning

confidence: 99%

Relational autonomy: what does it mean and how is it used in end-of-life care? A systematic review of argument-based ethics literature

2019

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BackgroundRespect for autonomy is a key concept in contemporary bioethics and end-of-life ethics in particular. Despite this status, an individualistic interpretation of autonomy is being challenged from the perspective of different theoretical traditions. Many authors claim that the principle of respect for autonomy needs to be reconceptualised starting from a relational viewpoint. Along these lines, the notion of relational autonomy is attracting increasing attention in medical ethics. Yet, others argue that relational autonomy needs further clarification in order to be adequately operationalised for medical practice. To this end, we examined the meaning, foundations, and uses of relational autonomy in the specific literature of end-of-life care ethics.MethodsUsing PRESS and PRISMA procedures, we conducted a systematic review of argument-based ethics publications in 8 major databases of biomedical, philosophy, and theology literature that focused on relational autonomy in end-of-life care. Full articles were screened. All included articles were critically appraised, and a synthesis was produced.ResultsFifty publications met our inclusion criteria. Twenty-eight articles were published in the last 5 years; publications were originating from 18 different countries. Results are organized according to: (a) an individualistic interpretation of autonomy; (b) critiques of this individualistic interpretation of autonomy; (c) relational autonomy as theoretically conceptualised; (d) relational autonomy as applied to clinical practice and moral judgment in end-of-life situations.ConclusionsThree main conclusions were reached. First, literature on relational autonomy tends to be more a ‘reaction against’ an individualistic interpretation of autonomy rather than be a positive concept itself. Dichotomic thinking can be overcome by a deeper development of the philosophical foundations of autonomy. Second, relational autonomy is a rich and complex concept, formulated in complementary ways from different philosophical sources. New dialogue among traditionally divergent standpoints will clarify the meaning. Third, our analysis stresses the need for dialogical developments in decision making in end-of-life situations. Integration of these three elements will likely lead to a clearer conceptualisation of relational autonomy in end-of-life care ethics. This should in turn lead to better decision-making in real-life situations.

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Section: Resultsmentioning

confidence: 99%

Relational autonomy: what does it mean and how is it used in end-of-life care? A systematic review of argument-based ethics literature

2019

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“…Although relational ethics was referenced only once in the ethical literature we reviewed,34 this lens may help deepen understanding of nurses' commitment to wraparound care. Relational ethics is built upon the assumption that good care can only be determined in the space between nurses and patients.…”

Section: Resultsmentioning

confidence: 99%

Ethical, Policy, and Practice Implications of Nurses' Experiences With Assisted Death

Pesut

Thorne

Greig

et al. 2019

Advances in Nursing Science

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The conceptualization of assisted death as an act performed by physicians has resulted in a lack of attention to nurses' roles and experiences with the processes that surround an assisted death. In this article, we synthesize evidence from 6 articles focusing on the experiences of 55 nurses from Canada, Belgium, and the Netherlands, with relevant ethical and policy implications derived from the literature. Nurses have a central role in negotiating inquiries about assisted death and in providing wraparound care for patients, families, and other health care providers. This role is impactful for nurses and requires significant personal and professional moral work.

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“…Relational ethics focuses on the relationships and the context of the connections between individuals, and highlight values and concepts such as mutual respect, engagement, environment and embodiment [46,47]. This view is mostly developed in nursing literature [48], but we found it to be quite suited and useful to reflect upon the issues relating to the ethics and the quality of the relationship fostered with patient-partners, within research teams and research institutions, and on the quality and the sincerity of the engagement of patients in the research process. We have identified several issues linked with this concern in our review (n = 12), mostly relating to an unmeaningful or insincere partnership being established with patients in the context of research, or to the absence of a shared vision of patientpartnership between members of the research team.…”

Section: Ethical Framework For Patient Partnership In Researchmentioning

confidence: 99%

Partnering with patients in healthcare research: a scoping review of ethical issues, challenges, and recommendations for practice

2020

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Background: Partnering with patients in healthcare research now benefits from a strong rationale and is encouraged by funding agencies and research institutions. However, this new approach raises ethical issues for patients, researchers, research professionals and administrators. The main objective of this review is to map the literature related to the ethical issues associated with patient partnership in healthcare research, as well as the recommendations to address them. Our global aim is to help researchers, patients, research institutions and research ethics boards reflecting on and dealing with these issues. Methods: We conducted a scoping review of the ethical issues and recommendations associated with partnering with patients in healthcare research. After our search strategy, 31 peer reviewed articles published between 2007 and 2017 remained and were analyzed. Results: We have identified 58 first-order ethical issues and challenges associated with patient partnership in research, regrouped in 18 second-order ethical themes. Most of the issues are transversal to all phases and stages of the research process and a lot of them could also apply to patient-partnership in other spheres of health, such as governance, quality improvement, and education. We suggested that ethical issues and challenges of partnered research can be related to four ethical frameworks: 1) Research ethics; 2) Research integrity; 3) Organizational ethics, and 4) Relational ethics. Conclusions: We have identified numerous ethical issues associated with the recent approach of patientpartnership in research. These issues are more diverse than the issues associated with a more traditional research approach. Indeed, the current discussion on how we address ethical issues in research is anchored in the assumption that patients, as research participants, must be protected from risk. However, doing research with, and not on, the patient involves changes in the way we reflect on the ethical issues associated with this approach to research. We propose to broaden the ethical discussion on partnered research to not only rely on a research ethics framework, but to also frame it within the areas of research integrity, organizational ethics and relational ethics.

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Nurse leaders’ role in medical assistance in dying: A relational ethics approach

Cited by 19 publications

References 11 publications

Relational autonomy: what does it mean and how is it used in end-of-life care? A systematic review of argument-based ethics literature

Relational autonomy: what does it mean and how is it used in end-of-life care? A systematic review of argument-based ethics literature

Ethical, Policy, and Practice Implications of Nurses' Experiences With Assisted Death

Partnering with patients in healthcare research: a scoping review of ethical issues, challenges, and recommendations for practice

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