Pertinence du recours au concept de transgression face aux nouvelles situations de fin de vie

Jacquemin, Dominique; Rodrigues, Paulo

doi:10.1016/j.jemep.2015.10.001

Cited by 3 publications

(4 citation statements)

References 3 publications

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“…They find it difficult to accept their ambivalence toward sedation – the tension between the reasoned approach to the decision based on the intention to provide relief and the fear of harmful consequences that the power of the act of sedation generates in their minds [ 38 , 39 ]. This tension should be examined from an ethics perspective, by looking at intention to treat principles in care provision and in clinical practice [ 40 – 43 ] and at the fact that although the decision is made by the team, its implementation involves the conscience of the individual nurse or physician carrying it out [ 6 , 44 – 46 ].…”

Section: Discussionmentioning

confidence: 99%

Palliative sedation challenging the professional competency of health care providers and staff: a qualitative focus group and personal written narrative study

et al. 2017

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BackgroundDespite recent advances in palliative medicine, sedating a terminally ill patient is regarded as an indispensable treatment to manage unbearable suffering. With the prospect of widespread use of palliative sedation, the feelings and representations of health care providers and staff (carers) regarding sedation must be carefully explored if we are to gain a better understanding of its impact and potential pitfalls. The objective of the study was to provide a comprehensive description of the opinions of carers about the use of sedation practices in palliative care units (PCU), which have become a focus of public attention following changes in legislation.MethodsData were collected using a qualitative study involving multi-professional focus groups with health care providers and staff as well as personal narratives written by physicians and paramedical staff. A total of 35 medical and paramedical providers volunteered to participate in focus group discussions in three Palliative Care Units in two French hospitals and to write personal narratives.ResultsHealth care provider and staff opinions had to do with their professional stance and competencies when using midazolam and practicing sedation in palliative care. They expressed uncertainty regarding three aspects of the comprehensive care: biomedical rigour of diagnosis and therapeutics, quality of the patient/provider relationship and care to be provided. Focusing on the sedative effect of midazolam and continuous sedation until death, the interviewed health care providers examined the basics of their professional competency as well as the key role played by the health care team in terms of providing support and minimizing workplace suffering. Nurses were subject to the greatest misgivings about their work when they were called upon to sedate patients.ConclusionsThe uncertainty experienced by the carers with regard to the medical, psychosocial and ethical justification for sedation is a source of psychological burden and moral distress, and it has proved to be a major source of suffering in the workplace. Lastly, the study shows the uncertainty can have the positive effect of prompting the care team to devise ways to deal with it.

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Section: Discussionmentioning

confidence: 99%

Palliative sedation challenging the professional competency of health care providers and staff: a qualitative focus group and personal written narrative study

et al. 2017

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“…It requires them to recognize and name the reality of law violation if they want to ‘maintain coherence within palliative care practices’. 34 , 35 , 38 …”

Section: Discussionmentioning

confidence: 99%

“…according to patients, 'it is done even if it's forbidden') trivializes the subjective and social relationship with law violation and desacralizes the prohibition of murder. [34][35][36] Whether or not euthanasia is legal, a death request while in palliative care cannot fail to raise questions about the discrepancy it introduces into the usual benchmarks and values at the core foundation of care. 37 It can lead HCP to ponder the significance of resorting to acts that are breaking or would break away from their work ethic and values.…”

Section: Confusion Between Palliative Care and Euthanasiamentioning

confidence: 99%

“…It requires them to recognize and name the reality of law violation if they want to 'maintain coherence within palliative care practices'. 34,35,38 Evolving patient-HCP relationship dynamic in the face of suffering Second, euthanasia requests underline the need to recognize the unacceptability of living subjected to total pain. 39 The connection between unbearable pain and euthanasia request is documented but is not always decisive.…”

Section: Confusion Between Palliative Care and Euthanasiamentioning

confidence: 99%

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Understanding why patients request euthanasia when it is illegal: a qualitative study in palliative care units on the personal and practical impact of euthanasia requests

Leboul¹,

Bousquet²,

Chassagne

et al. 2022

Palliat�Care

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Context: Some patients in palliative care units request euthanasia regardless of legislation. Although studies have explored the reasons for these requests, little is known about the subjective, relational, and contextual repercussions for the patient. Objectives: The aim of this study is to understand the purpose of euthanasia requests from the patient’s viewpoint and their personal and practical impact. Methods: We conducted in-depth interviews with patients requesting euthanasia, their family members, and health care providers in 11 French palliative care units. A thematic analysis of the data was performed. Results: In total, 18 patients were interviewed within 48 h of the request being made; 1 week later, 9 patients were interviewed again. Five main themes emerged: assuming the possibility of transgressing the forbidden, a call for unbearable suffering to be recognized, encouragement to change clinical practice, reclaiming a sense of freedom over medical constraints, and imagining a desirable future for oneself. Conclusions: A request for euthanasia appears to be a willful means to remove oneself from the impasse of an existence paralyzed by suffering. It creates a space for discussion, which promotes negotiation with patients on care practices and therapeutics, and strengthens patients’ sense of autonomy. Investigating the relationship between the evolution of euthanasia requests within the palliative care setting could be beneficial. It is important to encourage health care professionals to adopt a readiness to listen by interacting with patients in a way that is not momentarily action-oriented but rather focused on proactive discussion.

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Peut-on mourir sans rites ? À propos de l’euthanasie et de la sédation

Rodrigues

Jacquemin

2018

Médecine Palliative

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Pertinence du recours au concept de transgression face aux nouvelles situations de fin de vie

Cited by 3 publications

References 3 publications

Palliative sedation challenging the professional competency of health care providers and staff: a qualitative focus group and personal written narrative study

Palliative sedation challenging the professional competency of health care providers and staff: a qualitative focus group and personal written narrative study

Understanding why patients request euthanasia when it is illegal: a qualitative study in palliative care units on the personal and practical impact of euthanasia requests

Peut-on mourir sans rites ? À propos de l’euthanasie et de la sédation

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