1,720,981 research outputs found
The role of values and emotions in patients’ health care decision-making
Get PDFAim: As the decision-making science progresses, in recent years, there has been an increasing discussion about non-cognitive components involved in decision-making process. This paper aims to provide an inclusive overview of current knowledge on the state of the science related to the role of values and emotions in decision making. In an effort to provide the most inclusive review possible, internal rationality, awareness of values, and practical wisdom will be considered.Method: It was conducted a comprehensive narrative review of literature on the topic of interest.Results: Sharp distinction between rational and emotional decisions would be a false dichotomy. Both values and emotions underpin every aspect of a decision-making process. Interpersonal comparisons of value judgments are thought of as being inherent in the very activity of interpretation. This is important when considering reasonableness of another’s decision. Moreover, as decision-makers has to be aware of and then navigate their own, feelings and values, it is noticeable that emotions may not only affect the development of the values of an individual, but also affect an individual’s introspective awareness of her values, beliefs and preferences. Finally, it is interesting to note that it has been suggested an alternative approach to decision-making competence based on decision-maker’s practical wisdom.Conclusion: The ways by which beliefs, values, and emotions affect decision-making processes seem to be unclear and overlapping, thus giving a boost to uncertainties. Further research into complexities related to the role of values and emotions in decision making seems to be necessary
Nurses’ emotional reactions and compassion fatigue: A systematic review
Get PDFAim: While working as a nurse a number of situations arise that cause nurses to be constantly exposed to a variety of factors promoting compassion fatigue which has negative effects on nurses’ well-being and patient care. The paper aims at summarizing the current state of knowledge of the topic of interest. Methods: The PRISMA checklist was followed to conduct a systematic review using PICo worksheet and searching into PubMed database. Reference lists and citations of eligible articles were also screened and reviewed for additional papers. Additional records identified through other sources without however providing an element of selection bias. Results: A wide range of stressful factors and negative emotions promote compassion fatigue. Psychological distress may lead to compassion fatigue through reducing self-esteem and creating negative emotions. Secondary traumatic stress may have a mediating role between empathy and compassion fatigue in the nurses. In case of death, nurses’ experience of physical loss and grief considered inconsistent with their role may promote compassion fatigue, especially when the patient had not a ‘good death’ being surrounded by and communicating with family members. Thoughtful reflection (conceived in an inclusive way) may promote compassion satisfaction and prevent compassion fatigue. Trait-negative affect is considered very important factor promoting compassion fatigue. Survivor guilt and omnipotent guilt are types of pathogenic empathy-based guilt and have a mediating role between empathy and compassion fatigue in the nurses. Furthermore, it is argued that touch providing emotional containment and emotion role dissonance are predictors of emotional exhaustion. Moral disengagement has a mediating role between negative emotions and nurses counterproductive work behaviourConclusion: A wide variety of factors are most likely to contribute to the presence of compassion fatigue in nurses. Further research is required to make clear the importance and role of each factor and probably identify new factors. Supportive policies must be a priority to give nurses coping and communication skills and inner resources, and enhance their resilience.
Offering surgical castration to detainee sex-offenders: The ‘unkindest cut’
Get PDFThe still available in some jurisdictions offer of surgical castration to sex-offenders raises ethical concerns. The narrow castration law in Texas has found supporters since it does not mandate castration, instead reserving it for repeat offenders who seek the treatment. McMillan’s proposal views imprisoned sex-offender as competent agent to give valid and autonomous informed consent when certain requirements are met. Another major pro-castration argument asserts that compromising one’s autonomy for enhancing or restoring it in the long run can justify the non-consensual surgical castration. This paper challenges these arguments focusing mostly on sex-offender’s agency. The major point raised by this paper is that a sex-offender who is locked in prison, in all likelihood, is in an unhealthy (or quasi unhealthy) off balance state (from a phenomenological standpoint) and possibly he has limited human bandwidth and low self-esteem. Such a sex-offender could be unduly induced or nudged into consent to offered castration and this is a decisive moral problem. Besides, surgical castration is an intervention that leads to a situation which the person who request it has never experienced before. Therefore, the detainee sex-offender’s competence to give valid and autonomous informed consent to surgical castration is questionable. Besides, justice-related concerns are raised in case of offering surgical castration to detainee sex-offenders. Moreover, in author’s opinion the state might hardly offer surgical castration without pro-castration intention. Furthermore, this paper regards as questionable the role of psychiatrist as a guarantor of sex-offender’s agency and the effectiveness of surgical castration as medical treatment.
Toward a more nuanced understanding of biological parenthood
Get PDFGiven the rapid advances in assisted reproductive technology, the need for providing a more nuanced insight into the understanding of the concept biological parenthood becomes all the more evident. With the aim of providing nuance and balance to the extant literature regarding the concept of biological parenthood, this paper attempts to show that a) the desire for biological parenthood bears a deeper meaning than a prejudice-based legitimate will, and b) this assumption does not necessarily reflect a sharp distinction between biological and social parenthood, which may profoundly affect negatively intimate bonds between family members. The paper is articulated in three steps. In a first step, this paper attempts to identify a number of arguments that might count as good evidence to emphasize the role of biological relatedness between parent and offspring in the context of modern techno-science, social reality and theoretical thinking. In a second step, it defends the assumption that people are strongly motivated to desire genetic relatedness with as high as possible relatedness coefficient. Further, in a third step, this study moves forward on a novel (individual) account of parenthood that is a biological/social hybrid in the case where (social) parenthood starts during early neonatal period. This interim account of parenthood (between biological and social parenthood) comes from the heart and the parent-newborn attachment. Social parenthood would be considered not purely social when starting at the very beginning of child’s life. This borderline account of parenthood might smooth out the categorical distinction between biological and social parenthood
Emotions as parts of the inner lives of physicians in the modern clinical context
Get PDFAim: As physicians often struggle with devastating illness and loss, they often experience more or less intense emotions arising from the care of patients. As yet, however, little attention has been given to physicians’ emotional reactions. This paper aims at exploring the emotional reactions of physicians in the workplace as well as the impact of their emotions on their professionality and personal well-being.Method: A comprehensive narrative review of the currently available literature related to the topic of interest has been conducted placing considerable emphasis on the recently published sources.Results: Grief, sense of failure, frustration, feelings of powerlessness, death anxiety, self-blame or guilt, and a feeling of obligation to save the patient are among the most common emotions that physicians experience in the workplace. Importantly, while the relationship between physicians’ emotions and burnout, moral distress, medical communication, empathy, shared decision making and compassion fatigue seems to be to a greater or lesser extent correlative, it remains unclear in details. It is not easy for physicians to be engaged in identifying and controlling their emotional reactions in the workplace. Emotion recognition and regulation is of great importance for protecting physician’s professionality as well as professional and personal well-being. Conclusion: The physicians’ emotional reactions and the consequences of their emotions in the workplace is a complex and multifactorial topic that requires further exploration. Physicians’ emotional state may profoundly impact on the quality of their well-being and care delivery. Further education should be designed and strategies should be developed to increase physicians' ability to recognize and manage to cope with their unexamined emotional reactions
Might Reinfibulation be Medically Plausible in Carefully Screened Cases?
Get PDFIn light of the relational account of autonomy and the modern (holistic and phenomenological) account of health, this paper examines ethical justifications for ‗consensual‘ reinfibulation. Significant and constant discomfort in the body following deinfibulation might make a case for reinfibulation (considered as medical treatment in the traditional sense of the term). In any other case, the following requirements should be met for reinfibulation to be considered medically plausible: a) strong evidence that reinfibulation could help effectively improve woman‘s relational well-being, b) insignificant complications are expected, c) congruence between first-order and second-order autonomy or -in the context of political liberalism- strong second-order autonomy, d) an ―open door‖ for the woman to exit an oppressive context, e) rigorous scrutiny of woman‘s psychology, and f) woman‘s practical wisdom to organize her identity-related values, find a balance between her extreme emotions and realize herown goal of meaningful life in accordance with her own conception of the good. Conclusively, in carefully screened cases and individually judged requests for reinfibulation, it should not be ruled out that, after having been conducted a multi-disciplinary indepth investigation at social, psychological and medical level may be met conditions that make a case for reinfibulation.
Keywords: Reinfibulation, deinfibulation, autonomy, sexuality, health, well-bein
The competence of adolescents to make autonomous and valid decisions on their own medical treatment
Get PDFAim: To provide an overview of current knowledge on the state of science related to the problem of competence of adolescent patients to make health care decisions. Furthermore, the paper aims to provide a contribution to the current debate on the topic of interest. Method: A meta-review of scholarly knowledge on the topic of interest was conducted, combining literature from related fields in light of new research evidence. A broader reflection on the findings of the literature was provided, including the author’s opinion.Results: A subset of adolescents have adequate maturity to give valid consent to their own treatment. Adolescents’ involvement in decision-making is important to them and promotes the therapeutic alliance. There is variance in adolescents’ decision-making competence. Their competence is determined by several factors related to adolescents themselves and their current context (and relationships), as well as other situational factors. Family, physicians and peers play an important role in adolescents’ decision-making competence. Asymmetry in development of various structures in adolescent’s brain is a key factor that makes adolescence a unique developmental period requiring a tailored response. Adolescents’ decision-making competence should be considered in each individual case. Their autonomy should be approached as relational autonomy. Conclusion: Adolescents should be involved in treatment decisions to the extent possible. Therefore, apart from the individual assessment of adolescent’s decision-making competence, the establishment of a climate that enables adolescents to give valid consent to their own treatment is required. Moreover, adolescent patients should be activated and empowered to become fully engaged in the decision-making process. Training of physicians and development of strategies for achieving the desirable goals are necessary
Principlism And Aristotelean Virtue Ethics Are Not Mutually Exclusive
No full textThe final aim of this commentary is to highlight the role of Aristotle’s model of virtue ethics as an approach of the modern bioethical dilemmas. Ultimately, and most importantly, it should be highlighted that virtue ethics and principlism are not mutually exclusive. In my opinion, this consideration must inform what we call “medical Ethos” referring to the spirit of the medical culture that is underpinning medical practice and professional ethics
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