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Healthcare ethics and human values: an introductory text with readings and case studies
... Due to the dialogical nature of being human, narrative is widely recognised as significant in enhancing ethical understandings [31][32][33][34][35]. By voicing our experiences in dialogue with another, our shared common understandings are deepened which in turn opens each person to the rich complexities of each other's lives. ...
... Criminal Records Bureau (CRB) checks are also necessary for researchers working with children and with other groups deemed 'vulnerable'. There are several useful resources which explore the legal issues around research with children, especially in relation to consent and competence (see, e.g. Morrow & Richards, 2002; Alderson & Morrow, 2004; Farrell, 2005). A further legal issue regarding research with children concerns confidentiality in cases where a child discloses that they are being seriously harmed or mistreated. ...
http://eprints.ncrm.ac.uk/421/1/MethodsReviewPaperNCRM%2D011.pdf
This inquiry, which employed a narrative research approach, critically explored the ethical dimension of hospice palliative care. Hospice palliative care is the profession specifically developed to care for the dying. The development of this practice has grown significantly since the 1980s in Australia, yet ethical inquiry into this professional practice has largely focused on particular issues, problems or dilemmas, such as euthanasia. Although particular ethical issues are important considerations, a broader investigation of the ethics of hospice palliative care practice has not been given sufficient consideration in the growing accumulation of the research literature in Australia. Jennings (1997) surmises that “systematic reflection on ethics in the hospice field is curiously underdeveloped” (p. 2). This study goes someway towards filling this gap. In building upon the Pallium research by European scholars and integrating a social practice framework (Isaacs, 1998) this inquiry provides an alternative account of the ethical agenda and one which has privileged an internal exploration, rather than assume that the ethics would be the same as any other health care modality or to simply adopt a dominant, principles-based approach. These internal explorations were located in the storied accounts of thirty interdisciplinary hospice palliative care professionals.
This thesis provides a thorough, textual conversation into the realm of ethical caregiving at the end of life. Several key insights were illuminated. Firstly, total care must be central to the philosophy underpinning hospice palliative care practice, but this concept and practice of total care was being eroded and contested. Secondly, a predominantly modernist account of personhood was located in the narrative accounts. This modernist account of personhood was thought to be insufficient for the practice of total care and needed to be reconceptualised. An embedded ontological account was provided which would assist with the understanding and practice of total care. Thirdly, initially it was thought that there was no common, shared understanding of the purpose of the practice. It was suggested that the profession was “wandering in the wilderness” when it came to the aim of its practice. However, the professionals did share a common telos (aim towards a good) and it was overwhelmingly relational. This led to the proposal of a new telos for hospice palliative care practice centered on the creation and maintenance of unique relationships which would assist people in their final stage of life. Lastly, the ethical frameworks which guided practice for the professionals were presented. In these frameworks it was significant values (acceptance of human mortality, total care and honest and open communication) and relationships (how we treat each other) which played the main role in what constituted hospice palliative care ethics. An account of a hospice palliative care ethical relationship was provided which included a proximity stance of in-between. Overall, any ethic for hospice palliative care must have at the heart the relationship between professional caregiver and living-dying person. The relationships in this social practice, between each other, accompanying one another, are our ethical compass.
This thesis concluded that hospice palliative care, as a social practice, has a rich ethical dimension as understood and articulated by its professional members. These insights have resulted in the construction of a new ethical framework reflecting, formalising and adapting the ethical dimension as understood by its professional members. This ethical framework - A Relational Ethic of Accompanying - is needed to help maintain, sustain and protect the unique identity of this profession. This framework adds to the “moral vocabulary” (Jennings, 1997) and “moral specificity” (ten Have & Clark, 2002) of hospice palliative care practice. In addition, it would provide important guidance to palliateurs reflecting on how best to provide quality, compassionate and ethical care at the end of life.
The WPA Institutional Program on Psychiatry for the Person: from Clinical Care to Public Health (IPPP), ap- proved by the 2005 General Assembly, involves a WPA ini- tiative affirming the whole person of the patient in context as the center and goal of clinical care and health promo- tion, at both individual and community levels. This in- volves the articulation of science and humanism to opti- mize attention to the ill and positive health aspects of the person. Ancient Greek philosophers and physicians, like Socrates, Plato and Hippocrates, advocate holism in med- icine (1). Socrates taught that "if the whole is not well it is impossible for the part to be well". It is striking that these perspectives are re-emerging with renewed vigor in today's world through assertions that there is no health without mental health and by focusing local and international health efforts on the totality of the person (2-4).
Clinical complexity is emerging as a pointed indicator of the conceptual and empirical richness of psychiatry and general medicine and of the intricate challenges faced by our field. This complexity needs to be appraised, understood and formulated in attention to its various aspects and levels in order to inform adequately the development of crucial clinical tools such as an effective diagnostic model. A broad model relevant to this concern is being outlined under the term of person-centered integrative diagnosis (PID) 1,2.
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