Georges Canguilhem’s philosophy of life, according to which the living is a normative subject, grounds its epistemology in medicine. Medicine is a technique or an art that aims to restore the individual normativity of the patient. It can only be practiced based on the knowledge and understanding of the life norms, and on experience and values, in other words, on the subjectivity. This explains why the clinic and the therapeutics require a personal relationship between the physician and the patient.

Patient engagement in healthcare is increasingly discussed in the literature, and initiatives engaging patients in quality improvement activities, organizational design, governance, and research are becoming more and more common and have even become mandatory for certain health institutions. Here we discuss a number of ethical challenges raised by this engagement from patients from the perspectives of research, organizational/quality improvement practices, and patient experiences, while offering preliminary recommendations as to how to address them. We identified three broad categories of ethical issues (...) that intersect between the different types of patient engagement: (1) establishing a shared vision about goals of patient engagement and respective roles; (2) the process and method of engaging with patients; and (3) practical aspects of patient engagement. To explain these issues, we build from our personal, professional, and academic experiences, as well as traditions such as pragmatism and hermeneutics that stress the importance of participation, empowerment, and engagement. Patient engagement can be highly valuable at numerous levels, but particular attention should be paid to the process of engaging with patients and related ethical issues. Some lessons from the literature on the ethics of participatory research can be translated to organizational and quality improvement practices. (shrink)

This integrative review aims to provide a synthesis of research findings of health-care professionals’ knowledge, attitudes and behaviours relating to patient capacity to consent to or refuse treatment within the general hospital setting. Search strategies included relevant health databases, hand searching of key journals, ‘snowballing’ and expert recommendations. The review identified various knowledge gaps and attitudinal dispositions of health-care professionals, which influence their behaviours and decision-making in relation to capacity to consent processes. The findings suggest that there is tension between (...) legal, ethical and professional standards relating to the assessment of capacity and consent within health care. Legislation and policy guidance concerning capacity assessment processes are lacking, and this may contribute to inconsistencies in practice. (shrink)

Medical billing has become so intertwined with patient care, that in order to be truly committed to the physician's telos of managing a patient's medical suffering, it is imperative that physician ought to reexamine many of the ethical considerations about billing.

August 2006 marked the 10th anniversary of landmark legislation when Israel’s parliament passed the unique Patient’s Rights Law. This law underscores the importance of medical ethics in Israeli society. During a seminar at the Shaare Zedek School of Nursing, third-year students performed a qualitative research study investigating ethical issues arising in the field of nursing, and how nursing staff dealt with these issues in relation to the law. The research was conducted using semistructured questionnaires. The results showed that the staff (...) participants knew the law, but did not differentiate between legal and ethical problems. The establishment of a framework for dealing with these issues would help to promote professional ethics, encourage broad-based agreements related to ethical decisions, reduce ethical conflict, and increase implementation of the law on patients’ rights. (shrink)

"Vous n'avez rien à dire. Le médecin, ici, c'est moi! " Cette phrase, trop de patients l'ont entendue et l'entendent encore de la bouche d'un médecin. Pour quelles raisons, lorsque nous consultons, avons-nous trop souvent la sensation de n'être ni écoutés ni entendus, mais au contraire négligés, observés comme un cas clinique de plus? Pourquoi pensons-nous que c'est "un mauvais moment à passer"? Formation des médecins? Hiérarchie des professions de santé? Idéologie du monde médical? D'où vient le problème? Martin Winckler, (...) qui fut sous son vrai nom médecin généraliste de campagne, répond. Il nous raconte comment les facultés de médecine françaises fabriquent des praticiens qui sont avant tout des techniciens, et non des soignants. Il nous explique aussi ce que devrait être la relation entre patient et soignant. (shrink)

Notre proposition engage à (re)problématiser l’intérêt de la linguistique de et sur corpus quant à ses applications professionnelles. Ancrée en pragmatique, elle retrace le mode de recueil et d’exploitation de données dans le cadre applicatif du corpus DECLICS2016, ce, pour servir les questions de métier en médecine. Nous testons l’efficience de la linguistique, comme discipline de SHS contributive éclairant l’activité professionnelle, en produisant des scénarios pédagogiques à partir d’extraits de discours. On s’attache à réfléchir sur la « reconstruction de la (...) relation médecin patient », à partir d’un matériau de paroles authentiques. En premier lieu, l’accent est porté sur la constitution même du corpus DECLICS2016. En second lieu, c’est l’application en santé qui est interrogée via nos résultats. Ceux–ci dégagent, à partir d’entretiens de confrontation croisée entre médecins mis face aux paroles authentiques et données d’études linguistiques de patients, qu’il est délicat, pour ces médecins, de profiter de nos catégories pragmatiques prédéterminées : rapports de place, intercompréhension et stratégie discursive du médecin. (shrink)

Maintenance and promotion of patient dignity is an ethical responsibility of healthcare workers. The aim of this study was to investigate patient dignity and related factors in patients with heart failure. In this qualitative study, 22 patients with heart failure were chosen by purposive sampling and semi-structured interviews were conducted until data saturation. Factors related to patient dignity were divided into two main categories: patient/care index and resources. Intrapersonal features (inherent characteristics and individual beliefs) and interpersonal interactions (communication, respect, enough (...) information, privacy, and authority) were classified as components of the patient/care index category. Human resources (management and staff) and environmental resources (facilities and physical space) were classified as components of the resources category. The results will increase healthcare staff's understanding of patient dignity and its related factors, and provide information regarding the development of systems and processes that support patients in ways that are consistent with these values. (shrink)

Posttraumatic growth has been correlated with coping style among patients with breast cancer. However, to date, there is no consensus on the extent to which coping style is associated with PTG in patients with breast cancer. Therefore, we performed a meta-analysis to quantitatively synthesize previous findings. Based on the PRISMA method, this study employed a random effects model using the Stata software to calculate the pooled correlation coefficient and examined a range of moderators: cancer stage, publication type, participants’ age, and (...) coping style measurement tools. Relevant studies, published from inception to 9 March 2022, were identified through a systematic search in PubMed, Embase, Web of Science, PsycINFO, WANFANG DATA, Chinese National Knowledge Infrastructure, and China Science and Technology Journal Database databases. Finally, 20 studies involving 3,571 breast cancer patients were included in this investigation. The results showed a high positive relation between confrontation coping and PTG and a moderate positive relation between avoidance coping and PTG. Additionally, a moderate negative relation was identified between acceptance–resignation coping and PTG. Publication type and coping style measurement tools moderated the relation between coping style and PTG among breast cancer patients. The findings indicated that breast cancer patients should either confront the disease or avoid coping with it according to their disease state, which would facilitate better growth. More studies, especially, large prospective studies, are warranted to verify our findings.Systematic review registration[https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022319107], identifier [CRD42022319107]. (shrink)

Despite extensive theoretical debate, concrete efforts to overcome paternalism and unbalanced power relations between patients and doctors have produced limited results. In this article, I examine...

Loneliness in medicine is a serious problem not just for patients, for whom illness is intrinsically isolating, but also for physicians in the contemporary condition of medicine. We explore this problem by investigating the ideal physician-patient relationship, whose analogy with friendship has held enduring normative appeal. Drawing from Talbot Brewer and Nir Ben-Moshe, we argue that this appeal lies in a dynamic form of companionship incompatible with static models of friendship-like physician-patient relationships: a mutual refinement of embodied virtue that draws (...) both persons together. The ideal physician-patient relationship has a dialectical character that fosters each member's improvement of phenomenologically recognizing and embodying moral virtues. A key component of this dynamic is a commitment to the common goal of the patient's health, realized through joint interactivities and conversations over time. The physician's presence to the patient's suffering—understood best as an alienating phenomenological condition for the patient—orients and discloses possibilities for virtuous caregiving by structuring the meanings of the goals, conversations, and joint narrative constitutive of their relationship. Presence to suffering, paradoxically, is perhaps an important prerequisite for this dynamic partnership. These activities dialectically build an interpretive horizon of understanding through which moral goods and character refinement—in and for the other—may become revealed for both persons in their shared being-in-the-world. This analysis of suffering, mood, and revealing of (possible) moral goods has implications for addressing the modern problem of loneliness for patients and physicians, who are increasingly inhibited from building flourishing relationships with each other. (shrink)

In 1999, Médecins Sans Frontières set out to explore and demonstrate the feasibility of preventing and treating HIV/AIDS in a so-called resource-poor, economically and socially disadvantaged setting. The first MSF mission to incorporate antiretroviral treatment into its HIV-AIDS-oriented medical program was undertaken in Bangkok. The second project was launched in Khayelitsha where MSF has been providing ARV treatment for persons with HIV/AIDS since May 2001. Khayelitsha is an enclave of some 500,000 inhabitants, most of whom live in corrugated-iron shacks, without (...) running water or electricity. Unemployment is extremely high; crime and violence are rampant. The general prevalence of HIV/AIDS is 26%, measured among pregnant women. The tuberculosis incidence rate is one of the world's highest for open-space sites. Unsurprisingly, TB/HIV coinfection is very high too: 63% of those with TB are also infected with HIV. (shrink)

Despite enthusiasm for patient-centered care, the practice of patient-centered care is proving challenging. Further, it is curious that the literature about this subject does not explicitly address patient autonomy, since patients guide care in patient-centered care, and respect for patient autonomy is a prominent health-care value. We argue that by explicitly adopting a relational conception of autonomy as an essential component, patient-centered care becomes more coherent, is strengthened, and could help practitioners to make better use of a principle of respect (...) for autonomy. Hence, its use appears promising to narrow the theory–practice gap. (shrink)

Background: Over the last decade, new healthcare policies are transforming healthcare practices towards independent living and self-care of older people and people with a chronic disease or disability within the community. For professional caregivers in home care, such as nurses, this requires a shift from a caring attitude towards the promotion of patient autonomy. Aim: To explore how nurses in home care deal with the transformation towards fostering patient autonomy and self-care. Research design and context: A case study was conducted (...) in a professional development course for home care nurses, including participant observations and focus groups. The theoretical notion of ‘relational agency’ and the moral concept of ‘practices of responsibility’ were used to conduct a narrative analysis on the nurses’ stories about autonomy. Participants: Eight nurses, two coaches and two university lecturers who participated in the learning circle. Ethical considerations: Informed consent was sought at the start of the course and again, at specific moments during the course of the learning circle. Findings: Three main themes were found that expressed the moral demands experienced and negotiated by the nurses: adapting to the person, activating patients’ strengths and collaboration with patients and informal caregivers. Discussion: On a policy and organisational level, the moral discourse on patient autonomy gets intertwined with the instrumental discourse on healthcare budget savings. This is manifested in the ambiguities the nurses face in fostering patient autonomy in their daily home care practice. To support nurses, critical thinking, moral sensitivity and trans-professional working should be part of their professional development. Conclusion: The turn towards autonomy in healthcare raises moral questions about responsibilities for care. Promoting patient autonomy should be a collaborative endeavour and deliberation of patients, professional and informal caregivers together. (shrink)

Currently, the common theoretical models of "preferred" decision-making relationships do not correspond well with clinical experience. This interview study of congestive heart failure (CHF) patients documents the variety of patient preferences for decision-making, and the necessity for attention to family involvement. In addition, these findings illustrate the confusion as to the designation of surrogate decision-makers and physicians in charge. We conclude that no single model of physician-patient decision-making should be preferred, and that physicians should first ask patients how they want (...) medical information and decision-making to be handled. (shrink)

For successful goal-directed behavior, a performance monitoring system is essential. It detects behavioral errors and initiates behavioral adaptations to improve performance. Two electrophysiological potentials are known to follow errors in reaction time tasks: the error-related negativity, which is linked to error processing, and the error positivity, which is associated with subjective error awareness. Furthermore, the correct-related negativity is linked to uncertainty about the response outcome. Here we attempted to identify the involvement of the nucleus accumbens in the aforementioned performance monitoring (...) processes. To this end, we simultaneously recorded cortical activity and local field potentials during a flanker task performed by four patients with severe opioid abuse disorder who underwent electrode implantation in the NAc for deep brain stimulation. We observed significant accuracy-related modulations in the LFPs at the time of the ERN/CRN in two patients and at the time of Pe in three patients. These modulations correlated with the ERN in 2/8, with CRN in 5/8 and with Pe in 6/8, recorded channels, respectively. Our results demonstrate the functional interrelation of striatal and cortical processes in performance monitoring specifically related to error processing and subjective error awareness. (shrink)

The author of the article helps to understand the patient-doctor relation in the light of axiological psychiatry developed by the Polish psychiatrist, Antoni Kępiński (1918–1972). Kępiński was a doctor who, with great dedication and reverence, fulfilled his duties towards patients. First of all, he paid special attention to the uniqueness and specificity of the level of contact between a doctor and a patient and pointed out its friendly character. The article also introduces the sources of the axiological psychiatry developed by (...) Kępiński, which can be found in the philosophy of dialogue. In the light of the Cracow psychiatrist’s work, one can notice that his philosophical anthropology was saturated with the influence of dialogue thought. According to Kępiński, only a specific kind of emotional relationship based on empathy and trust can be the key to complete knowledge of a man fighting with mental illnesses. (shrink)

Engagement with the historical and theoretical underpinnings of measuring quality of life (QoL) and patient‐reported outcomes (PROs) in healthcare is important. Ideas and values that shape such practices—and in the endgame, people's lives—might otherwise remain unexamined, be taken for granted or even essentialized. Our aim is to explicate and theoretically discuss the philosophical tenets underlying the practices of QoL assessment and PRO measurement in relation to the notion of person‐centredness. First, we engage with the late‐modern history of the concept of (...) QoL and the act of assessing and measuring it. Working with the historical method of genealogy, we describe the development of both QoL assessments and PRO measures (PROMs) within healthcare by accounting for the contextual conditions for their possibility. In this way, the historical and philosophical underpinnings of these measurement practices are highlighted. We move on to analyse theoretical and philosophical underpinnings regarding the use of PROMs and QoL assessments in clinical practice, as demonstrated in review studies thereof. Finally, we offer a critical analysis regarding the state of theory in the literature and conclude that, although improved person‐centredness is an implied driver of QoL assessments and PROMs in clinical practice, enhanced theoretical underpinning of the development of QoL assessments is called for. (shrink)

Impaired performance in verbal fluency tasks is a frequent observation in Parkinson’s disease. As to the nature of the underlying cognitive deficit, it is commonly attributed to a frontal-type dysexecutive syndrome due to nigrostriatal dopamine depletion. Whereas dopaminergic medication typically improves VF performance in PD, e.g., by ameliorating impaired lexical switching, its effect on semantic network activation is unclear. Data from priming studies suggest that dopamine causes a faster decay of semantic activation spread. The aim of the current study was (...) to examine the impact of dopaminergic medication on the dynamic change of word frequency during VF performance as a measure of semantic spreading activation. To this end, we performed a median split analysis of word frequency during phonemic and semantic VF task performance in a PD group tested while receiving dopaminergic medication as well as after drug withdrawal, and in a sample of age-matched healthy volunteers. Dopaminergic medication in the PD group significantly affected phonemic VF with improved word production as well as increased error-rates. The expected decrease of word frequency during VF task performance was significantly smaller in the PD group ON medication than in healthy volunteers across semantic and phonemic VF. No significant group-difference emerged between controls and the PD group in the OFF condition. The comparison between both treatment conditions within the PD group did not reach statistical significance. The observed pattern of results indicates a faster decay of semantic network activation during lexical access in PD patients on dopaminergic medication. In view of improved word generation, this finding is consistent with a concept of more focused neural activity by an increased signal-to-noise ratio due to dopaminergic neuromodulation. However, the effect of dopaminergic stimulation on VF output suggests a trade-off between these beneficial effects and increased error-rates. (shrink)

The Roman Catholic theological approach to euthanasia is radically prohibitive. The main theological argument for this prohibition is the so-called “stewardship argument”: Christians cannot escape accounting to God for stewardship of the bodies given them on earth. This contribution presents an alternative approach based on European existentialist and philosophical traditions. The suggestion is that exploring the fullness of our relational responsibility is more apt for a pluralist – and even secular – debate on the legitimacy of euthanasia.

Disturbed identity is one of the defining characteristics of Borderline Personality Disorder manifested in a broad spectrum of dysfunctions related to the self, including disturbances in meaning-generating self-narratives. Autobiographical memories are memories of personal events that provide crucial building-blocks in our construction of a life-story, self-concept, and a meaning-generating narrative identity. The cultural life script represents culturally shared expectations as to the order and timing of life events in a prototypical life course within a given culture. It is used to (...) organize one’s autobiographical memories. Here, 17 BPD-patients, 14 OCD-patients, and 23 non-clinical controls generated three important autobiographical memories and their conceptions of the cultural life script. BPD-patients reported substantially more negative memories, fewer of their memories were of prototypical life script events, their memory narratives were less coherent and more disoriented, and the overall typicality of their life scripts was lower as compared with the other two groups. (shrink)

New brain-computer interface and neuroimaging techniques are making differentiation less ambiguous and more accurate between unresponsive wakefulness syndrome patients and patients with higher cognitive function and awareness. As research into these areas continues to progress, new ethical issues will face physicians of patients suffering from total locked-in syndrome, characterized by complete loss of voluntary muscle control, with retention of cognitive function and awareness detectable only with neuroimaging and brain-computer interfaces. Physicians, researchers, ethicists and hospital ethics committees should be aware of (...) and prepared to handle ethical issues unique to these totally locked-in patients. Several thought experiments are discussed, to highlight potential ethical dilemmas surrounding surrogate decision-making, autonomy, end-of-life care, and pediatric care, which will be unique to total LIS patients. These, along with other ethical problems especially relevant to total LIS patients, merit further discussion among physicians, researchers, ethicists and hospital ethics committees, to facilitate consensus regarding these issues, and improve patient care. (shrink)

This study investigated the effect of obstructive sleep apnea on the neural mechanism of visual perception. A preliminary case-control study was conducted. Seventeen patients with moderate to severe OSA in the sleep center of Civil Aviation General Hospital and 20 healthy controls matched for age, sex, and education were recruited. The participants accepted the perceptual contour integration task, compared the differences in behavioral indicators between the two groups, and compared the differences in electroencephalography data between the two groups through event-related (...) potential technology. The groups did not differ significantly in age and gender, but they differed significantly in body mass index. The groups were not statistically different in terms of sleep structure and total sleep time. AHI, sleep efficiency, and minimal SaO2 value in the OSA group were significantly different from those of the control group. The results showed that the average reaction time of the OSA group was significantly longer than that of the healthy control group in the contour integration task. There was no significant difference in the accuracy rate. The results of EEG showed that the amplitudes of N100 of the OSA group were significantly higher than those of the control group at O1, Oz, and O2 electrodes. There was no significant difference in latency between the two groups. At the FCz electrode, the amplitudes of N200 of the OSA group were significantly higher than those of the control group. Therefore, we concluded that in the early stage of the perceptual integration task, although the neural response activity of patients with moderate and severe OSA was not accelerated, they need to call on more psychological resources, activate more neurons in the contour global recognition processing stage, and the compensatory effect of frontal lobe appeared in the stage of visual perception. (shrink)

It is commonplace that care should be patient-centered. Nevertheless, no universally agreed-upon definition of patient-centered care exists. By consequence, the relation between patient-centered care as such and ethical principles cannot be investigated. However, some research has been performed on the relation between specific models of patient-centered care and ethical principles such as respect for autonomy and beneficence. In this article, I offer a detailed case study on the relationship between specific measures of patient-centered care and the ethical principle of respect (...) for autonomy. Decision Quality Instruments (DQIs) are patient-centered care measures that were developed by Karen Sepucha and colleagues. The model of patient-centered care that guided the development of these DQIs pays special attention to the ethical principle of respect for autonomy. Using Jonathan Pugh’s theory of rational autonomy, I will investigate how the DQIs relate to patient autonomy. After outlining Pugh’s theory of rational autonomy and framing the DQIs accordingly (Part I), I will investigate whether the methodological choices made while developing these DQIs align with respect for autonomy (Part II). My analysis will indicate several tensions between DQIs and patient autonomy that could result in what I call “structural paternalism.” These tensions offer us sufficient reasons, especially given the importance of the ethical principle of respect for autonomy, to initiate a more encompassing debate on the normative validity of Decision Quality Instruments. The aim of the present paper is to highlight the need for, and to offer a roadmap to, this debate. (shrink)