Background: Nurses are the largest professional group in healthcare and those who make more decisions. In 2014, the Committee on Bioethics of the Council of Europe launched the “Guide on the decision-making process regarding medical treatment in end-of-life situations”, aiming at improving decision-making processes and empowering professionals in making end-of-life decisions. The Guide does not mention nurses explicitly. Objectives: To analyze the ethical principles most valued by nurses working in palliative care when making end-of-life decisions and investigate if they are (...) consistent with the framework and recommendations of the Guide; to identify what disputed/controversial issues are more frequent in these nurses’ current end-of-life care practices. Design: Qualitative secondary analysis. Participants/context: Three qualitative datasets including 32 interviews from previous studies with nurses working in palliative care in Portugal. Ethical consideration: Ethical approval was obtained from the Ethics Research Lab of the Instituto de Bioética. Ethical procedures are thoroughly described. Findings: All participant nurses referred to autonomy as an ethical principle paramount in end-of-life decision-making. They were commonly involved in end-of-life decision-making. Palliative sedation and communication were the most mentioned disputed/controversial issues. Discussion: Autonomy was highly valued in end-of-life care and decision-making. Nurses expressed major concerns in assessing patients’ preferences, wishes, and promoting advance care planning. Nurses working in palliative care in Portugal were highly involved in end-of-life decision-making. These processes embraced a collective, inclusive approach. Palliative sedation was the most mentioned disputed issue, which is aligned with previous findings. Communication also emerged as a sensitive ethical issue; it is surprising, however, that only three nurses referred to it. Conclusion: While the Guide does not explicitly mention nurses in its content, this study shows that nurses working in palliative care in Portugal are involved in these processes. Further research is needed on nurses’ involvement and practices in end-of-life decision-making. (shrink)

Burnout is a phenomenon characterized by fatigue and frustration, usually related to work stress and dedication to a cause, a way of life that does not match the person’s expectations. Although it seems to be associated with risk factors stemming from a professional environment, this problem may affect any person. Palliative care is provided in a challenging environment, where professionals often have to make demanding ethical decisions and deal with death and dying. This article reports on the findings of a (...) systematic review aimed at identifying described burnout levels in palliative care nurses and physicians, and the related risks and protective factors. The main findings indicate that burnout levels in palliative care, or in health care settings related to this field, do not seem to be higher than in other contexts. (shrink)

This paper is about the relationship between leadership, organisational morals, and temporality. We argue that engaging with questions of time and temporality may help us overcome the overly agentic view of organisational morals and leadership ethics that dominates extant literature. Our analysis of the role of time in organizational morals and leadership ethics starts from a virtue-based approach to leading large-scale moral endeavours. We ask: how can we account for organizational morality across generations and independently of the leader? To address (...) this question, we studied the leadership model of the Jesuits, a Catholic Religious Order. Our case reveals that a virtue-based model of leadership does not necessarily imply that those who are selected to lead the organization are themselves virtuous, but that the processes underpinning the exercise of leadership are cyclical and repeated as truthfully as possible. Virtuous leadership, for the Jesuits, is therefore about the construction of an ideal type of leadership against which the processes which sustain it were designed. Our theoretical contribution is twofold. First, we propose an habitual understanding of moral forms of leadership, in which the procedural is constitutive of moral forms of organising; second, we explain how “timelessness”, understood as the quality of not changing as years go by, allowed the Jesuits to centre the processes which sustain their ethical model on the repetition, across space and time, of said processes, rather than on their outcome. We conclude that the search for virtue might be more relevant for large-scale moral endeavours than virtue itself. (shrink)