Background: Dementia care at home often involves decisions in which the caregiver must weigh safety concerns with respect for autonomy. These dilemmas can lead to situations where caregivers provide care against the will of persons living with dementia, referred to as involuntary treatment. To prevent this, insight is needed into how family caregivers of persons living with dementia deal with care situations that can lead to involuntary treatment. Objective: To identify and describe family caregivers’ experiences regarding care decisions for situations (...) that can lead to involuntary treatment use in persons living with dementia at home. Research design: A qualitative descriptive interview design. Data were analysed using the Qualitative Analysis Guide of Leuven. Participants and research context: A total of 10 family caregivers providing care for 13 persons living with dementia participated in in-depth semi-structured interviews. Participants were recruited by registered nurses via purposive sampling. Ethical consideration: The study protocol was approved by the Ethics Committee of the University Hospitals Leuven and the Medical Ethical Test Committee Zuyderland. Findings: Family caregivers experience the decision-making process concerning care dilemmas that can lead to involuntary treatment as complicated, stressful and exhausting. Although they consider safety and autonomy as important values, they struggle with finding the right balance between them. Due to the progressive and unpredictable nature of dementia, they are constantly seeking solutions while they adapt to new situations. Family caregivers feel responsible and experience social pressure for the safety of persons living with dementia. They may be blamed if something adverse happens to the persons living with dementia, which increases an already stressful situation. Their experience is influenced by characteristics of the care triad such as practical and emotional support, knowledge, and previous experiences. Discussion and conclusion: To prevent involuntary treatment, professionals need to proactively inform family caregivers, and they need to support each other in dealing with complex care situations. (shrink)
The participation of vulnerable patients in clinical research poses apparent ethical dilemmas. Depending on the nature of the vulnerability, their participation may challenge the ethical principles of autonomy, non-maleficence, or justice. On the other hand, non-participation may preclude the building of a knowledge base that is a prerequisite for defining the optimal clinical management of vulnerable patients. Such clinical uncertainty may also incur substantial economic costs. We present the participation of pre-menopausal women with atrial fibrillation in trials of novel oral (...) anticoagulant drugs as a case study. Due to their non-participation in pivotal trials, it is uncertain whether for them, the risks that are associated with these drugs are outweighed by the advantages compared with conventional treatment. We addressed the question whether research of this new class of drugs in this subgroup would be appropriate from both, an ethical as well an economic perspective. We used the method of specifying norms as a wider framework to resolve the apparent ethical dilemma, while incorporating the question whether research of oral anticoagulants in premenopausal women with atrial fibrillation can be justified on economic grounds. For the latter, the results of a value-of-information analysis were used. Further clinical research on NOACs in premenopausal women with atrial fibrillation can be justified on both, ethical and economic grounds. Addressing apparent ethical dilemmas by invoking a method such as specifying norms can improve the quality of public practical reasoning. As such, the method should also prove valuable to committees that have formally been granted the authority to review trial protocols and proposals for scientific research. (shrink)
L' auteur distingue entre la philosophie comme attitude mentale et la philosophie comme science. La philosophie dans la première acception regarde, plus ou moins, tous les hommes. La philosophie scientifique est la pensée qui scrute méthodiquement le sens de l' Univers. Le mot "philosophie" indique une attitude mentale, mais ce mot n' est pas un nom qui pourrait désigner la science qu' est la philosophie. Jusqu' ici cette science, n' a pas de nom caractéristique. Car ce nom devrait indiquer le (...) sujet de cette science, comme le font p.e. géologie, anthropologie, psychologie. Une simple analogie logique nous incite à appeler la philosophie scientifique du nom de pantologie. Ce nom la défendrait peut-être contre le dilettantisme verbeux et les rêveries nébuleuses qui ne manquent pas dans la philosophie pour autant qu'elle est et qu'elle doit être l' affaire de tout être humain. (shrink)
L'auteur distingue entre la vérité constatante et la vérité vécue. Ces deux vérités sont qualitativement distinctes, et elles sont des ennemies archanées, dès qu'elles se trouvent en présence l'une de l'autre. De nos jours elles se combattent sous les noms de rationalisme et antirationalisme. Pourtant elles peuvent sans aucun compromis se transformer en une synthèse. Et cette synthèse se réalise lorsque la vérité constatante aboutit à sa suprême subtilité: l'observation introspective d'idées à tendance universelle (cette observation s'exprime en définitions exactes) (...) et l'introspection du mouvement de ces idées (qui s'exprime en logique exacte). Cette ultime introspection est la tâche de la philosophie. Le sens véritable de la philosophie est donc d'invoquer logiquement l'intuition postlogique. Cette intuition succède nécessairement à la pure logique philosophique et révèle aussi la valeur universelle des idées logiques par une rétrospection clarifiaǹte. (shrink)
