In the last decade, nurse scholars have focused extensively on the nature of nursing and its relationship to art and science. This emphasis has also been accompanied by an increasing literature on nursing ethics. In spite of this growing interest, the relationship of nursing art and nursing ethics has been left unclear. This paper proposes that nursing must be considered as a practical art because this conception explicates the relationship of nursing art and nursing ethics. It is based on the (...) thesis that nursing art is subordinated to nursing ethics and as such is a moral art. Different conceptions of nursing art (craft and fine art) will be explored to show their limits. This will be followed by the conception of nursing art as a practical art. (shrink)

OBJECTIVES: This study was designed to identify and compare the attitudes of patients and health care professionals towards advance directives. Advance directives promote recognition of the patient's autonomy, letting the individual exercise a certain measure of control over life-sustaining care and treatment in the eventuality of becoming incompetent. DESIGN: Attitudes to advance directives were evaluated using a 44-item self-reported questionnaire. It yields an overall score as well as five factor scores: autonomy, beneficence, justice, external norms, and the affective dimension. SETTING: (...) Health care institutions in the province of Québec, Canada. Survey sample: The sampling consisted of 921 subjects: 123 patients, 167 physicians, 340 nurses and 291 administrators of health care institutions. RESULTS: Although the general attitude of each population was favourable to the expression of autonomy, multivariate analysis of variance (MANOVA) indicated that physicians attached less importance to this subscale than did other populations (p < .001). Above all, they favoured legal external norms and beneficence. Physicians and administrators also attached less importance to the affective dimension than did patients and nurses. Specifically, physicians' attitudes towards advance directives were shown to be less positive than patients' attitudes. CONCLUSION: More attention should be given to the importance of adequately informing patients about advance directives because they may not represent an adequate means for patients to assert their autonomy. (shrink)

Euthanasia remains controversial in Canada and an issue of debate among physicians. Most studies have explored the opinion of health professionals regarding its legalization, but have not investigated their intentions when faced with performing euthanasia. These studies are also considered atheoretical. The purposes of the present study were to fill this gap in the literature by identifying the psychosocial determinants of physicians’ intention to practice euthanasia in palliative care and verifying whether respecting the patient’s autonomy is important for physicians.

This article seeks to shed light on the beliefs that influence nurses’ intention of respecting or not respecting an advance directive document, namely a living will or a durable power of attorney. Nurses’ beliefs were measured using a 44-statement questionnaire. The sample was made up of 306 nurses working either in a long-term care centre or in a hospital centre offering general and specialized care in the province of Québec. The results indicate that nurses have a strong intention of complying (...) with advance directives written by patients. The analysis also shows that four variables determine the strength of this intention: respect for autonomy; the location of the workplace; justice; and the dimension of relationships and emotions. Although these documents favour the expression of patients’ wishes, nurses should be aware that they do not systematically guarantee respect of a patient’s autonomy, nor do they replace a relationship based on trust between patients and health care professionals. (shrink)

From the Middle Ages onto the 19th century, following the trend set in leper hospitals, madness was to be hidden, secluded in dark places, far away from the mainstream of society. The emergence of the mad person, perceived as inevitably different, allows to make the boundaries between reason and folly, between human and inhuman, irrelevant. If leper hospitals have almost emptied out, if there are much fewer confinement facilities, the values and images related to the leper or the mad person, (...) as well as the sense of exclusion, continue to persist. The purpose of this paper is to show clearly that this matter of exclusion is a serious legacy that could very well apply nowadays to other figures that, each in their own way, symbolize menace or mockery. It applies notably to the aged and the dying who both appear as the opposite of modern society and its values of efficiency, productivity and profitability. The multiplication of places where old people are left to die, and the elderly who are crowded in old folks homes, stand as proof of their exclusion from society. Nevertheless, youth and old age coexist, as well as life and death. If care of others is the trait of a humane civilization, must it be understood that barbarism consists in ignoring its own humanity as well as that of others? In view of such practices of exclusion, policy statements based on recognition of human dignity, where ethical obligation rests on recognition of others and humanism, are rather paradoxical. Is this a paradox or a deadlock; a condition of exclusion or of reconnaissance? (shrink)

Les notions de «mort» et de «mourir», parfois utilisées sans distinctions dans la littérature, font référence à deux dimensions fort différentes pour la personne en fin de vie, de même que pour toutes les personnes appelées à en prendre soin . Alors que la personne malade voit venir la mort, elle doit vivre son mourir. La mort succède ainsi au mourir, dans le temps. Par ailleurs, une réflexion d’ordre philosophique permet de préciser que la mort s’avère une ordonnance de la (...) nature, elle est privation de la vie et un mystère. Et en tant que mystère, elle prendra forme selon les différentes croyances attribuées à l’immortalité de l’âme. Quant au mourir, il est l’épreuve par excellence d’une situation-limite. De plus, en dépit du caractère unique et individuel de cette expérience nouvelle pour tous, il assume différents visages. Si l’espoir de «connaître une belle mort» se conçoit aisément, le mourir n’en demeure pas moins le moment le plus tragique de l’existence humaine. (shrink)