Like most goods‐producing sectors in the West, modern health‐care systems have been profoundly changed by globalization and the neoliberal policies that attend it. Since the 1970s, the role of the welfare state has been considerably reduced; funding and management of health systems have been subjected to wave upon wave of reorganization and assimilated to the private sector. At the same time, neoliberal policy has imposed the notion of patient empowerment, thus turning patients into consumers of health. The literature on nursing (...) has accordingly reported on the significant repercussions on all aspects of the profession, from delivery of care and treatment, through training for new nurses, to legislated policy reforms regarding the role and responsibilities of modern nurses. In light of these developments, this paper analyses and theorizes about the way the injection of neoliberal policy is linked to and affects the practice of nursing. Drawing on a number of Nietzschean arguments, we begin with an exploration of the complex effects of neoliberalism, bureaucratization, and technocratization on the health system and the practice of nursing. Our main theoretical point here is that neoliberal policy engenders and promotes a neoliberal tide, which results in the conversion of the values that drive modern nursing practice. We then examine this tide in the light of Nietzsche's concepts. Starting with an analysis based on the ontology of the will to power, we show that nurses are dominated by neoliberal values embedded in technocratic and bureaucratic ideologies. Finally, we argue that the application of neoliberal policy constitutes a form of domestication from which one might potentially be freed through the Nietzschean concept of transvaluation of values. This transvaluation, as its freeing from some of the neoliberal tide, may be accomplished in accordance with a hierarchy of specific life‐affirming values for nursing culture and practice. (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)

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)

Le féminisme a réussi à transformer partiellement le monde dans lequel nous vivons. Mais la résistance de la société traditionnelle à ces changements, ainsi que la remontée de la droite et la valorisation forcenée de l'individualisme, risquent de compromettre ses acquis. Dans ce contexte, l'avènement d'un discours pseudo-féministe qui véhicule les valeurs traditionnellement considérées comme « féminines » par les hommes risque d'embrouiller le message féministe pour tous ceux qui y accordaient créance et espéraient le voir aller plus loin dans (...) sa quête d'une société nouvelle. Nous voulons analyser ce discours en montrant comment il tend à remettre en question l'effort de transformation sociale amorcé par le féminisme.Feminism has partly transformed our world. Traditionnal society's resistance to these changes together with the rise of the Right and individualism endanger these gains. In that context, the advent of pseudo-feminist discourse carrying the values traditionnally seen by men as "féminine" might blur the feminist message for those who give it credit and hope to see it progress in its quest for a new society. We wish to analyse that discourse and show how it tends to challenge the social transformation effort launched through feminism. (shrink)

Discussions about real knowledge contained in grand theories and models seem to remain an active quest in the academic sphere. The most fervent of these defendants is Rosemarie Parse with her Humanbecoming School of Thought (1981, 1998). This article first highlights the similarities between Parse's theory and Blumer's symbolic interactionism (1969). This comparison will act as a counterargument to Parse's assertions that her theory is original ‘nursing’ material. Standing on the contemporary philosophy of science, the very possibility for discovering specific (...) nursing knowledge will be questioned. Second, Parse's scientific assumptions will be thoroughly addressed and contrasted with Blumer's more moderate view of knowledge. It will lead to recognize that the valorization of the social nature of existence and reality does not necessarily induce requirements and methods such as those proposed by Parse. According to Blumer's point of view, her perspective may not even be desirable. Recommendations will be raised about the necessity for a distanced relationship to knowledge, being the key to the pursuit of its improvement, not its circular contemplation. (shrink)

This article explores the experience of death from the perspective of existential philosophy, for the purpose of finding ways to humanize end‐of‐life nursing care. A person in his or her final days is seen by the caregiver as a being seeking the continual creation of his human becoming, from the experience of sickness to death. From the moment the torment of suffering begins, a person needs a presence of humanistic professionalism that embraces the values of the nursing profession.