Compassionate care: a moral dimension of nursingThis paper focuses on the concept of compassion and its meaning for nursing practice. Compassion is often considered to be an essential component of nursing care; however, it is difficult to identify what exactly comprises compassionate care. To begin with, there is a general discussion of the meaning of compassion and an examination of its common usage. An argument then is presented that compassion is more than just a natural (...) response to suffering, rather that it is a moral choice. The paper outlines the extent to which this concept has implications for nursing care, highlighting some of the obstacles that nurses need to overcome in order to maintain this essential moral value of the caring role. (shrink)

Background eHealth was widely used during the COVID-19 pandemic. Much attention was given to the technical aspects of eHealth, such as infrastructure and cost, while the soft skill of compassion remained underexplored. The wide belief in compassionate care is more compatible with in-person interactions but difficult to deliver via e-platforms where personal and environmental clues were lacking urges studying this topic. Purpose to explore the experience of delivering compassionate care via an eHealth platform among healthcare professionals (...) working to contain the COVID-19 pandemic. Methods A qualitative study design with an interpretative phenomenological analysis approach was used. Twenty healthcare professionals (fifteen nurses and five physicians) who provided care using technology platforms, such as telephone hotlines, mobile apps, and social media, were interviewed individually. Ethical considerations Permission to conduct the study was obtained from the Institutional Review Board. Results Participants stated that “eHealth enabled compassionate care during the pandemic” by ensuring patient care availability and accessibility. They shared experiences of “communicating compassionate care via eHealth” with suggestions of addressing patients’ needs with empathy, adopting a structured protocol to guide eHealth communication, and using more advanced visual-media methods to promote human-to-human interaction. They recommended “setting realistic mutual expectations” considering the limitations of eHealth in handling complex health situations and staffing shortages. Participants considered “low eHealth literacy hinders compassion.” Additionally, they recommended the need for “institutional/system-level support to foster compassionate care.” Conclusion Participants recognized the importance of integrating compassion into eHealth services. Promotion of compassionate care requires standardization of eHealth services with institutional and system-level support. This also includes preparing adequate staffing who can communicate compassionate care via eHealth, set realistic expectation, and adjust communication to eHealth literacy level while meeting the needs of their patients. (shrink)

Background:Withdrawal of treatment is a common practice in intensive care units when treatment is considered futile. Compassion is an important aspect of care; however, it has not been explored much within the context of treatment withdrawal in intensive care units.Objectives:The aim was to examine how concepts of compassion are framed, utilised and communicated by intensive care nurses in the context of treatment withdrawal.Design:The study employed a qualitative approach conducting secondary analysis of an original data set. In (...) the primary study, 13 nurses were recruited from three intensive care units within a large hospital in United Kingdom. Deductive framework analysis was used to analyse the data in relation to compassionate care.Ethical considerations:The primary study was approved by the local Research Ethics Committee and the hospital’s Research and Development services.Findings:Compassionate care was mostly directed to the patient’s family and was demonstrated through care and emotional support to the family. It was predominantly expressed through attempts to maintain the patient’s dignity by controlling symptoms, maintaining patient cleanliness and removing technical apparatus.Conclusion:This study’s findings provide insight about compassionate care during treatment withdrawal which could help to understand and develop further clinicians’ roles. Prioritising the family over the patient raised concerns among nurses, who motivated by compassion, may feel justified in taking measures that are in the interests of the family rather than the patient. Further work is needed to explore the ethics of this. (shrink)

Volume 20, Issue 2, February 2020, Page 55-57.

In the face of forced migrants’ urgent needs and ongoing human rights violations endured within and across borders, scholars note the ‘dual imperative’ (Jacobsen and Landau 2003) of documenting these realities while also responding through humanitarian advocacy and/or political activism. This article documents one such experience, that is, an action research process that began with the first author’s accompaniment of Central American asylum-seeking mothers and children in Boston and included witnessing to and documenting these mothers’ narratives in a context of (...) systemic injustice, while contributing to the creation of a humanitarian grassroots network. The latter supported migrants’ needs while advocating for their right to asylum. Reflecting on these experiences, we explore how research that creates knowledge while acting in the world, demands what we herein describe as feminist activist scholarship grounded in dialogic relationality and compassionate care. The latter moves beyond empathetically feeling for or documenting the suffering of others, towards mutual accompaniment to engage in concrete actions to alleviate that suffering. The dialogic relationships of care in which scholars accompany and act with those at the margins have the potential to transform conventional, post-positivist knowledge production strategies from distancing or objectifying processes towards mutual accompaniment and activist scholarship. (shrink)

In this article we describe the successes of Aetna’s Compassionate Care Program in providing case management services for people with advanced illnesses.

Compassion, as an indicator for quality care, is highly valued by patients and healthcare professionals. Compassionate care is considered a moral dimension of nursing practice and an essential component of high quality care. This study aimed to answer these questions: What are the facilitators and barriers of providing compassionate nursing care in the clinical setting? Which strategies do nurses use to provide compassionate care? What is the specific model of compassionate (...) class='Hi'>care for the nursing context? A grounded theory approach was used in this study. A total of 21 nurses working in diverse clinical settings participated in the study. Purposive and theoretical sampling was used to select the participants. Data were collected by in-depth face to face interviews and analyzed by the constant comparative method. Ethical approval was gained from the Ethical Review Board of Tabriz University of Medical sciences. The analysis resulted in the development of three main themes: contextual factors affecting compassionate care, the compassionate care actions, and the consequences of compassionate care. The main dimensions of compassionate care are demonstrated in a Compassionate Nursing Care Model. Nurses’ ability on providing compassionate care is influenced by individual and organizational factors that may facilitate or inhibit this type of care. Leadership and nurse managers should remove the barriers which diminish the nurses’ ability to provide compassionate care and support them to engage in compassionate care programs. Identifying and recruiting compassionate nurses, developing their compassionate capacity, and providing role models of compassion could improve the flourishing of person-centered and compassionate care in clinical settings. The Compassionate Nursing Care Model provides a model to guide nursing care and research. (shrink)

Alasdair MacIntyre described the late modern West as driven by two moral values: efficiency and effectiveness. Regardless of whether you accept MacIntyre's overarching story, it seems clear that efficiency and effectiveness have achieved a zenith in institutional health care structures, such that these two aspects of care become the final arbiters of what counts as “good” care. At the very least, they are dominant in many clinical contexts and act as the interpretative lens for the judgments of (...) successful health care managers. The drive of efficiency can also be seen in “lean” management methods (originally imported from the automotive manufacturing industry) increasingly deployed in the intensive care unit. This drive gives us pause. The high stress of the ICU is exacerbated by the enormous complexity of technological interventions designed to maintain physiological functioning as the body heals, as well as the ever‐present concerns related to cost, effectiveness, and efficiency. The ICU, therefore, provides an illustrative view of the challenges facing clinicians, as well as resource managers, in terms of delivering care. In short, the goal of technocratic efficiency often ends up at odds with humane purposes. To better understand these contemporary health care dynamics, we conducted a limited series of focus group discussions and interviews with residents experienced in the challenges of delivering care in the ICU environment. In what follows, we highlight some narrative observations drawn from these focus groups. We found a recurrent and disconcerting refrain among our informants that has not been adequately described or addressed in the literature: technocratic management techniques have crept into and bifurcated clinical care strategies in the ICU. Specifically, we highlight the influence of concerns around efficiency and effectiveness and the ways in which these foci have contributed to a bifurcation in care in the ICU along two trajectories: either compassionate care or curative care. (shrink)

Public health strategies recommend isolating patients with SARS-CoV-2 infection. But compassionate care in the intensive care unit (ICU) is an ethical obligation of modern medicine that cannot be justified by the risk of infection or the lack of personal protective equipment. This article describes the experiences of clinicians in ICUs in the south of Spain promoted by the Andalusian Society of Intensive Care SAMIUC, in the hope it will serve to improve the conditions in which these (...) patients die, and to help their families who suffer when they cannot say good-bye to their loved ones.In the south of Spain, healthcare professionals use daily videoconferencing to improve communication between clinicians, patients, and their relatives who cannot visit them in the ICU. This close communication allows families to see their loved ones and extends communication between healthcare professionals, patients, and their relatives. To allow family members to accompany patients at the end of life, it is possible to adapt public health rules to the epidemic situation. (shrink)

Through careful interpretive analysis, the piece argues that the Christian cosmic vision reveals the wrongness of industrial animal agriculture and that taking up more intentional eating practices is a morally significant spiritual discipline for Christians. It also testifies to our claim in the introduction [to the "Food and Religion" chapter of *Food, Ethics, and Society*] that religious food ethics have practical advantages over purely secular ethics insofar as the latter usually tries to begin from a neutral perspective that has very (...) little power to compel a person, whereas religious food ethics hooks into one's deepest commitments. (shrink)

For thousands of years, various spiritual traditions and social activists have appealed to humans to adopt compassionate ways of living to address the suffering of life. Yet, along with our potential for compassion and self-sacrifice, the last few thousand years of wars, slavery, tortures, and holocausts have shown humans can be extraordinarily selfish, callous, vicious, and cruel. While there has been considerable engagement with these issues, particularly in the area of moral psychology and ethics, this paper explores an evolutionary (...) analysis relating to evolved resource-regulation strategies that can be called “care and share” versus “control and hold.” Control and hold are typical of primates that operate through intimidatory social hierarchies. Care and share are less common in non-human primates, but evolved radically in humans during our hunter-gatherer stage when our ancestors lived in relatively interdependent, small, mobile groups. In these groups, individualistic, self-focus, and self-promoting control and hold strategies (trying to secure and accumulate more than others) were shunned and shamed. These caring and sharing hunter-gatherer lifestyles also created the social contexts for the evolution of new forms of childcare and complex human competencies for language, reasoning, planning, empathy, and self-awareness. As a result of our new ‘intelligence’, our ancestors developed agriculture that reduced mobility, increased group size, resource availability and storage, and resource competition. These re-introduced competing for, rather than sharing of, resources and advantaged those who now pursue (often aggressively) control and hold strategies. Many of our most typical forms of oppressive and anti-compassionate behavior are the result of these strategies. Rather than (just) thinking aboutindividualscompeting with one another, we can also consider these different resource regulation strategies ascompeting within populationsshaping psychophysiological patterns; both wealth and poverty change the brain. One of the challenges to creating a more compassionate society is to find ways to create the social and economic conditions that regulate control and hold strategies and promote care and share. No easy task. (shrink)

Background: Compassion is the core of nursing care and the basis of ethical codes. Due to the complex and abstract nature of this concept, there is a need for further investigations to explore the meaning and identify compassionate nursing care. Objectives: The purpose of this study was to identify and describe compassionate nursing care based on the experiences of nurses, patients, and family caregivers. Research design: This was a qualitative exploratory study. Data were analyzed using (...) the conventional content analysis method. Participants and research context: Nurses, hospitalized patients, and family caregivers in different educational hospitals in an urban area of Iran were selected from February 2016 to December 2017 using a purposeful sampling method. In-depth and semi-structured interviews, focus group interviews, and field notes were used for data collection. Ethical considerations: The study was approved by the University’s Ethics Committee. The participants were informed about the aim and method of the study, reasons for recording the interviews, confidentiality of data, and voluntary nature of participation in this study. Findings: Data from interviews and filed notes were analyzed and classified into three themes: “effective interaction,” “professionalism,” and “continuous comprehensive care.” Discussion and conclusion: Emerged themes of this study involved holistic care in the current literature on nursing with an emphasis on effective interaction and professionalism. Nurses can understand patients’ and family caregivers’ comprehensive needs through interaction skills. In addition, clinical proficiency, maintaining professional ethics’ standards along with holism, and continuity in care are examples of compassionate care. Education program about compassionate care can enhance the quality of nursing care. (shrink)

It is inevitable that some inmates in large state prison systems will suffer from terminal conditions and die while incarcerated. But how those inmates experience that event is primarily controlled by correctional policies and by the prison medical and correctional staff assigned to their care. Compassion for inmates who are dying cannot be legislated or mandated, but humane and compassionate care for the dying can be facilitated or thwarted by legislative and correctional policies, and by the manner (...) in which correctional personnel interpret those policies.Death in New York State prisons is a frequent event, occurring at a rate substantially higher than that in most other states. With a prison population that has risen to 70,000 inmates and with the nation’s highest rate of human immunodeficiency virus infection, more than 2,817 inmates died in New York prisons during the period 1990-1998. In April 1992, in the face of an ever-increasing death rate in its prisons, the New York State legislature passed the Medical Parole Law, a measure designed to permit dying inmates to be released on parole prior to their normal release eligibility date. (shrink)

It is inevitable that some inmates in large state prison systems will suffer from terminal conditions and die while incarcerated. But how those inmates experience that event is primarily controlled by correctional policies and by the prison medical and correctional staff assigned to their care. Compassion for inmates who are dying cannot be legislated or mandated, but humane and compassionate care for the dying can be facilitated or thwarted by legislative and correctional policies, and by the manner (...) in which correctional personnel interpret those policies.Death in New York State prisons is a frequent event, occurring at a rate substantially higher than that in most other states. With a prison population that has risen to 70,000 inmates and with the nation’s highest rate of human immunodeficiency virus infection, more than 2,817 inmates died in New York prisons during the period 1990-1998. In April 1992, in the face of an ever-increasing death rate in its prisons, the New York State legislature passed the Medical Parole Law, a measure designed to permit dying inmates to be released on parole prior to their normal release eligibility date. (shrink)

In the present paper, we discuss the ethics of compassionate psychedelic psychotherapy and argue that it can be morally permissible. When talking about psychedelics, we mean specifically two substances: psilocybin and MDMA. When administered under supportive conditions and in conjunction with psychotherapy, therapies assisted by these substances show promising results. However, given the publicly controversial nature of psychedelics, compassionate psychedelic psychotherapy calls for ethical justification. We thus review the safety and efficacy of psilocybin- and MDMA-assisted therapies and claim (...) that it can be rational for some patients to try psychedelic therapy. We think it can be rational despite the uncertainty of outcomes associated with compassionate use as an unproven treatment regime, as the expected value of psychedelic psychotherapy can be assessed and can outweigh the expected value of routine care, palliative care, or no care at all. Furthermore, we respond to the objection that psychedelic psychotherapy is morally impermissible because it is epistemically harmful. We argue that given the current level of understanding of psychedelics, this objection is unsubstantiated for a number of reasons, but mainly because there is no experimental evidence to suggest that epistemic harm actually takes place. (shrink)

An indispensable guide to reducing the suffering -- of patients and caregivers alike -- and to improving healthcare delivery for all. The Antidote to Suffering is the first book to explore the pervasiveness of suffering in our healthcare system, and to offer a powerful, detailed, evidence-based plan for optimizing the patient and caregiver experience. Timely and important, the book defines compassionate and connected care, presenting specific recommendations drawn from proprietary research. It provides a comprehensive solution to suffering in (...) healthcare, addressing the clinical, operational, cultural, and behavioral aspects of care delivery. Readers will find insightful personal accounts from patients and providers, as well as practical, tangible strategies for improving healthcare without sacrificing the respect, dignity, and compassion we all deserve. (shrink)

As evidence of the unintended consequences of industrial farm animal production continues to mount, it is becoming increasingly clear that, far from being a trivial matter of personal preference, eating is an activity that has deep moral and spiritual significance. Surprising as it may sound, the simple question of what to eat can prompt Christians daily to live out their spiritual vision of Shalom for all creatures--to bear witness to the marginalization of the poor, the exploitation of the oppressed, the (...) suffering of the innocent, and the degradation of the natural world, and to participate in the reconciliation of these ills through intentional acts of love, justice, mercy, and good stewardship. The aim of this work is to understand the cultivation of more intentional "compassionate eating" habits as a form of engaged Christian discipleship that responds to a wide array of practical, moral, and spiritual problems affecting all aspects of creation--human, animal, and environmental. The guiding suggestion is that compassionate eating is a spiritual discipline that offers a symbolically significant and practically effective way to live in faithful anticipation of the "peaceable kingdom" described in Judeo-Christian creation and redemption narratives. (shrink)

This article proposes a retrospective analysis of a compassionate use, using a case study of request for Avelumab for a patient suffering from Merkel Cell Carcinoma. The study is the result of a discussion within a Provincial Ethics Committee following the finding of a high number of requests for CU program. The primary objective of the study is to illustrate the specific ethical and clinical profiles that emerge from the compassionate use program issue. The secondary goals are: a) (...) to promote a moral reflection among physicians who require approval for the CUP and b) provide the basis for recommendations on how to request CUP. The instruments for carrying out the analysis of the case study and the discussion are as follows: Analysis of the audio-recording of the EC meeting regarding the selected Case study. In-depth discussion of topics that emerged during the meeting by means of administration of 5 semi-structured interviews with 2 doctors involved in the case and with 3 components of the EC who played a major role in the EC internal discussion. In an exploration of emerging clinical and ethical issues, four primary themes arise: 1. efficacy, safety of the treatment and patient’s quality of life; 2. clear, realistic, adequate communication; 3. right to hope; 4. simultaneous Palliative Care approach. The results of ethical analysis carried out concern two areas: 1) ethical profiles relating to the use of CUP; 2) the role of the EC concerning the compassionate use of drugs and the need to provide recommendations on how to request CUP. With the aim of implementing these conclusions, the provincial EC of Reggio Emilia chose to steer the request for drugs for compassionate use through recommendations for good clinical and ethical practice based on the following assumptions: 1) the “simultaneous care” approach must be preferred. Secondly, 2) the EC’s assessment must be part of the decision-making process that the care team conducts before proposing compassionate use to the patient. (shrink)

This book presents the case for Compassionate Reasoning as a moral and psychosocial skill for the positive transformation of individuals and societies. It has been developed from a reservoir of moral philosophical, cultural, and religious wisdom traditions over the centuries. These have been derived from a careful combination of classical schools of ethical thought that are artfully combined with compassion neuroscience, contemporary approaches to conflict resolution, public health methodologies, and positive psychological approaches to social change. There is an urgent (...) need for human civilization to invest in the broad-based cultivation of compassionate thoughts, feelings, and especially habits. This skill is then combined with moral reasoning to move the self and others toward less anger and fear, more joy and care in the pursuit of reasonable policies that build peaceful families, communities, and societies. There are many people across the planet who work every day for the sake of others but who are ensconced in exhausting work with dangerous and difficult situations of conflict. These people are often heroic bridge-builders and creators of peaceful societies, and they have a common set of cultivated moral character traits and psychosocial skills. They tend to be kinder, more reasonable, more self-controlled, and more goal-oriented to peace. They are united by a particular set of moral values and the emotional skills to put those values into practice. The aim of this book is to articulate the best combination of those values and skills that lead to personal and communal sustainability, not burnout and self-destruction. The book pivots on the observable difference in the mind-and proven in neuroscience imaging experiments-between destructive empathic distress, on the one hand, and, on the other, joyful, constructive, compassionate care. Facing existential threats to life on the planet, humans can and must make such skills universally sustainable and ingrained. (shrink)

Hastings Center Report, Volume 52, Issue S1, Page S42-S45, March‐April 2022.

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Compassionate Justice: An Interdisciplinary Dialogue with Two Gospel Parables on Law, Crime, and Restorative Justice by Christopher D. MarshallGlen StassenCompassionate Justice: An Interdisciplinary Dialogue with Two Gospel Parables on Law, Crime, and Restorative Justice CHRISTOPHER D. MARSHALL Eugene, OR: Cascade Books, 2012. 386 pp. $33.60Christopher Marshall is known to Society of Christian Ethics members for his highly acclaimed book on restorative justice, Beyond Retribution, and for his (...) plenary address at the SCE annual meeting published in the JSCE 27, no. 2 (2007). The plenary address forms one chapter of the present Compassionate Justice. Well [End Page 221] informed on ethics, criminal justice, and human rights, Marshall is a New Testament scholar at Victoria University in New Zealand.Marshall points out that the two best-known of Jesus’s parables—the Compassionate Samaritan, and the Prodigal Son—have been the most influential of Jesus’s parables in Western culture and legal theory. The Compassionate Samaritan is Jesus’s response to a lawyer’s question that answers a central legal question of the time: Who is my neighbor, whom I am obligated by Leviticus 19:7 to love as myself? In the Prodigal Son, the three main characters in legal offense are clearly portrayed as the offender, the victim, and the law-abiding community; in turn, as Marshall points out, “the older brother’s reaction centers directly on the justice of his father’s actions” (192–93). Marshall argues that present legal theory can learn from careful dialogue with these two parables. These parables are not only historically influential but also so insightfully and beautifully crafted that dialogue with them can bring incisive insights. In addition, dialogue with them presses Anglo-Saxon liberalism where it is weak and needs to grow.The parable of the Compassionate Samaritan opens up questions about the need for Good Samaritan laws that defend persons who come to the aid of a person in danger of death (e.g., from an accident, fire, or drowning) against liability for inadvertently and unintentionally causing damage. Under present Anglo-Saxon law, such good Samaritans can be sued for damages. This is not the case, however, in most European countries. Similarly, most European and Latin American countries have bad Samaritan laws: Where “victims are in mortal danger and unable to save themselves,” there is a legal duty for “those who are consciously aware of the victim’s predicament, who are close enough to intervene, and who have the effective means of intervention available to them” to come to the aid of the victims. “The most glaring exception to this pattern,” Marshall argues, “occurs in Anglo-American legal systems” because of liberalism’s maximization of individual liberty even against coercion to come to the aid of persons who would die if no help arrives (155). Samaritan laws “give formal expression to the supreme value of human life, to the bonds of solidarity and empathy that comprise human identity and that bind people together in social community, and to ongoing need human beings have to be committed to one another’s rescue and restoration when severe harm befalls them” (174).Responding to the parable of the Prodigal Son, Marshall argues that both compassion and repentance are crucial for understanding the humanity and the sufferings of persons being defended or judged by law. This does not replace the standard tools of legal interpretation; it takes account of the more holistic context (288–90). In fact, “unreflective compassion can be dangerous and distorting” (296). Marshall discusses the complications insightfully and in a balanced [End Page 222] way. He concludes with an extensive discussion and refutation of perhaps the most important book-length criticism of restorative justice.Marshall’s interpretation of these two parables surpasses any other that I have read. His sensitive and thoughtful analysis of the experience of victimization goes beyond any other interpretation of the Compassionate Samaritan that I have seen. In this he resembles Daniel Philpott’s interpretation of victimization in Just and Unjust Peace (Oxford University Press, 2012). His description of the shameful rupture of relationship with father, family, and community by the prodigal son goes well beyond what I have seen previously. I think... (shrink)

Since the onset of the SARS-CoV-2 pandemic, an array of off-label interventions has been used to treat patients, either provided as compassionate care or tested in clinical trials. There is a challenge in determining the justification for conducting randomised controlled trials over providing compassionate use in an emergency setting. A rapid and more accurate evaluation tool is needed to assess the effect of these treatments. Given the similarity to the Ebola Virus Disease (EVD) pandemic in Africa in (...) 2014, we suggest using a tool designed by the WHO committee in the aftermath of the EVD pandemic: Monitored Emergency Use of Unregistered and Investigational Interventions (MEURI). Considering the uncertainty around SARS-CoV-2, we propose using an improved MEURI including the Plan–Do–Study–Act tool. This combined tool may facilitate dynamic monitoring, analysing, re-evaluating and re-authorising emergency use of unproven treatments and repeat it in cycles. It will enable adjustment and application of outcomes to clinical practice according to changing circumstances and increase the production of valuable data to promote the best standard of care and high-quality research—even during a pandemic. (shrink)

This article reviews the literature on deception to illuminate the phenomenon as a background for an appraisal within nursing. It then describes nursing as a practice of caring. The character of the Good Samaritan is recommended as indicative of the virtue of compassion that ought to underpin caring in nursing practice. Finally, the article concludes that a caring nurse, responding virtuously, acts by being compassionate, for a time recognizing the prima facie nature of the rules or principles of truth (...) telling. (shrink)

In this article I wish to show how care ethics puts forward a fundamental critique on the ideal of independency in human life without thereby discounting autonomy as a moral value altogether. In care ethics, a relational account of autonomy is developed instead. Because care ethics is sometimes criticized in the literature as hopelessly vague and ambiguous, I shall begin by elaborating on how care ethics and its place in ethical theory can be understood. I shall (...) stipulate a definition of care ethics as a moral perspective or orientation from which ethical theorizing can take place. This will mean that care ethics is more a stance from which we can theorize ethically, than ready-made theory in itself. In conceiving care ethics in this way, it becomes possible to make clear that, for instance, a moral concept of autonomy is not abandoned, but instead is given a particular place and interpretation. In the final part of this article I will show how ‘relational autonomy’ can be applied fruitfully in the practice of psychiatric care. (shrink)

Background:Moral distress is a complex phenomenon frequently experienced by critical care nurses. Ethical conflicts in this practice area are related to technological advancement, high intensity work environments, and end-of-life decisions.Objectives:An exploration of contemporary moral distress literature was undertaken to determine measurement, contributing factors, impact, and interventions.Review Methods:This state of the science review focused on moral distress research in critical care nursing from 2009 to 2015, and included 12 qualitative, 24 quantitative, and 6 mixed methods studies.Results:Synthesis of the scientific (...) literature revealed inconsistencies in measurement, conflicting findings of moral distress and nurse demographics, problems with the professional practice environment, difficulties with communication during end-of-life decisions, compromised nursing care as a consequence of moral distress, and few effective interventions.Conclusion:Providing compassionate care is a professional nursing value and an inability to meet this goal due to moral distress may have devastating effects on care quality. Further study of patient and family outcomes related to nurse moral distress is recommended. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Compassionate Justice: An Interdisciplinary Dialogue with Two Gospel Parables on Law, Crime, and Restorative Justice by Christopher D. MarshallGlen StassenCompassionate Justice: An Interdisciplinary Dialogue with Two Gospel Parables on Law, Crime, and Restorative Justice CHRISTOPHER D. MARSHALL Eugene, OR: Cascade Books, 2012. 386 pp. $33.60Christopher Marshall is known to Society of Christian Ethics members for his highly acclaimed book on restorative justice, Beyond Retribution, and for his (...) plenary address at the SCE annual meeting published in the JSCE 27, no. 2 (2007). The plenary address forms one chapter of the present Compassionate Justice. Well [End Page 221] informed on ethics, criminal justice, and human rights, Marshall is a New Testament scholar at Victoria University in New Zealand.Marshall points out that the two best-known of Jesus’s parables—the Compassionate Samaritan, and the Prodigal Son—have been the most influential of Jesus’s parables in Western culture and legal theory. The Compassionate Samaritan is Jesus’s response to a lawyer’s question that answers a central legal question of the time: Who is my neighbor, whom I am obligated by Leviticus 19:7 to love as myself? In the Prodigal Son, the three main characters in legal offense are clearly portrayed as the offender, the victim, and the law-abiding community; in turn, as Marshall points out, “the older brother’s reaction centers directly on the justice of his father’s actions” (192–93). Marshall argues that present legal theory can learn from careful dialogue with these two parables. These parables are not only historically influential but also so insightfully and beautifully crafted that dialogue with them can bring incisive insights. In addition, dialogue with them presses Anglo-Saxon liberalism where it is weak and needs to grow.The parable of the Compassionate Samaritan opens up questions about the need for Good Samaritan laws that defend persons who come to the aid of a person in danger of death (e.g., from an accident, fire, or drowning) against liability for inadvertently and unintentionally causing damage. Under present Anglo-Saxon law, such good Samaritans can be sued for damages. This is not the case, however, in most European countries. Similarly, most European and Latin American countries have bad Samaritan laws: Where “victims are in mortal danger and unable to save themselves,” there is a legal duty for “those who are consciously aware of the victim’s predicament, who are close enough to intervene, and who have the effective means of intervention available to them” to come to the aid of the victims. “The most glaring exception to this pattern,” Marshall argues, “occurs in Anglo-American legal systems” because of liberalism’s maximization of individual liberty even against coercion to come to the aid of persons who would die if no help arrives (155). Samaritan laws “give formal expression to the supreme value of human life, to the bonds of solidarity and empathy that comprise human identity and that bind people together in social community, and to ongoing need human beings have to be committed to one another’s rescue and restoration when severe harm befalls them” (174).Responding to the parable of the Prodigal Son, Marshall argues that both compassion and repentance are crucial for understanding the humanity and the sufferings of persons being defended or judged by law. This does not replace the standard tools of legal interpretation; it takes account of the more holistic context (288–90). In fact, “unreflective compassion can be dangerous and distorting” (296). Marshall discusses the complications insightfully and in a balanced [End Page 222] way. He concludes with an extensive discussion and refutation of perhaps the most important book-length criticism of restorative justice.Marshall’s interpretation of these two parables surpasses any other that I have read. His sensitive and thoughtful analysis of the experience of victimization goes beyond any other interpretation of the Compassionate Samaritan that I have seen. In this he resembles Daniel Philpott’s interpretation of victimization in Just and Unjust Peace (Oxford University Press, 2012). His description of the shameful rupture of relationship with father, family, and community by the prodigal son goes well beyond what I have seen previously. I think... (shrink)

IntroductionPalliative care is an emotionally and spiritually high-demanding setting of care. The literature reports on the main issues in order to implement self-care, but there are no models for the organization of the training course. We described the structure of training on self-care and its effects for a Hospital Palliative Care Unit.MethodWe used action-research training experience based mostly on qualitative data. Thematic analysis of data on open-ended questions, researcher’s field notes, oral and written feedback from (...) the trainer and the participants on training outcomes and satisfaction questionnaires were used.ResultsFour major themes emerged: “Professional role and personal feelings”; “Inside and outside the team”; “Do I listen to my emotions in the care relationship?”; “Death: theirs vs. mine.” According to participants’ point of view and researchers’ observations, the training course resulted in ameliorative adjustments of the program; improved skills in self-awareness of own’s emotions and sharing of perceived emotional burden; practicing “compassionate presence” with patients; shared language to address previously uncharted aspects of coping; allowing for continuity of the skills learned; translation of the language learned into daily clinical practices through specific facilitation; a structured staff’s support system for emotional experiences.DiscussionSelf-care is an important enabler for the care of others. The core of our intervention was to encourage a meta-perspective in which the trainees developed greater perspicacity pertaining to their professional role in the working alliance and also recognizing the contribution of their personal emotions to impasse experienced with patients. (shrink)

Background Cardiopulmonary Resuscitation (CPR) is one of the areas in which moral issues are of great significance, especially with respect to the nursing profession, because CPR requires quick decision-making and prompt action and is associated with special complications due to the patients’ unconsciousness. In such circumstances, nurses’ ability in terms of moral sensitivity can be determinative in the success of the procedure. Identifying the components of moral sensitivity in nurses in this context can promote moral awareness and improve moral performance. (...) Objective This study was conducted to explore and identify the experiences of critical care nurses about moral sensitivity components in CPR. Research design and methods This study was implemented with a qualitative approach. Data were collected via 22 in-depth semi-structured interviews held with 20 eligible participants with maximum variation. The data were then analyzed using the grounded theory approach. Participants and research context In total, thirteen clinical nurses, three head nurses, two educational supervisors, and two faculty members from different universities of Iran were interviewed. Ethical considerations This study was conducted with the ethical approval (IR.UMSU.REC.1399.337) of the Ethics Committee of Urmia University of Medical Sciences. Findings Four themes and 12 sub-themes were extracted from the analysis of the data, including “Consciously and compassionate attention to resuscitate the patient,” “Awareness of families’ anxiety,” “Understanding the teamwork and interactive guidance of the CPR process,” and “Compulsory violation of moral principles.” Discussion It is anticipated that this discussion will prompt further debate, raise awareness and help clarify the dimensions of moral sensitivity in unconscious patients especially during CPR, so that it can be more clearly named and defended as a moral authority in CPR. Conclusion identifying the components of moral sensitivity in nurses, facilitates their encounter with moral issues and can improve their moral performance and encourage right decisions. (shrink)

The Jewish tradition has important perspectives, history and wisdom that can contribute significantly to crucial contemporary healthcare deliberations. This book is an attempt to show how numerous classic Jewish texts and ideas have significant things to say about some of the most urgent debates in the world of medicine today, with the potential to significantly expand and benefit the field of bioethics. But this book is not only about applying classical Jewish values to bioethical dilemmas. It seeks to develop an (...) approach that is primarily informed by personal and communal obligations and social responsibilities. Jewish values focus on requirements, obligations, and commandments, and has thus sometimes been called an "Ethics of Responsibility," by advancing new relevant approaches that can encourage healthcare providers to remain dedicated to preventing harm and providing compassionate care to all, based on these inspiring and timeless values. Each chapter of this book explores questions such as: "Are we expected to risk our lives on behalf of others?" "When we can only help a limited number of people, how do we prioritize?" "What are the obligations and expectations of a society or government?" "Are issues of cultural sensitivity relevant in how we discharge our obligations to others?" "What should we do when obligations for others violate our own moral principles or commitments?" "Are there limits to how far one can be expected to go for others?" These and other issues are addressed in this book, as it attempts to describe a meaningful and compassionate Jewish bioethic of responsibility for our times. (shrink)

In the Netherlands there is a growing debate over the possibility of introducting ‘compassionate interference’ as a form of good psychiatric care. Instead of respecting the autonomy of the patient by adopting an attitude of non‐interference, professional carers should take a more active and commited role. There was a great deal of hostile reaction to this suggestion, the most commonly voiced criticism being that it smacked of ‘modern paternalism’. Still, the current conception of care leaves us with (...) a paradox. On the one hand patients are regarded as individuals who have a strong interest in ( and a right to) freedom and non‐interference; on the other hand many of them have a desperate need for flourishing, viable relationships. In fact, part of their problem is that they cannot relate very well with other people. This creates a dichotomy, because respecting patients' autonomy often means that they cannot be given the help they so desperately need. In this respect current care practices do not answer the caring needs of these patients.The criticism on care practices is to be considerd as important. It invites us to reexamine and reevaluate the current conception of caring relationships and its main values. In line with this reexamination an alternative perspective on care is introduced in this paper, a perspective in which `compassionate interference' is not so much a threat to autonomy, but a means of attaining autonomy. For this we need a different definition of autonomy than that commonly used in current care practice. (shrink)

Good medical practice requires evidence of effectiveness to address deficits in care, strive for further improvements, and justly apportion finite resources. Nevertheless, the potential of palliative care is still held back by a paucity of good evidence. These circumstances are largely attributable to perceived ethical challenges that allegedly distinguish dying patients as a special client class. In addition, practical limitations compromise the quality of evidence that can be obtained from empirical research on terminally ill subjects.This critique aims to (...) appraise the need for focused research, in order to develop clinical and policy decisions that will guide health care professionals in their care of dying patients. Weighted against this need are tenets that value the practical and ethical challenges of palliative care research as unique and insurmountable. The review concludes that, provided investigators compassionately apply ethical principles to their work, there is no justification for not endeavouring to improve the quality of palliative care through research. (shrink)

This article reports findings of a hermeneutic phenomenological study that explored the clinical learning experience for Malawian undergraduate student nurses. The study revealed issues that touch on both nursing education and practice, but the article mainly reports the practice issues. The findings reveal the emotions that healthcare workers in Malawi encounter as a consequence of practising in resource-poor settings. Furthermore, there is severe nursing shortage in most clinical settings in Malawi, and this adversely affects the performance of nurses because of (...) the excess workload it imposes on them. The results of the study also illustrate loss of professional pride among some of the nurses, and the article argues that such a demeanour is a consequence of burnout. However, despite these problems, the study also reveals that there are some nurses who have maintained their passion to care. (shrink)

Zusammenfassung Compassionate Use beschreibt die Anwendung zulassungsüberschreitender Arzneimittel für Patient*innengruppen, die an einer lebensbedrohlichen oder zu einer schweren Behinderung führenden Erkrankung leiden, ohne dass eine alternative Therapieoption besteht. An Ärzt*innen vorbei werden solche Programme ausschließlich von Pharmaunternehmen initiiert, was viele ethische Konflikte mit sich bringt. Eine neue Dimension erreichte das 2020 gestartete Programm für _Onasemnogenum abeparvovecum_ zur Therapie von Spinaler Muskelatrophie bei Kindern, welches die Krankheit nach nur einmaliger Gabe stoppen sollte. Die globale Allokation von nur 100 zur Verfügung (...) gestellten Dosierungen per Losverfahren stellte ein Novum bei der Allokation in Compassionate Use-Programmen dar und wurde vielfach kritisiert. Diese Arbeit untersucht mögliche alternative Allokationsprinzipien auf das Beispiel von _Onasemnogenum abeparvovecum_. Für jedes in Frage kommende Prinzip der Allokation medizinischer Güter bestehen Aspekte, die im Hinblick auf die drängende Zeit und die globale Verteilung bedacht werden müssen. Dies lässt einige Prinzipien wie First-Come-First-Served vernachlässigbar erscheinen. Verbliebene Prinzipien werden hierarchisch geordnet, um einen Algorithmus abzuleiten, der eine Alternative zum Losverfahren darstellen kann. Eine Kombination von Teilnahmebereitschaft bei Forschung, Dringlichkeit und Erfolgsaussicht (bezogen auf die Existenz supportiver Therapieoptionen) kann in ähnlichen Fällen bei zukünftigen globalen Compassionate Use-Programmen bei Kindern erwogen werden. Da universelle Algorithmen nur schwer definierbar sind, sollten Allokationskriterien in jedem Fall durch ein unabhängiges Expert*innengremium diskutiert werden. Sowohl die Konstitution eines solchen Gremiums sowie deren verpflichtende Konsultierung sind gefordert, um für Entlastung aller Beteiligten zu sorgen und Willkür vorzubeugen. (shrink)

Austerity in Greece resulted in poverty, political and social turmoil and intense debates about collective identities, citizenship and the future. One of the main arguments has been that the Greeks should re-evaluate their relationship with the past and their over-reliance on national narratives. The task of re-evaluation can only be accomplished in the public spheres of politics and culture, where individual and collective voices gradually transform the imaginary significations that animate the social body. One such voice is Rhea Galanaki, a (...) novelist with a long and distinguished presence in Greek and European literature. The present article draws on her 2015 novel I Akra Tapeinosi in order to flesh out a feminist political vision for the future. This vision draws inspiration from women’s struggles against patriarchy in past decades, and resonates with the concepts of vulnerability and care, contributing to thinking a compassionate alternative to the politics of despair within and beyond the Greek borders. (shrink)

Definition of the problem Compassionate use is the use of unapproved drugs in groups of patients suffering from a disease that, in the absence of an alternative treatment option, is life-threatening or leads to severe disability. Physicians are not in charge because access to the drug is only granted by pharmaceutical companies, which comes along with many ethical issues. Launched in 2020, the program of Onasemnogenum abeparvovecum against spinal muscular atrophy in children reached a new dimension. The intent of (...) this drug is to stop the progression of the disease with just a single dose, but the company limited the doses in the program to only 100. The global allocation was by lottery, which was considered a novelty in compassionate use history and therefore widely criticized. This paper investigates alternative allocation principles. Arguments Each possible principle is accompanied by many aspects that need to be considered with regard to urgency and global distribution. This makes some principles like first-come-first-served seem negligible. Remaining principles are ordered hierarchically to derive an algorithm that can represent an alternative to a lottery. A combination of willingness to participate in research, urgency, and likelihood of success (relative to the availability of supportive treatment options) may be considered in similar cases in future global compassionate use programs with children. Conclusion Since universal algorithms are difficult to define, allocation criteria should always be discussed by an independent panel of experts. Both the constitution of such a panel and its mandatory consultation are necessary in order to decrease the burden for all those involved and to prevent arbitrariness. (shrink)

Since the mid-1980s, there has been a gradual ethical drift in the provision of maternal care in African health facilities in general, and in Cameroon in particular, despite government efforts. In fact, in Cameroon, an increasing number of caregivers are reportedly not providing compassionate care in maternity services. Consequently, many women, particularly the financially vulnerable, experience numerous difficulties in accessing these health services. In this article, we highlight the unequal access to care in public maternity services (...) in Cameroon in general and the Noun Division in particular. For this study, in addition to documentary review, two qualitative data collection techniques were used: direct observation and individual interviews. Following the field work, the observation data were categorized and analyzed to assess their relevance and significance in relation to the topics listed in the observation checklist. Interviews were recorded using a dictaphone; they were subsequently transcribed and the data categorized and coded. After this stage, an analysis grid was constructed for content analysis of the transcripts, to study the frequency of topics addressed during the interviews, as well as divergences and convergences among the respondents. The results of this data analysis showed that money has become the driving force in service provision. As such, it is the patient’s economic capital that counts. Considered “clients”, pregnant women without sufficient financial resources wait long hours in corridors; some die in pain under the indifferent gaze of the professionals who are supposed to take care of them. In sharp contrast, the findings revealed that financially privileged patients are able to bribe caregivers to attract their favour and obtain prompt, careful, and effective care. These ethical abuses observed in the Noun public health facilities drive women to use, from the beginning of their pregnancies to the delivery, only healthcare delivered by traditional health attendants. (shrink)