Mary Donnelly and Claire Murray (eds)
- Published in print:
- 2016
- Published Online:
- May 2016
- ISBN:
- 9780719099465
- eISBN:
- 9781526104410
- Item type:
- book
- Publisher:
- Manchester University Press
- DOI:
- 10.7228/manchester/9780719099465.001.0001
- Subject:
- Sociology, Culture
The Irish health system is confronted by a range of challenges, both emerging and recurring. In order to address these, it is essential that spaces are created for conversations around complex ...
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The Irish health system is confronted by a range of challenges, both emerging and recurring. In order to address these, it is essential that spaces are created for conversations around complex ethical and legal issues. This collection aims to provide a basis for ongoing engagement with selected issues in contemporary Irish health contexts. It includes contributions from scholars and practitioners across a range of disciplines, most particularly, ethics, law and medicine. The focus of the collection is interdisciplinary and the essays are situated at the intersection between ethics, law and medicine. Important issues addressed include admission to care homes; assisted suicide; adolescent decision-making; allocation of finite resources; conscientious objection; data protection; decision-making at the end of life; mental health; the rights of older people; patient responsibilities; stem cell research; the role of carers; and reproductive rights. From these discussion, the collection draws out the following interlinking themes, addressing difference; context and care; oversight and decision-making; and, regulating research. The essays are theoretically informed and are grounded in the realities of the Irish health system, by drawing on contributors’ contextual knowledge. This book makes an informed and balanced contribution to academic and broader public discourse.Less
The Irish health system is confronted by a range of challenges, both emerging and recurring. In order to address these, it is essential that spaces are created for conversations around complex ethical and legal issues. This collection aims to provide a basis for ongoing engagement with selected issues in contemporary Irish health contexts. It includes contributions from scholars and practitioners across a range of disciplines, most particularly, ethics, law and medicine. The focus of the collection is interdisciplinary and the essays are situated at the intersection between ethics, law and medicine. Important issues addressed include admission to care homes; assisted suicide; adolescent decision-making; allocation of finite resources; conscientious objection; data protection; decision-making at the end of life; mental health; the rights of older people; patient responsibilities; stem cell research; the role of carers; and reproductive rights. From these discussion, the collection draws out the following interlinking themes, addressing difference; context and care; oversight and decision-making; and, regulating research. The essays are theoretically informed and are grounded in the realities of the Irish health system, by drawing on contributors’ contextual knowledge. This book makes an informed and balanced contribution to academic and broader public discourse.
Susan P. Shapiro
- Published in print:
- 2019
- Published Online:
- January 2020
- ISBN:
- 9780226615608
- eISBN:
- 9780226615882
- Item type:
- book
- Publisher:
- University of Chicago Press
- DOI:
- 10.7208/chicago/9780226615882.001.0001
- Subject:
- Sociology, Gerontology and Ageing
Seventy percent of Americans age 60 or over requiring decisions about medical treatment in the final days of life lack capacity to make these decisions. The biggest life-and-death decisions of their ...
More
Seventy percent of Americans age 60 or over requiring decisions about medical treatment in the final days of life lack capacity to make these decisions. The biggest life-and-death decisions of their lives—literally—had to be made by someone else. Yet despite their critical role, we know remarkably little about these surrogate decision makers, the process they follow, the criteria they consider, the choices they make, and the challenges they face. Drawing on observations of two diverse intensive care units, day after day, for more than two years, this book exposes how and why surrogates navigate this grueling role and the impact of the course they fashion. Readers will learn how decision makers are selected, the interventions they weigh in on, the information they seek and evaluate, the values and memories they draw on, the criteria they weigh, the outcomes they choose, the conflicts they become embroiled in, and the challenges they face. Observations also provide insight into why some decision makers authorize one aggressive intervention after the next while others do not—even on behalf of patients with similar problems and prospects. And they expose the limited role of advance directives in structuring the process decision makers follow or the outcomes that result. These findings provide important lessons to future patients, their loved ones and surrogates; those who serve, counsel, or care for those as they near life’s end and their families (physicians, nurses, chaplains, social workers, and lawyers); and scholars, bioethicists, and health policy makers as well.Less
Seventy percent of Americans age 60 or over requiring decisions about medical treatment in the final days of life lack capacity to make these decisions. The biggest life-and-death decisions of their lives—literally—had to be made by someone else. Yet despite their critical role, we know remarkably little about these surrogate decision makers, the process they follow, the criteria they consider, the choices they make, and the challenges they face. Drawing on observations of two diverse intensive care units, day after day, for more than two years, this book exposes how and why surrogates navigate this grueling role and the impact of the course they fashion. Readers will learn how decision makers are selected, the interventions they weigh in on, the information they seek and evaluate, the values and memories they draw on, the criteria they weigh, the outcomes they choose, the conflicts they become embroiled in, and the challenges they face. Observations also provide insight into why some decision makers authorize one aggressive intervention after the next while others do not—even on behalf of patients with similar problems and prospects. And they expose the limited role of advance directives in structuring the process decision makers follow or the outcomes that result. These findings provide important lessons to future patients, their loved ones and surrogates; those who serve, counsel, or care for those as they near life’s end and their families (physicians, nurses, chaplains, social workers, and lawyers); and scholars, bioethicists, and health policy makers as well.
Mary Donnelly
- Published in print:
- 2016
- Published Online:
- May 2016
- ISBN:
- 9780719099465
- eISBN:
- 9781526104410
- Item type:
- chapter
- Publisher:
- Manchester University Press
- DOI:
- 10.7228/manchester/9780719099465.003.0016
- Subject:
- Sociology, Culture
This chapter examines the legal context within which decisions about the end of life are made. It argues that an ethical approach to end-of-life care must be centred on the dying person and that ...
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This chapter examines the legal context within which decisions about the end of life are made. It argues that an ethical approach to end-of-life care must be centred on the dying person and that finding ways to ensure that this person’s voice is heard must be core to the development of legal frameworks. In this respect, the law has, to date, been inadequate. It explores the ways decisions about the end of life are made in Ireland and identifies likely changes, including an increased formalisation of dying. Drawing on experiences from the United States and the United Kingdom, it develops arguments regarding the most appropriate decision-making structures within which to consider difficult questions around end-of-life care.Less
This chapter examines the legal context within which decisions about the end of life are made. It argues that an ethical approach to end-of-life care must be centred on the dying person and that finding ways to ensure that this person’s voice is heard must be core to the development of legal frameworks. In this respect, the law has, to date, been inadequate. It explores the ways decisions about the end of life are made in Ireland and identifies likely changes, including an increased formalisation of dying. Drawing on experiences from the United States and the United Kingdom, it develops arguments regarding the most appropriate decision-making structures within which to consider difficult questions around end-of-life care.
David Smith and Carlos Moreno-Leguizamon
- Published in print:
- 2017
- Published Online:
- May 2018
- ISBN:
- 9781447333746
- eISBN:
- 9781447333791
- Item type:
- chapter
- Publisher:
- Policy Press
- DOI:
- 10.1332/policypress/9781447333746.003.0005
- Subject:
- Social Work, Communities and Organizations
This chapter discusses and evaluates the use of a learning alliance (LA) as a methodology for community engagement and capacity building through a case study examining the use of, and attitudes ...
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This chapter discusses and evaluates the use of a learning alliance (LA) as a methodology for community engagement and capacity building through a case study examining the use of, and attitudes towards, palliative and end-of-life care services among black and minority ethnic groups in north and mid-Kent in the United Kingdom. The first section summarises the key tenets of the LA methodology before summarising the project itself and the process of implementing the LA. The final sections of the chapter discusses the formation and evolution of the Learning Alliance on Palliative Care and End of Life project, and considers what this approach added to the project in terms of inter-organisational learning, knowledge creation and dissemination.Less
This chapter discusses and evaluates the use of a learning alliance (LA) as a methodology for community engagement and capacity building through a case study examining the use of, and attitudes towards, palliative and end-of-life care services among black and minority ethnic groups in north and mid-Kent in the United Kingdom. The first section summarises the key tenets of the LA methodology before summarising the project itself and the process of implementing the LA. The final sections of the chapter discusses the formation and evolution of the Learning Alliance on Palliative Care and End of Life project, and considers what this approach added to the project in terms of inter-organisational learning, knowledge creation and dissemination.
Susan P. Shapiro
- Published in print:
- 2019
- Published Online:
- January 2020
- ISBN:
- 9780226615608
- eISBN:
- 9780226615882
- Item type:
- chapter
- Publisher:
- University of Chicago Press
- DOI:
- 10.7208/chicago/9780226615882.003.0001
- Subject:
- Sociology, Gerontology and Ageing
Seventy percent of Americans age 60 or over requiring decisions about treatment in the final days of life lack capacity to make these decisions. The biggest life-and-death decisions of their ...
More
Seventy percent of Americans age 60 or over requiring decisions about treatment in the final days of life lack capacity to make these decisions. The biggest life-and-death decisions of their lives—literally—had to be made by someone else. Loved ones hold life and death in their hands because constitutional rights of autonomy and self-determination are extended by law to surrogates authorized to make medical decisions on patients’ behalf when the latter cannot. Yet despite their critical role, we know remarkably little about these surrogates, the decision-making process they follow, the choices they make, and the challenges they face. Drawing on the stories of two families—one demanding that physicians “just pull the damn plug” and another that life support be continued despite brain death—this chapter introduces the surrogates who determine the trajectories of life’s end. Systematic observations in two intensive care units, day after day, for more than two years offer a window on how these end-of-life trajectories take shape and change course. The chapter concludes by showing how lessons from the intensive care units are relevant to future patients and their loved ones as well as physicians, nurses, chaplains, social workers, lawyers, scholars, bioethicists, and policy makers.Less
Seventy percent of Americans age 60 or over requiring decisions about treatment in the final days of life lack capacity to make these decisions. The biggest life-and-death decisions of their lives—literally—had to be made by someone else. Loved ones hold life and death in their hands because constitutional rights of autonomy and self-determination are extended by law to surrogates authorized to make medical decisions on patients’ behalf when the latter cannot. Yet despite their critical role, we know remarkably little about these surrogates, the decision-making process they follow, the choices they make, and the challenges they face. Drawing on the stories of two families—one demanding that physicians “just pull the damn plug” and another that life support be continued despite brain death—this chapter introduces the surrogates who determine the trajectories of life’s end. Systematic observations in two intensive care units, day after day, for more than two years offer a window on how these end-of-life trajectories take shape and change course. The chapter concludes by showing how lessons from the intensive care units are relevant to future patients and their loved ones as well as physicians, nurses, chaplains, social workers, lawyers, scholars, bioethicists, and policy makers.
