Does coercion matter? Supporting young next-of-kin in mental health care.

BACKGROUND: Coercion can cause harm to both the patient and the patient's family. Few studies have examined how the coercive treatment of a close relative might affect young next-of-kin. RESEARCH QUESTIONS: We aimed to investigate the views and experiences of health professionals being responsible for supporting young next-of-kin to patients in mental health care (children-responsible staff) in relation to the needs of these young next-of-kin in coercive situations and to identify ethical challenges. RESEARCH DESIGN: We conducted a qualitative study based on semistructured, focus group interviews and an individual interview. PARTICIPANTS AND RESEARCH CONTEXT: We held three focus group interviews with six to seven children-responsible staff in each group (a total of 20 participants) and one individual interview with a family therapist. The participants were recruited from three hospital trusts in the eastern part of Norway. ETHICAL CONSIDERATIONS: The study was approved by the National Data Protection Official for Research and based on informed consent and confidentiality. FINDINGS: Coercion was not a theme among the participants in relation to their work with young next-of-kin, and there was much uncertainty related to whether these young people need special support to deal with the coercive treatment of their close relative. Despite the uncertainty, the study indicated a need for more information and emotional support among the youth. DISCUSSION: Few studies have addressed the potential impact of coercive treatment of a close family member on young next-of-kin. The findings were consistent with existing research but highlighted disagreement and uncertainty among the children-responsible staff about to what extent the young next-of-kin should visit and whether they should enter the ward unit or not. We identified ethical challenges for the children-responsible staff related to the principle of not inflicting harm (nonmaleficence). CONCLUSION: From the perspective of children-responsible staff, it appears that the coercive treatment of a close family member entails a need for extra support of young relatives both in relation to information and the facilitation of visits, but more systematic knowledge about these issues is needed.

The silent world of young next of kin in mental healthcare.

BACKGROUND:: Young next of kin to patients with mental health problems are faced with many challenges. It is important to focus on the special needs of children and adolescents as next of kin to ensure their welfare and prevent harm. RESEARCH QUESTIONS:: We aimed to investigate young next of kin's need for information and involvement, to examine the ways they cope with situations involving coercion related to the treatment of their relative, and to identify ethical challenges. RESEARCH DESIGN:: We conducted a qualitative study based on semi-structured, individual interviews. PARTICIPANTS AND RESEARCH CONTEXT:: Seven young next of kin aged 14-22 years participated in the study. The informants were recruited from a regional hospital trust in Norway. ETHICAL CONSIDERATIONS:: The study was approved by the National Data Protection Official for Research and based upon informed consent and confidentiality. FINDINGS:: The adolescents wanted more information and described a need for increased interaction with their sick relative at the hospital. They struggled to keep their relationship with their relative intact, and they described communication problems in the family. Coercive treatment was perceived in a negative way. DISCUSSION:: The study finds that there are ethical challenges at stake for young next of kin and their families other than those that are often emphasized by traditional healthcare, which often focuses on the individual patient's rights. These challenges are related to the young next of kin's needs for interconnectedness and for the preservation of relationships as well as challenges related to family communication and the need for information. CONCLUSION:: The study finds a need for more family-oriented perspectives in both mental healthcare practices and healthcare ethics.

Illness as a condition of our existence in the world: on illness and pathic existence.

This paper seeks to find different ways of addressing illness as an experience essential to the understanding of being a human being. As a conceptual point of departure, we suggest the notion of 'pathic existence' as developed by the German physician and philosopher Viktor von Weizsäcker (1886-1957). Through an analysis of his conceptualisation of the pathic and of pathic categories, we demonstrate how this auxiliary typology may be of help in unveiling different modes of ill-being, or Kranksein. Furthermore, we show how illness plays a paradigmatic role in this type of existence. We discuss how von Weizsäcker's claim of illness as "a way of being human" indicates how such a view of the illness existence both differs from and touches upon other streams of thought within the philosophy of medicine and medical ethics. Finally, we highlight some of the normative implications emerging from this perspective of relevance in today's medicine.

Harm in the absence of care: Towards a medical ethics that cares.

The aim of this article is to investigate the concept of care in contemporary medical practice and medical ethics. Although care has been hailed throughout the centuries as a crucial ideal in medical practice and as an honourable virtue to be observed in codes of medical ethics, I argue that contemporary medicine and medical ethics suffer from the lack of a theoretically sustainable concept of care and then discuss possible reasons that may help to explain this absence. I draw on the empirical studies of Carol Gilligan on care and connectedness as ontologically situated realities in human life. Based on a philosophical elaboration of her findings on the ethics of care emphasizing relationality, I try to show how the notion of 'relational ontology' originating from this stream of thought may be of help in developing a medical ethics that acknowledges care as a perspective to be observed in all interactions between physicians and patients.

Care for nurses only? Medicine and the perceiving eye.

In this paper I introduce a theoretical framework on care developed by the Norwegian nurse and philosopher Kari Martinsen, and I argue that this approach has relevance not only within nursing, but also within clinical medicine. I try to substantiate this claim by analysing some of the key concepts in this approach, and I illustrate the potential clinical relevance of this approach by applying it in relation to two care scenarios. Finally, I discuss some of the concerns that have been raised in relation to the aim of highlighting care in medicine.