Comfort in Labor: "Like Being Able to Exhale".

Comfort is a fundamental human need to seek relief, ease, and transcendence. Comfort is relevant to women in labor who experience intense pain and mixed emotions. The subjective meaning of comfort in labor for women is not fully understood. This work was part of a phenomenological study of the experience of childbirth, in which the dynamic of keeping-it-together-falling-apart was identified as an essential quality of women's perceptions of childbirth. Comfort was a salient element of keeping-it-together-falling-apart. In this report, the concept of comfort is explored in greater depth, using qualitative descriptive analysis. Eight participants, aged 23 to 38 years, with spontaneous vaginal births, were each interviewed twice about the childbirth experience. Comfort was a holistic experience of relaxation and relief, where the needs of the body and the person were being met. Comfort and pain coexisted with each other, and relief of pain did not always provide comfort. Women had an innate knowledge of comfort, but their capacity for choice was at times restricted by caregivers in the hospital. There are aspects of labor care that do not support comfort, particularly as it relates to mobility and choice. Prioritizing comfort as well as pain relief may contribute to a more holistic, satisfying birth experience for women.

'Compassionate transfer': an alternative option for surplus embryo disposition.

Compassionate transfer is a procedure wherein in vitro-created embryos are placed in a patient's cervix, vagina or uterus at an infertile period in the menstrual cycle where they are expected to perish. Patients report that they feel this procedure is a more natural means of disposition and provides them with the opportunity to grieve the loss of a potential child. However, some have argued that the procedure is an unnecessary, and illogical, addition to fertility treatment and that it detracts resources from medical care. Here, we introduce compassionate transfer as an alternative disposition option and argue that, for certain patients, it may constitute an ethical extension of fertility care that respects patient autonomy and psychosocial health.

Rethinking Brain Death as a Legal Fiction: Is the Terminology the Problem?

Brain death, or the determination of death by neurological criteria, has been described as a legal fiction. Legal fictions are devices by which the law treats two analogous things (in this case, biological death and brain death) in the same way so that the law developed for one can also cover the other. Some scholars argue that brain death should be understood as a fiction for two reasons: the way brain death is determined does not actually satisfy legal criteria requiring the permanent cessation of all brain function, and brain death is not consistent with the biological conception of death as involving the irreversible cessation of the functioning of an organism as a whole. Critics counter that the idea that brain death is a legal fiction is deceptive and undemocratic. I will argue that diagnosing brain death as a hidden legal fiction is a helpful way to understand its historical development and current status. For the legal-fictions approach to be ethically justifiable, however, the fact that brain death is a legal fiction not aligned with the standard biological conception of death must be acknowledged and made transparent.

Perspective: Reductionist Nutrition Research Has Meaning Only within the Framework of Holistic and Ethical Thinking.

Today, it seems that nutrition is in a state of great confusion, especially for the general public. For decades, some nutrients (e.g., cholesterol, saturated fats, sugars, gluten, salt) and food groups (e.g., dairy, cereals, meats) have been regularly denigrated. In this position paper, we hypothesize that such a state of confusion is mainly the result of the reductionist paradigm applied to nutrition research for more than a century, and by being pushed to its extreme, this perspective has led to accusations about some nutrients and foods. However, the real issue is about foods taken as a whole and therefore about their degree of processing, which affects both the food matrix and composition. Indeed, we eat whole foods, not nutrients. Therefore, the objectives of this article are to emphasize the need for more holistic approaches in nutrition to preserve our health, animal welfare, and planet. We propose to first redefine the food health potential on a holistic basis and then to show that reductionism and holism are interconnected approaches that should coexist. Then, we try to explain how extreme reductionism has been disconnected from reality and ethical considerations and has ultimately led to environmental degradation and loss of biodiversity, notably through very specific crops, and to an increased prevalence of chronic diseases. Furthermore, to address the confusion of the general public and to simplify nutritional messages, we propose 3 holistic golden rules based on scientific evidence to protect human health, animal welfare, and the environment (climate and biodiversity). Finally, we try to show how these 3 rules can be easily applied worldwide while respecting the environment, cultural traditions, and heritage.

Responsabilidad, ciencia y evidencia frente a las pseudoterapias / No disponible

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Transfiguring Light and Symphonic Blooming: A Wabi Sabi Story of Humanbecoming and Human Caring.

Transfiguring Light and Symphonic Blooming is word-art to describe the flowering of the humanbecoming and human caring schools of thought over time. A Wabi Sabi story journey was created to turn the tide in a world where the building of a unique body of knowledge for nursing has fallen into disfavor with nursing itself. Using nature-aligned paintings and a Japanese story-art aesthetic with poetry, the beauty of falling away to unitary essentials and holding the value of "both-and" in unitary consciousness was illuminated. Co-creating art-knowledge may transfigure nursing theory development and its acceptance with cosmic tree-rooted arches.

Integración de los principios de cuidados paliativos en cuidados intensivos / Integration of the principles of palliative care in intensive care medicine

En la literatura científica se constata un reciente interés por integrar los principios de la medicina paliativa en el trabajo cotidiano de la unidad de cuidados intensivos (UCI). El artículo revisa este planteamiento con la idea de fondo de que su aplicación pueda aportar luz en la resolución de ciertos problemas éticos presentes. Los pacientes con procesos avanzados y en situación de final de vida ingresados en cuidados intensivos se encuentran con un nivel de sufrimiento y vulnerabilidad que sólo una atención comprensiva y holística puede dar un alivio adecuado. Sin embargo, la realidad clínica del cuidado de estos pacientes en UCI, por el momento, está lejana a ese ideal. La mejora de la atención clínica en este sentido, especialmente en el fallecimiento, es el punto de interés que nos ocupa. Avanzar en este aspecto es complejo pero se hace necesario un esfuerzo. La propuesta es recurrir a la medicina paliativa como modelo de referencia en los cuidados del final de vida y en la atención holística, e introducir sus principios de tratamiento en la UCI. El objetivo del artículo es exponer una estrategia práctica para llevarlo a cabo y que pueda ser útil en la mejora de la atención clínica y ética de los pacientes

Recent scientific literature has shown a growing interest to integrate palliative medicine principles into the daily workflow in the intensive care unit (ICU). This article reviews this trend with the goal that its application might provide more understanding in the resolution of some current ethical issues. Patients with an advanced disease process and at the end of life who are admitted in the intensive care unit are in such a profound level of suffering and vulnerability that only an holistic and comprehensive approach can provide adequate relief to them. Nevertheless, the reality of the clinical care of these patients in the ICU is far beyond that ideal. Our primary end point is the improvement in the clinical care provided, especially when the patient is dying. It is indeed very complex to make progress in this field, but an effort has to be made. The project is to turn to palliative medicine as a role model for end of life care and as an holistic approach, and introduce palliative medicine principles in the ICU. The goal of this article is to reveal a practical approach to accomplish this, and make it functional in order to improve our patients' clinical and ethical care

Venkatapuram's Capability theory of Health: A Critical Discussion.

The discussion about theories of health has recently had an important new input through the work of Sridhar Venkatapuram. He proposes a combination of Lennart Nordenfelt's holistic theory of health and Martha Nussbaum's version of the capability approach. The aim of the present article is to discuss and evaluate this proposal. The article starts with a discussion of Nordenfelt's theory and evaluates Venkatapuram' critique of it, that is, of its relativism, both regarding goals and environment, and of the subjectivist theory of happiness used. Then the article explains why Nordenfelt's idea of a reasonable environment is not a problem for the theory, and it critiques Venkatapuram's own incorporation of the environment into the concept of health, suggesting that this makes the concept too wide. It contends, moreover, that Venkatapuram's alternative theory retains a problem inherent in Nordenfelt's theory, namely, that health is conceived of as a second-order ability. It is argued that health should, instead, be defined as first-order abilities. This means that health cannot be seen as a capability, and also that health cannot be seen as a meta-capability of the kind envisioned by Venkatapuram. It is, furthermore, argued that the theory lacks one crucial aspect of health, namely, subjective wellbeing. Finally, the article tries to illustrate how health, in the suggested alternative sense, as first-order abilities, fits into Nussbaum's capability theory, since health as an 'actuality' is part of all the 'combined capabilities' suggested by Nussbaum.

Vulnerability, Health Agency and Capability to Health.

One of the defining features of the capability approach (CA) to health, as developed in Venkatapuram's book Health Justice, is its aim to enable individual health agency. Furthermore, the CA to health hopes to provide a strong guideline for assessing the health-enabling content of social and political conditions. In this article, I employ the recent literature on the liberal concept of vulnerability to assess the CA. I distinguish two kinds of vulnerability. Considering circumstantial vulnerability, I argue that liberal accounts of vulnerability concerned with individual autonomy, align with the CA to health. Individuals should, as far as possible, be able to make health-enabling decisions about their lives, and their capability to do so should certainly not be hindered by public policy. The CA to health and a vulnerability-based analysis then work alongside to define moral responsibilities and designate those who hold them. Both approaches demand social policy to address circumstances that hinder individuals from taking health-enabling decisions. A background condition of vulnerability, on the other hand, even though it hampers the capability for health, does not warrant the strong moral claim proposed by the CA to health to define health as a meta-capability that should guide social policy. Nothing in our designing social policy could change the challenge to health agency when we deal with background conditions of vulnerability.

Agitation.

The CPD article about caring for older people experiencing agitation is relevant to my practice. I work on an acute oncology assessment ward, which provides rapid assessment and care for acutely unwell patients.

Medicine and the holistic understanding of the human being: ultrasound examination as dialog.

Ultrasound can capture the living nature of a person. This capturing of life depends greatly on experience as well as sense of touch, intuition, sense of speech, and not least a sense for the distinctiveness of every person. Performing ultrasound is not simply the application of a technique but rather a merging of man and technology in the framework of an interpersonal encounter. Therefore, as much should be invested in the interpersonal nature of the encounter as in the development of the technical principles of the ultrasound probe. To effectively perform ultrasound, it is necessary to avoid viewing ultrasound from a purely technical view and to always remember the importance of the relationship to the patient, particularly during the technical examination.

Treating the whole patient: passing time-honoured skills for building doctor-patient relationships on to generations of doctors.

OBJECTIVES: This paper aims to honour the Hippocratic Oath in modern practice by providing reflections on the development of ways for doctors to know the whole person that have accrued over the five decades to the present. METHODS: I present a perspective piece, which includes personal reflections and cites relevant literature. RESULTS: Powerful role models sustained the concept of knowing the whole patient in an era of scientific medicine. Beginning in the 1980s, skills allowing ordinary doctors to know the whole patient were made transparent to learners in courses and medical school curricula. As we approach the 2020s, increasing numbers of doctors have mastered these skills and are teaching them. CONCLUSIONS: A modern way of practice is emerging; this emphasises the human side of medicine and its rewards, despite barriers such as those imposed by time limitations.

Patients who make terrible therapeutic choices.

The traditional approaches to dental ethics include appeals to principles, duties (deontology), and consequences (utilitarianism). These approaches are often inadequate when faced with the case of a patient who refuses reasonable treatment and does not share the same ethical framework the dentist is using. An approach based on virtue ethics may be helpful in this and other cases. Virtue ethics is a tradition going back to Plato and Aristotle. It depends on forming a holistic character supporting general appropriate behavior. By correctly diagnosing the real issues at stake in a patient's inappropriate oral health choices and working to build effective habits, dentists can sometimes respond to ethical challenges that remain intractable given rule-based methods.