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1.
Am J Bioeth ; 22(9): 37-39, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-36040892
2.
Perspect Biol Med ; 65(2): 171-178, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35938424

RESUMO

This article uses multiple interwoven personal narratives to explicate the relationships among several concepts crucial to bioethics brought into focus by Robert Perske's 1972 article on "The Dignity of Risk," including dignity, risk, paradox, disability, autonomy, uncertainty, diagnosis, and prognosis. The use of personal narrative as a form of evidence and a knowledge-making method allows for the exploration of the meaning-making work of language and story and the introduction of humanities and social science concepts such as stigma management and dignity maintenance into Perske's concept of the dignity of risk. The personal narratives the article draws include Mark, a character in Perske's article; W. E. B. Du Bois; Frantz Fanon; and myself. Finally, the article calls for humility in medical science's predictive narratives for all patients, but particularly for people with disabilities.


Assuntos
Bioética , Pessoalidade , Humanos , Respeito
3.
Perspect Biol Med ; 65(2): 242-251, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35938432

RESUMO

Managing risk is a necessary component of living a full moral life. Evaluating which risks are acceptable, for what reasons, in what conditions, and then taking actions based on those evaluations, are exercises of moral agency-of intentionally actualizing values that shape an embodied personhood. Health-care institutions in the United States are risk averse, designed to manage risk in ways that can impede the full exercise of patients' moral agency. Home hospice care, conceived as an alternative to institutionally based end-of-life care and driven explicitly by patient goals and values, would seem to be an environment in which patients are empowered to express the full spectrum of their personhood-including making decisions about risk consistent with their values. While home hospice patients have more discretion over risk than patients receiving care in institutions like hospitals and nursing homes, efforts to limit that discretion abound. Such limits can be experienced by patients as failures to recognize their dignity as persons, even while those limits are perceived by others as necessary to preserve that very dignity by keeping them safe. This article uses a running case study to reconceptualize "risk" in home hospice care by (1) challenging the clinical assumption that physical harm is the most important lens through which to view risk, and (2) presenting and applying the concept of positive risk-taking as one way to develop the concept and assessment of risk more fully.


Assuntos
Cuidados Paliativos na Terminalidade da Vida , Hospitais para Doentes Terminais , Humanos , Casas de Saúde , Pessoalidade , Respeito , Estados Unidos
5.
J Aging Stud ; 62: 101040, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36008023

RESUMO

Personhood is a complex concept in gerontological research. It is often used to explore the maintenance or reconstruction of self-identity. Narrative analysis has commonly explored how the stories that older individuals living with cognitive impairment(s) produce preserve the personhood that is perceived to be threatened by cognitive decline. This article moves beyond this exploration by focusing on the experiences of aging more generally to better understand how non-cognitively impaired older adults construct personhood through narrative writing. This article uses thematic narrative analysis and argues that older adults articulate personhood through written narratives by creating coherent constructions of self. Importantly, it demonstrates that older adults are concerned with maintaining a sense of self rather than embracing changed aspects of identity in accordance with popularized conceptualizations of personhood as well as ideals of coherence and consistency promoted in successful and active aging discourses.


Assuntos
Geriatria , Pessoalidade , Idoso , Envelhecimento/psicologia , Humanos , Narração , Redação
6.
BMC Palliat Care ; 21(1): 118, 2022 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-35787278

RESUMO

BACKGROUND: A socioculturally appropriate appreciation of dignity is pivotal to the effective provision of care for dying patients. Yet concepts of dignity remain poorly defined. To address this gap in understanding and enhance dignity conserving end-of-life care, a review of current concepts of dignity is proposed. METHODS: To address its primary research question "How do patients conceive the concept of dignity at the end of life?", this review appraises regnant concepts and influences of dignity, and evaluates current dignity conserving practices. To enhance accountability, transparency and reproducibility, this review employs the Ring Theory of Personhood (RToP) as its theoretical lens to guide a Systematic Evidence Based Approach guided Systematic Scoping Review (SSR in SEBA) of patient perspectives of dignity. Three independent teams of reviewers independently analysed included articles from a structured search of PubMed, Embase, PsycINFO, Scopus, CINAHL and Cochrane Databases using thematic and content analyses. The themes and categories identified were compared and combined using the Funnelling Process to create domains that guide the discussion that follows. RESULTS: Seventy-eight thousand five hundred seventy-five abstracts were identified, 645 articles were reviewed, and 127 articles were included. The three domains identified were definitions of dignity, influences upon perceptions of dignity, and dignity conserving care. CONCLUSIONS: This SSR in SEBA affirms the notion that dignity is intimately entwined with self-concepts of personhood and that effective dignity conserving measures at the end of life must be guided by the patient's concept of dignity. This SSR in SEBA posits that such personalised culturally sensitive, and timely support of patients, their family and loved ones may be possible through the early and longitudinal application of a RToP based tool.


Assuntos
Respeito , Assistência Terminal , Morte , Humanos , Pessoalidade , Reprodutibilidade dos Testes
7.
J Law Med ; 29(2): 489-508, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35819388

RESUMO

This article explores the intersex experience in Australian law and society through the lens of hermeneutical (in)justice - a form of injustice in knowing that prevents a person from making sense of their own lived experience due to a lacuna in social understanding. It makes an original contribution to legal scholarship first by tracking the advances towards understanding reflected in recent legal and social reform; second by highlighting the shortcomings of these advances; and third by examining new questions and possibilities for moving forward, including through the deliberate creation of a stronger sense of shared identity between different intersex community sub-groups.


Assuntos
Estado de Consciência , Pessoalidade , Austrália , Humanos , Justiça Social
8.
AMA J Ethics ; 24(7): E622-633, 2022 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-35838391

RESUMO

This article considers ethical questions raised during development of an online art exhibit for and with people with dementia and their care partners. This article also describes a participant engagement process emphasizing patient autonomy as a means of dismantling stigma, promoting personhood, and stimulating community engagement. This co-creative project suggests the potential for patients' art to spark attitude change and promote reciprocal, regenerative care practices.


Assuntos
Demência , Demência/terapia , Humanos , Princípios Morais , Pessoalidade
9.
Lancet ; 400(10348): 266-267, 2022 07 23.
Artigo em Inglês | MEDLINE | ID: mdl-35871807
10.
BMC Med Educ ; 22(1): 466, 2022 Jun 17.
Artigo em Inglês | MEDLINE | ID: mdl-35710490

RESUMO

BACKGROUND: Characterised by feelings of helplessness in the face of clinical, organization and societal demands, medical students are especially prone to moral distress (MD). Despite risks of disillusionment and burnout, efforts to support them have been limited by a dearth of data and understanding of MD in medical students. Yet, new data on how healthcare professionals confront difficult care situations suggest that MD could be better understood through the lens of the Ring Theory of Personhood (RToP). A systematic scoping review (SSR) guided by the RToP is proposed to evaluate the present understanding of MD amongst medical students. METHODS: The Systematic Evidence-Based Approach (SEBA) is adopted to map prevailing accounts of MD in medical students. To enhance the transparency and reproducibility, the SEBA methodology employs a structured search approach, concurrent and independent thematic analysis and directed content analysis (Split Approach), the Jigsaw Perspective that combines complementary themes and categories, and the Funnelling Process that compares the results of the Jigsaw Perspective with tabulated summaries to ensure the accountability of these findings. The domains created guide the discussion. RESULTS: Two thousand six hundred seventy-one abstracts were identified from eight databases, 316 articles were reviewed, and 20 articles were included. The four domains identified include definitions, sources, recognition and, interventions for MD. CONCLUSIONS: MD in medical students may be explained as conflicts between the values, duties, and principles contained within the different aspects of their identity. These conflicts which are characterised as disharmony (within) and dyssynchrony (between) the rings of RToP underline the need for personalised and longitudinal evaluations and support of medical students throughout their training. This longitudinal oversight and support should be supported by the host organization that must also ensure access to trained faculty, a nurturing and safe environment for medical students to facilitate speak-up culture, anonymous reporting, feedback opportunities and supplementing positive role modelling and mentoring within the training program.


Assuntos
Tutoria , Estudantes de Medicina , Humanos , Mentores , Pessoalidade , Reprodutibilidade dos Testes
11.
J Aging Stud ; 61: 101003, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35654555

RESUMO

In long-term care for people with dementia, person-centred care (PCC) is widely promoted as an approach that contributes to the well-being of persons in psycho-geriatric care. The goal of PCC is to acknowledge the personhood of residents and to indicate the responsibility of others to ensure the personhood of persons with dementia. In 2016 and 2018, qualitative empirical research was conducted with the purpose to enhance PCC and meaningful care. Five Dutch nursing homes and a total of eight communities of practice participated in the research project 'People and their Stories'. The aim of this project was to strengthen the hermeneutic competence of care practitioners, with a focus on informal everyday interpersonal interactions between residents and care professionals. This article highlights how care professionals, by enhancing their hermeneutical competence, can do justice to the unique personhood of residents in everyday care practice. Three distinguished features for strengthening the hermeneutic competence of care professionals were formulated: respectful curiosity as a prerequisite, being able to differentiate between fact and meaning, and the awareness of own perspectives and assumptions.


Assuntos
Demência , Idoso , Hermenêutica , Humanos , Casas de Saúde , Pessoalidade , Pesquisa Qualitativa
13.
BMC Palliat Care ; 21(1): 83, 2022 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-35590293

RESUMO

BACKGROUND: A nurse's role in caring for the dying is fraught with ethical, professional, and psychosocial challenges that impact how they perceive their roles as professionals. When unsupported, nurses caring for the dying experience burnout, career dissatisfaction and leave the profession. Better understanding of how caring for the dying affects the professional identity formation (PIF) of nurses will guide efforts to better support nurses. METHODS: Guided by new data on the subject, we adopt the theoretical lens of the Ring Theory of Personhood (RToP) to evaluate how caring for the dying impacts the values, beliefs, principles, professional identities and personhood of nurses. We employ Krishna's Systematic Evidence-Based Approach (SEBA) to guide the design and piloting of the semi-structured interview tool. RESULTS: Analysis of interviews with eight senior nurses in Supportive, Palliative and Oncology care revealed three domains: Identity 1) Formation; 2) Conflict and 3) Refinement. Identity Formation occurs early in a nurse's career, upon entering a new specialist field, and at the start of Supportive, Palliative and Oncology care. Identity Formation reveals significant changes to how self-concepts of professional identities are tied to individual concepts of personhood. Caring for the dying, however, resulted in Conflicts between values, beliefs, and principles within regnant concepts of personhood and their professional duties. These conflicts are captured as conflicts within ('disharmony') and/or between ('dyssynchrony') the rings of the RToP. These conflicts can result in changes to self-concepts of personhood and professional identities. Identity Refinement sees experience and timely support helping nurses attenuate the impact of difficult experiences. This reduces the risk of burnout and mitigates changes to their professional identities. Identity Refinement helps them develop a 'rooted identity' which remains relatively consistent in the face of adversity. CONCLUSIONS: Ongoing Identity Construction amongst nurses, particularly in caring for the dying, underscore the host organisation's role in ensuring structured, longitudinal, accessible, and personalised assessments and support of nurses, especially when they are prone to dyssynchrony and disharmony whilst caring for the terminally ill. Further study into assessment methods and the role of the environment is critical.


Assuntos
Esgotamento Profissional , Neoplasias , Humanos , Pessoalidade , Pesquisa Qualitativa , Singapura , Doente Terminal
14.
J Med Philos ; 47(2): 240-256, 2022 05 11.
Artigo em Inglês | MEDLINE | ID: mdl-35543468

RESUMO

Brain transplants have long been no more than the subject of science fiction and engaging thought experiments. That is no longer true. Neuroscientists have announced their intention to transplant the head of a volunteer onto a donated body. Response has been decidedly mixed. How should we think about the moral permissibility of head transplants? Is it a life-saving/life-enhancing opportunity that appropriately expands the boundaries of medical practice? Or, is it a bioethical morass that ought not to be attempted? For the purposes of this paper, I set aside questions regarding the surgical operation's technological plausibility so as to focus on very basic questions regarding personal identity and the morality of head transplantation. The analysis begins with an exploration of the embodiment of persons. It considers whether persons can be conceptually distinguished from all parts of their body, even if they cannot be physically separated from some parts without loss of personhood. It argues that in most cases replacing body parts with reasonably similar parts will not destroy the conditions for sustaining personhood. However, as I explore, the phenomenology of personhood is such that some physical changes may prove to be too significant to maintain personal identity successfully over time. Given such complexity and the significance of the costs involved, the moral permissibility of head transplantation likely depends on recognizing that persons may give permission to collaborate in common activities, including projects with which others deeply disagree, provided that they only utilize the services and resources of free and consenting others.


Assuntos
Pessoalidade , Autoimagem , Encéfalo , Humanos , Princípios Morais
15.
Nurs Philos ; 23(3): e12393, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35561023

RESUMO

In this study, I explore the challenges that ideological hegemonies of personhood imbibed by nurses and other healthcare workers could pose for the nursing profession, particularly in terms of inhibiting the acknowledgment of difference. Dominant or hegemonic conceptions of personhood in particular spaces often consist of self-contained ideas and essentialist ontologies and normativity of what it means to be a person, lack of which results in the denial of personhood and the othering as non-person or sub-person. The other as the residue of such self-contained notions of personhood is most often denied the quality of care that the one who fits within such conceptions enjoy. For nurses and other healthcare workers to overcome such exclusionary tendencies in healthcare, they must overcome hegemonies and ideological dominance and be more open to alternative viewpoints and theories of personhood. I develop these lines of thought by focusing on the rich ideological traditions of Continental and African philosophies showing how exclusion takes place within these traditions based on conceptions of personhood and how such exclusion on the basis of difference impacts negatively on healthcare. I conclude by highlighting the need to go beyond hegemonic philosophies of personhood by decolonizing and demasculinizing healthcare, thereby allowing difference to flourish in an ecology of medical knowledge.


Assuntos
Pessoalidade , Filosofia , Atenção à Saúde , Humanos , Conhecimento
16.
Med Health Care Philos ; 25(3): 429-437, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-35618867

RESUMO

Thought experiments that concoct bizarre possible world modalities are standard fare in debates on personal identity. Appealing to intuitions raised by such evocations is often taken to settle differences between conflicting theoretical views that, albeit, have practical implications for ethical controversies of personal identity in health care. Employing thought experiments that way is inadequate, I argue, since personhood is intrinsically linked to constraining facts about the actual world. I defend a moderate modal skepticism according to which intuiting across conceptually incongruent worlds constitutes 'invalid intuition-inferences'-i.e., carrying over intuitions gathered from facts about possible worlds that are at odds with facts about the actual world, for the purpose of making claims about real-life persons and their identity, leads to conceptual incongruences. Such a methodological fallout precludes accurate, informative judgments about personal identity in the actual world, calling into question the adequacy of thought experimental considerations for potential real-world applications in medical ethics.


Assuntos
Ética Médica , Pessoalidade , Humanos , Intuição , Julgamento , Princípios Morais
17.
J Med Philos ; 47(2): 189-209, 2022 05 11.
Artigo em Inglês | MEDLINE | ID: mdl-35435964

RESUMO

A surgical head-transplant technique, HEAVEN, promises to offer significantly improved quality of life for quadriplegics and others whose minds are functional, but whose bodies require artificial support to continue living. HEAVEN putatively actualizes a thought-experiment long debated by philosophers concerning the definition of personhood and criterion of personal identity through time and change. HEAVEN's advocates presume to preserve the identity of the person whose head is transplanted onto another's living body, leaving one's previous body behind as one would their corpse. Various classical and contemporary theories of personhood and personal identity would support this presumption, while others would contest it as providing an accurate or complete view of what is essential for a human person to persist through this procedure. This paper brings such theories to bear in analyzing whether HEAVEN can indeed deliver on its promise of complete ontological survival for the person whose head is transplanted.


Assuntos
Pessoalidade , Qualidade de Vida , Humanos
18.
Nurs Philos ; 23(3): e12381, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35416420

RESUMO

The phrase 'person-centred care' (PCC) reminds us that the fundamental philosophical goal of caring for people is to uphold or promote their personhood. However, such an idea has translated into promoting individualist notions of autonomy, empowerment and personal responsibility in the context of consumerism and neoliberalism, which is problematic both conceptually and practically. From a conceptual standpoint, it ignores the fact that humans are social, historical and biographical beings, and instead assumes an essentialist or idealized concept of personhood in which a person is viewed as an individual static object. From a practical standpoint, the application of such a concept of personhood can lead to neglect of a person's fundamental care needs and exacerbate the problems of social inequity, in particular for older people and people with dementia. Therefore, we argue that our understanding of PCC must instead be based on a dynamic concept of personhood that integrates the relevant social, relational, temporal and biographical dimensions. We propose that the correct concept of personhood in PCC is one in which persons are understood as socially embedded, relational and temporally extended subjects rather than merely individual, autonomous, asocial and atemporal objects. We then present a reconceptualization of the fundamental philosophical goal of PCC as promoting selfhood rather than personhood. Such a reconceptualization avoids the problems that beset the concept of personhood and its application in PCC, while also providing a philosophical foundation for the growing body of empirical literature that emphasizes the psychosocial, relational, subjective and biographical dimensions of PCC.


Assuntos
Demência , Pessoalidade , Idoso , Demência/psicologia , Humanos , Assistência Centrada no Paciente/métodos , Autocuidado
19.
Enferm. clín. (Ed. impr.) ; 32(2): 1-8, Mar - Abr, 2022. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-203654

RESUMO

Objetivo: El presente estudio tuvo como objetivo evaluar la aplicación del modelo comunitario de enfermería de salud mental (CMHN) utilizando una intervención de atención estándar de enfermería y terapia cognitiva conductual en habilidades para la vida y productividad laboral para la población adulta con esquizofrenia.Método: Estudio experimental con un grupo de control equivalente que utilizó 193 participantes asignados al azar al grupo de intervención o control en el centro de salud comunitario en Cipayung, Yakarta. La intervención consistía en una terapia cognitiva conductual de cuatro meses que fue implementada por 33 enfermeros psiquiátricos comunitarios para mejorar las habilidades para la vida y la productividad laboral de las personas con esquizofrenia. Los instrumentos utilizados para evaluar la intervención fueron la versión indonesia del cuestionario de perfil de habilidades para la vida (LSP) y la escala de productividad laboral y deterioro de la actividad (WPAI). El análisis de datos utilizó una prueba t pareada.Resultados: Los resultados muestran que hubo una diferencia significativa en las puntuaciones en el LSP antes y después de la implementación en el grupo de intervención (19,94 ± 1,27 y 38,83 ± 9,32) con p < 0,001 en comparación con el grupo control (26,93 ± 12,50 y 30,8 ± 12,41) con p = 0,002. Los resultados también muestran que hubo una diferencia significativa de WPAI antes y después de la implementación para el grupo de intervención (2,21 ± 1,12 y 3,82 ± 1,28) con p < 0,05 y en el grupo control (1,91 ± 1,42 y 2,19 ± 1,58) con p = 0,188.Conclusiones: Los modelos CMHN que utilizan intervenciones básicas de enfermería en salud mental comunitaria pueden utilizarse para mejorar las habilidades para la vida y la productividad laboral de las personas con esquizofrenia en Indonesia. La mejora de las habilidades para la vida y la productividad laboral podría fortalecer la capacidad de vivir en la comunidad en este tipo de pacientes.


Objective: This study aimed to evaluate the application of community mental health nursing (CMHN) model using an intervention of nursing standard care and cognitive behavioral therapy on life skills and work productivity for the adult population with schizophrenia.Method: This study was an experimental study with an equivalent control group using randomly allocated 193 participants to either the intervention or control group at community health center in Cipayung, Jakarta. The intervention comprised in a 4-month cognitive behavioral therapy that was implemented by 33 community psychiatric nurse staff to improve the life skills and work productivity of people with schizophrenia. The instruments used to evaluate the intervention were the Indonesian version of the life skill profile (LSP) questionnaire and the work productivity and activity impairment scale (WPAI). The data analysis used a paired t-test.Results: The findings show that there was a significant difference in scores on the LSP before and after the implementation in the intervention group (19.94 ± 1.27 and 38.83 ± 9.32) with p < .001 and the control group (26.93 ± 12.50 and 30.89 ± 12.41) with p = .002. The findings also show that there was a significant difference of WPAI before and after the implementation for the intervention group (2.21 ± 1.12 and 3.82 ± 1.28) with p < .05 compared with the control group (1.91 ± 1.42 and 2.19 ± 1.58) with p = .188.Conclusions: CMHN models using basic community mental health nursing interventions can be used to improve life skills and work productivity of people with schizophrenia so this could be a skill to strengthen the ability to live in the community in this type of patients.


Assuntos
Humanos , Saúde Mental , Esquizofrenia , Enfermeiras Especialistas , Psiquiatria/métodos , Pessoas Mentalmente Doentes , Enfermagem , Enfermeiras e Enfermeiros , Enfermeiras Clínicas , Valor da Vida , Pessoalidade
20.
Cognition ; 224: 105068, 2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-35231669

RESUMO

Whether the corporation should be considered a person is a matter of active academic and public debate. Here, we examine whether, and in what ways, ordinary citizens conceptualize the corporation as a person. We present evidence that corporations are anthropomorphized, but only to a certain degree. Compared with other entities, the average corporation is considered about as similar to a person as an ant. Corporations differ in the extent to which people are willing to grant them personhood however, and this pattern is predicted by how salient the organization's mental and moral traits are. This process of anthropomorphization has important downstream consequences, increasing support for granting legal rights and responsibilities to corporations. Because our studies show that this relationship also obtains for animals, we conclude that perceptions of corporate personhood draw on a more general set of rules for assessing an entity's personhood.


Assuntos
Princípios Morais , Pessoalidade , Animais , Humanos
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