Hope in palliative care: A longitudinal qualitative study

This thesis describes hope in palliative care patients, their family members and their healthcare professionals. An interpretative synthesis of the literature (chapter 2) and a metaphor analysis of semi-structured interviews with palliative care professionals (chapter 3) highlight palliative care professionals’ perspectives on hope. The findings support healthcare professionals to reflect on their ethics of hope and to widen their communicative repertoire. A chapter on the dynamics of despair, hopelessness and hope over time, as experienced by palliative care patients, helps healthcare professionals to understand, for example, the co-existence of these concepts in their patients (chapter 4). A relational ethics of hope, in addition, is described as an ethics of solicitude, in which healthcare professionals should balance empowerment (hope) and compassion (suffering). This ethics of hope is based on analysis of semi-structured interviews with all participants in the study (chapter 5). The last empirical study consists of a pilot study that tested the feasibility of a hope communication tool. Participating healthcare professionals described the tool as useable, and it supported them to discuss end-of-life issues and spirituality with their palliative care patients (chapter 6). One of the conclusions of this thesis is that healthcare professionals should use a relational-ethical approach to hope, which also involves that they take into consideration their own (experiences of) hope, despair and hopelessness (chapter 7)

Sleepless Nights because of Ethical Dilemmas in Mental Health Care for Asylum Seekers

The number of asylum requests in the Netherlands in 2015 was relatively high but comparable to 20 years ago. This article compares the social, political and cultural factors in mental health professionals’ ethical dilemmas and reflections in both periods. The data consists of papers from an expert meeting in 1995 on Medical Ethical Standards in Mental Health Care for Refugees, and interviews and focus groups with health professionals on ethical dilemmas in mental health care for asylum seekers in 2015. Using a discursive approach to analyse the data, we found that, in 1995, as well as in 2015, the deliberations of mental health professionals reveal medical, social, cultural and judicial paradigms. In 2015, political factors tend to weigh more heavily than in 1995. We conclude that, in both periods, mental health professionals experience conflicts of values but the context of care for asylum seekers changed