De-tabooing dying control - a grounded theory study.

Dying is inescapable yet remains a neglected issue in modern health care. The research question in this study was "what is going on in the field of dying today?" What emerged was to eventually present a grounded theory of control of dying focusing specifically on how people react in relation to issues about euthanasia and physician-assisted suicide (PAS)

Proximity morality in medical school – medical students forming physician morality "on the job": Grounded theory analysis of a student survey

<p>Abstract</p> <p>Background</p> <p>The value of ethics education have been questioned. Therefore we did a student survey on attitudes about the teaching of ethics in Swedish medical schools.</p> <p>Methods</p> <p>Questionnaire survey on attitudes to ethics education with 409 Swedish medical students participating. We analyzed > 8000 words of open-ended responses and multiple-choice questions using classic grounded theory procedures.</p> <p>Results</p> <p>In this paper we suggest that medical students take a proximity morality stance towards their ethics education meaning that they want to form physician morality "on the job". This involves comprehensive ethics courses in which quality lectures provide "ethics grammar" and together with attitude exercises and vignette reflections nurture tutored group discussions. Goals of forming physician morality are to develop a professional identity, handling diversity of religious and existential worldviews, training students described as ethically naive, processing difficult clinical experiences, and desisting negative role modeling from physicians in clinical or teaching situations, some engaging in "ethics suppression" by controlling sensitive topic discussions and serving students politically correct attitudes.</p> <p>Conclusion</p> <p>We found that medical students have a proximity morality attitude towards ethics education. Rather than being taught ethics they want to form their own physician morality through tutored group discussions in comprehensive ethics courses.</p

Theoretical and empirical aspects of the assessment and practice of alternative medicine

The main purpose of this dissertation is to elucidate the problem of assessing and providing alternative medical technologies. The purpose is divisible into three parts: To investigate the bases of assessment for the acceptance of an alternative medical technology; 2. To investigate the professional and ethical problems connected with the practice of alternative medical technologies and find out whether the views of laymen and physicians differ with regard to the provision of treatments which are not in accordance with science and proven experience; 3. To investigate the interest physicians have shown in alternative medicine and the motives for this interest. These investigations are based partly on a study of the literature on alternative medicine dealing with the effects of the following alternative medical technologies: manipulation therapy, acupuncture, reflexio (zone) therapy, homoeopathy and magnetic therapy, and partly on empirical research into the attitudes expressed by doctors and patients towards non-scientific treatments. The results of these studies show that the acceptance of empirical data cannot be separated from the scientific paradigm within which the investigation has been planned. The documentation of the effect of alternative medical technologies is often empirically insufficient and based, in many instances, on so-called ”personal experience”. The interest shown by accredited physicians in alternative medicine is often motivated by the fact that certain complaints brought to them by their patients cannot be rectified by academic medical methods. The study also shows that physicians have professional interests which the patient is not prepared to respect in the same way as the physician is prepared to respect the right of a patient to refuse to undergo life-saving medical treatment. The main conclusion is that alternative medicine is a heterogeneous field where the interest expressed can be interpreted as a crisis phenomenon and an indication of the need for the assessment of alternative medicine as well as academic medicine. Laymen perceive the ethical and professional problems connected with the practice of alternative medicine relatively differently when compared to physicians. The possibility of scientific co-operation between practitioners of alternative medicine and academic medicine is difficult due to the fact that alternative medicine and academic medicine relate to different scientific paradigms. Clinical co-operation in the case of individual patients, on the other hand, is likely to occur.Diss. (sammanfattning) Umeå : Umeå universitet, 1991, härtill 6 uppsatserdigitalisering@um

Withholding and withdrawing life-sustaining treatment : a comparative study of the ethical reasoning of physicians and the general public

BACKGROUND: Our objective was to investigate whether a consensus exists between the general public and health care providers regarding the reasoning and values at stake on the subject of life-sustaining treatment. METHODS: A postal questionnaire was sent to a random sample of members of the adult population (n = 989) and to a random sample of intensive care doctors and neurosurgeons (n = 410) practicing in Sweden in 2004. The questionnaire was based on a case involving a severely ill patient and presented arguments for and against withholding and withdrawing treatment, and providing treatment that might hasten death. RESULTS: Approximately 70% of the physicians and 51% of the general public responded. A majority of doctors (82.3%) stated that they would withhold treatment, whereas a minority of the general public (40.2%) would do so; the arguments forwarded (for instance, belief that the first task of health care is to save life) and considerations regarding quality of life differed significantly between the two groups. Most physicians (94.1%) and members of the general public (77.7%) were prepared to withdraw treatment, and most (95.1% of physicians and 82% of members of the general public) agreed that sedation should be provided. CONCLUSION: There are indeed considerable differences in how physicians and the general public assess and reason in critical care situations, but the more hopelessly ill the patient became the more the groups' assessments tended to converge, although they prioritized different arguments. In order to avoid unnecessary dispute and miscommunication, it is important that health care providers be aware of the public's views, expectations, and preferences.Rydvall, Anders Lynoe, Niels Comparative Study Research Support, Non-U.S. Gov't England Critical care (London, England) Crit Care. 2008;12(1):R13. Epub 2008 Feb 15.</p