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Background: Clinical ethics support instruments aim to support healthcare professionals in dealing with moral challenges in clinical practice. CURA is a relatively new instrument tailored to the wishes and needs of healthcare professionals in palliative care, especially nurses. It aims to foster their moral resilience and moral competences. Aim: To investigate the effects of using CURA on healthcare professionals regarding their Moral Resilience and Moral Competences. Design: Single group pre-/post-test design with two questionnaires. Methods: Questionnaires used were the Rushton Moral Resilience Scale measuring Moral Resilience and the Euro-MCD, measuring Moral Competences. Respondents mainly consisted of nurses and nurse assistants who used CURA in daily practice. Forty-seven respondents contributed to both pre- and post-test with 18 months between both tests. Analysis was done using descriptive statistics and Wilcoxon signed rank tests. This study followed the SQUIRE checklist. Ethical considerations: This study was approved by the Institutional Review Board of Amsterdam UMC. Informed consent was obtained from all respondents. Results: The total Moral Resilience score and the scores of two subscales of the RMRS, that is, Responses to Moral Adversity and Relational Integrity, increased significantly. All subscales of the Euro-MCD increased significantly at posttest. Using CURA more often did not lead to significant higher scores on most (sub) scales. Conclusion: This study indicates that CURA can be used to foster moral resilience and moral competences of healthcare professionals. CURA therefore is a promising instrument to support healthcare professionals in dealing with moral challenges in everyday practice. [ABSTRACT FROM AUTHOR]

There is an increased focus on fostering integrity in research by through creating an open culture where research integrity dilemmas can be discussed. We describe a pilot intervention study that used Moral Case Deliberation (MCD), a method that originated in clinical ethics support, to discuss research integrity dilemmas with researchers. Our research question was: can moral case deliberation in research groups help to navigate research integrity dilemmas? We performed 10 MCDs with 19 researchers who worked in three different research groups from three different disciplinary fields at a university in the Netherlands. We analyzed the dilemmas and values discussed, sent out a survey questionnaire to assess self-perceived moral competencies, and conducted in-depth interviews. We found research integrity dilemmas pertained to authorship disputes, supervision of junior co-workers, and questionable handling of data. Participants perceived the majority of moral competencies to a higher degree during the MCD when compared to perceiving them in daily practice afterward. Interviewees told us that they felt most comfortable discussing dilemmas among peers with whom they were not closely affiliated. We conclude that MCD sessions could be relevant in navigating research integrity dilemmas, but that revisions to ensure commitment and safety are required. [ABSTRACT FROM AUTHOR]

Objective: To identify moral challenges experienced by nurses and volunteers in palliative care. Methods: A qualitative hermeneutic research design was used. Interviews with nurses (N = 10) and volunteers (N = 4) working in palliative care, in-home care, and hospice setting. Participants were recruited through maximum variation, a purposive sampling technique. Transcriptions were analyzed using qualitative thematic content analysis and open coding. Results: Two themes were identified, each with three subthemes: theme (A) Moral challenges regarding organizational and professional aspects contained the subthemes (1) dealing with protocols and regulations, (2) different professional perspectives on good care, and (3) limits of professionalism. Theme (B) Moral challenges regarding the patient and their family members contained the subthemes (1) dealing with the patient's wishes, (2) the patient's wish to die, and (3) dealing with family members. Conclusion: Nurses and volunteers working in palliative care are confronted with a wide range of moral challenges. Insight into 'real-world ethical challenges' of healthcare providers is important to provide adequate support to nurses and volunteers working in palliative care. [ABSTRACT FROM AUTHOR]

This article presents an ethics support instrument for healthcare professionals called CURA. It is designed with a focus on and together with nurses and nurse assistants in palliative care. First, we shortly go into the background and the development study of the instrument. Next, we describe the four steps CURA prescribes for ethical reflection: (1) Concentrate, (2) Unrush, (3) Reflect, and (4) Act. In order to demonstrate how CURA can structure a moral reflection among caregivers, we discuss how a case was discussed with CURA at a psychogeriatric ward of an elderly care home. Furthermore, we go into some considerations regarding the use of the instrument in clinical practice. Finally, we focus on the need for further research on the effectiveness and implementation of CURA. [ABSTRACT FROM AUTHOR]

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Moral Case Deliberation is intended to assist healthcare professionals faced with difficult dilemmas in their work. These are situations that involve emotions. During Moral Case Deliberation, participants are invited to reflect on moral views and deliberate on them. Emotions are not explicitly addressed. This article aims to elucidate the role of emotions in Moral Case Deliberation, by analysing experiences of Moral Case Deliberation facilitators. Our research shows the role of emotions varies according to the phase of the Moral Case Deliberation process. One negative aspect of emotions is that they can obstruct the Moral Case Deliberation discussion or distract from the moral question. A positive aspect is that they bring the dilemma into sharper focus. Devoting attention to emotions can help to ensure that responsible decisions are made, while also increasing the moral resilience of participants. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Psychiatry is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Moral case deliberation is a form of clinical ethics support to help healthcare professionals in dealing with ethically difficult situations. There is a lack of evidence about what outcomes healthcare professionals experience in daily practice after moral case deliberations. The Euro-MCD Instrument was developed to measure outcomes, based on the literature, a Delphi panel, and content validity testing. To examine relevance of items and adequateness of domains, a field study is needed. Aim: To describe experienced outcomes after participating in a series of moral case deliberations, both during sessions and in daily practice, and to explore correlations between items to further validate the Euro-MCD Instrument. Methods: In Sweden, the Netherlands, and Norway, healthcare institutions that planned a series of moral case deliberations were invited. Closed responses were quantitatively analyzed. The factor structure of the instrument was tested using exploratory factor analyses. Ethical considerations: The study was approved in Sweden by a review board. In Norway and the Netherlands, data services and review boards were informed about the study. Results: The Euro-MCD Instrument was completed by 443 and 247 healthcare professionals after four and eight moral case deliberations, respectively. They experienced especially outcomes related to a better collaboration with co-workers and outcomes about individual moral reflexivity and attitude, both during sessions and in daily practice. Outcomes were experienced to a higher extent during sessions than in daily practice. The factor structure revealed four domains of outcomes, which did not confirm the six Euro-MCD domains. Conclusion: Field-testing the Euro-MCD Instrument showed the most frequently experienced outcomes and which outcomes correlated with each other. When revising the instrument, domains should be reconsidered, combined with theory about underlying concepts. In the future, a feasible and valid instrument will be presented to get insight into how moral case deliberation supports and improves healthcare. [ABSTRACT FROM AUTHOR]

[3] experienced several pressing moral dilemmas while studying decision making with patients at the end of life in oncology. A dialogical empirical ethics approach to research may sometimes be at odds with current formal requirements to research with respect to following specific norms for conducting good research, such as the norms from research ethics committees who aim to foster research ethics and research integrity. Dialogical empirical ethics research would benefit from developing procedures that enable research-ethical scrutiny while taking into account the specificity of a dialogical approach to empirical ethics research methodology. [Extracted from the article]

Forensic psychiatry is pervaded by moral dilemmas. Although professionals in forensic psychiatry are trained in law and psychiatry and are certainly aware of ethical issues in the care for patients, they tend to make decisions in an implicit way and not to discuss their moral concerns or doubts. More structural attention for ethics seems to be required. In this paper, we show the value of moral case deliberation in forensic psychiatry. Moral case deliberation is a specific kind of clinical ethics support in which healthcare professionals discuss a moral issue from practice in a structured way, facilitated by an ethicist or specifically trained facilitator. It is applicable to a wide array of situations in healthcare practice. In contrast to other models of clinical ethics support, such as individual consultation, the focus is on the moral experience of professionals and using a structured method to foster dialog and joint moral learning. In this paper, an example of case on a forensic ward is presented. The case shows that moral case deliberation leads to reflection on values and stimulates openness and honesty regarding uncertainties. Moreover, the deliberation provides room for new insights and creates a basis for a joint decision on how to proceed further, recognizing the tensions and difficulties involved. [ABSTRACT FROM AUTHOR]

Background: Moral case deliberation is increasingly becoming part of various Dutch healthcare organizations. Although some evaluation studies of moral case deliberation have been carried out, research into the results of moral case deliberation within aged care is scarce. Research questions: How did participants evaluate moral case deliberation? What has moral case deliberation brought to them? What has moral case deliberation contributed to care practice? Should moral case deliberation be further implemented and, if so, how? Research design: Quantitative analysis of a questionnaire study among participants of moral case deliberation, both caregivers and team leaders. Qualitative analysis of written answers to open questions, interview study and focus group meetings among caregivers and team leaders. Participants and research context: Caregivers and team leaders in a large organization for aged care in the Netherlands. A total of 61 moral case deliberation sessions, carried out on 16 care locations belonging to the organization, were evaluated and perceived results were assessed. Ethical considerations: Participants gave informed consent and anonymity was guaranteed. In the Netherlands, the law does not prescribe independent ethical review by an Institutional Review Board for this kind of research among healthcare professionals. Findings: Moral case deliberation was evaluated positively by the participants. Content and atmosphere of moral case deliberation received high scores, while organizational issues regarding the moral case deliberation sessions scored lower and merit further attention. Respondents indicated that moral case deliberation has the potential to contribute to care practice as relationships among team members improve, more openness is experienced and more understanding for different perspectives is fostered. If moral case deliberation is to be successfully implemented, top-down approaches should go hand in hand with bottom-up approaches. Conclusion: The relevance of moral case deliberation for care practice received wide acknowledgement from the respondents. It can contribute to the team’s cohesion as mutual understanding for one another’s views is fostered. If implemented well, moral case deliberation has the potential to improve care, according to the respondents. [ABSTRACT FROM AUTHOR]

Background: Some patients with advanced and progressive diseases express a desire to hasten death. Aim: This study evaluated the motivations of patients expressing such a desire in a country with prohibitive legislation on euthanasia and physician-assisted suicide. Design: A modified form of Grounded Theory was used. Setting/participants: Patients from the departments of palliative medicine in three hospitals in Germany were recruited when they had made a statement or request to hasten death. Participants were interviewed face to face. Recruitment was stopped with 12 participants because of data saturation. Results: Thematic analysis revealed three main motivational themes: self-determination, agony, and time. Expectations toward health professionals, attitudes toward death, and secureness related to the end of life were additional main themes emerging from the analysis. Conclusions: The desire to hasten death may be used as an extreme coping strategy to maintain control against anticipated agony. Patients expected health professionals to listen to and respect their experiences. Emerging hypotheses included the following: (a) patients try to balance life time and anticipated agony, and the perception of time is distressing in this balancing act; (b) anticipated images of agony and suffering in the dying process occur frequently and are experienced by patients as intrusive; (c) patients expressing a desire to hasten death are in need of more information about the dying process; and (d) patients wanted their caregivers to listen to and respect their wish to hasten death, and they did not expect the caregivers to understand this as an order to actually hasten their death. [ABSTRACT FROM AUTHOR]

The article focuses on a study which aims to elicit the perspective of relatives of severe stroke patients with regard to the decision-making process in the acute phase to understand how they participate in treatment decisions. Accordingly, decision-making process may help physicians and other health-care providers to better involve relatives in decision-making and enhance the care, that includes palliative care.

This qualitative study explores (1) how members of the Dutch Association for People with Bipolar Disorder explain the affliction of bipolar disorder; (2) the relationship between genetic, environmental and personal factors in these explanations and (3) the relationship between illness explanations, self-management and identity. A total of 40 participants took part in seven different focus group discussions. The results demonstrate that there are two different explanatory idioms, each one centred around an opposing concept, that is, susceptibility and disease. Individuals who construct explanations around the concept of ‘disease’ attach more importance to ‘genes and chemicals’ than to environmental components in the onset of the disorder, whereas individuals adhering to the central concept of ‘susceptibility’ tend to do this much less. Compared with individuals using the ‘susceptibility’ idiom, those who use a ‘disease’ idiom tend to observe fewer possibilities for self-management and are less inclined to construct normalcy through a quest for personal growth. Stories of suffering seem more integral to the ‘disease’ idiom than to the ‘susceptibility’ idiom. The ‘disease’ idiom seems less integrated in a contemporary surveillance psychiatric discourse than the ‘susceptibility’ idiom; however, both vocabularies can offer normative constraints. [ABSTRACT FROM PUBLISHER]

Competence is central to informed consent and, therefore, to medical practice. In this context, competence is regarded as synonymous with decision-making capacity. There is wide consensus that competence should be approached conceptually by identifying the abilities needed for decision-making capacity. Incompetence, then, is understood as a condition in which certain abilities relevant to decisionmaking capacity are lacking. This approach has been helpful both in theory and practice. There is, however, another approach to incompetence, namely to relate it to mental disorder. This approach has been followed in recent research that has shown, for instance, that in anorexia nervosa a person's values may be changed, resulting in 'pathological' values. We explore some advantages and disadvantages of both abilities-based and pathology-based approaches. We argue that both can be valuable for further clarification of the concept of competence and improving clinical practice. Given the current predominance of the abilities-based approach, we make a plea for a greater focus on pathology-based practice and research. [ABSTRACT FROM AUTHOR]

There is a trend in medical and health research to involve patients in the research process. A recent role is the patient acting as a research partner in a team of professionals. There are a few publications about these collaborations and the value of research partners. But is the research partner accepted as a credible knower? How can equality in the collaboration be reached? And how to handle tensions between the research partner's personal agenda and the interests of and burdens on fellow patients? Finally there is the question of how the research influences the research partner's self-perception. The purpose of this article is to investigate these epistemological, relational, ethical, and existential issues, while presenting an ethnodrama. In this drama, the personal narrative of the research partner, a person with a renal disease, unfolds in dialogue with her research mates, whose voices are also present in the text. The article is based on a health research agenda-setting process with the Kidney Association in the Netherlands. [ABSTRACT FROM AUTHOR]

This article examines how people with type 2 diabetes perceive autonomous decision making and which moral capacities they consider important in diabetes nurses' support of autonomous decision making. Fifteen older adults with type 2 diabetes were interviewed in a nurse-led unit. First, the data were analysed using the grounded theory method. The participants described a variety of decision-making processes in the nurse and family caregiver context. Later, descriptions of the decision-making processes were analysed using hermeneutic text interpretation. We suggest first- and second-order moral capacities that nurses specializing in diabetes need to promote the autonomous decision making of their patients. We recommend nurses to engage in ongoing, interactive reflective practice to further develop these moral capacities. [ABSTRACT FROM AUTHOR]

Patients are increasingly actively involved in research. We depart from an approach that understands patient participation as dialogue. This idea is grounded in hermeneutic philosophy and responsive research. Patients are engaged in research via dialogues with other stakeholders. New is the inclusion of patients as research partners. Several methodological notions underpin responsive research. In two health research agenda-setting processes (intellectual disability and kidney disease), these notions have been applied and refined for collaboration with research partners in mixed research teams. The findings demonstrate that equal partnerships include involvement in all research activities from beginning to end, a focus on experiential knowledge, mutual learning, openness, and respect. Mutual learning processes help to overcome stereotypes and handle tensions. Other experiences include the financial reimbursement of research partners, and the necessity of an acceptable workload and scheme. The collaboration might then have a surplus value for the research process and for those involved. [ABSTRACT FROM AUTHOR]

The purpose of this article was to investigate the outcome measures developed and used in palliative care. The paper involved a literature review of published research. Many of the reviewed papers concluded similarly that there was lack of good quality evidence on which to base conclusions. More high quality evidence is needed to compare the relative merits of the differences in models of palliative care services, so that we can learn from other appropriate systems of care at end of life. It follows that quality of life is the main outcome of palliative care, in which the patient instead of the disease represents the target of the clinical approach. Patients struggling with serious illness have other concerns, including managing pain and other symptoms, coordinating care among multiple providers and settings, ensuring that treatments reflect preferences and balance benefits and harms as well as clinical appropriateness, achieving empathic communication and care, fostering well-being, maintaining function and practically supporting family and caregivers through illness and bereavement. [ABSTRACT FROM AUTHOR]

This article deals with the question of how ethicists respond to practical moral problems emerging in health care practices. Do they remain distanced, taking on the role of an expert, or do they become engaged with nurses and other participants in practice and jointly develop contextualized insights about good care? A basic assumption of dialogical ethics entails that the definition of good care and what it means to be a good nurse is a collaborative product of ongoing dialogues among various stakeholders engaged in the practice. This article discusses the value of a dialogical approach to ethics by drawing on the work of various nursing scholars. We present a case example concerning the quality of freedom restrictions for intellectually disabled people. Issues for discussion include the role and required competences of the ethicist and dealing with asymmetrical relationships between stakeholders. [ABSTRACT FROM AUTHOR]

The aim of this article is to conceptualize autonomy in the context of chronic physical illness. To this end, we compare and contrast a selection of contemporary philosophical theories of autonomy with social scientific perspectives on chronic illness, particularly models of disability and symbolic interactionism. The philosophical theories mainly depart from a positive conceptualization of autonomy, which involves actively shaping one's life and identifying with fundamental values. This conceptualization is preferred over a negative conceptualization, which defines autonomy as non- interference, for its compatibility with social models of disability and with the assumption that people are interdependent. Interference may disable, but also enable people with a chronic illness to shape their lives. What matters is that people can realize what they want to realize. We suggest that, in the context of chronic physical illness, autonomy might be conceptualized as correspondence between what people want their lives to be like and what their lives are actually like. Disturbed autonomy might be restored either by expanding opportunities to arrange life or by adjusting how one wants life to be arranged. The grounds for the latter approach might be questioned, first, if people have not adjusted what they want carefully, and second, if reorganization of the material and social environment would have made it unnecessary to adjust one's arrangement of life. [ABSTRACT FROM AUTHOR]

This article discusses the importance of social relations in evaluation, It focuses first on social relations among stakeholders in the evaluation setting. It is argued that social elations are crucial as an object of study, since they are integral to and partly constitutive of the quality and effectiveness of the programme being evaluated. Next, it focuses on the social relations between the evaluator and the stakeholders in the programme. Several positions concerning the evaluator—stakeholder relationship are identified and related to evaluative traditions and underlying normative frameworks. It is argued that evaluation is inherently and inevitably a social practice. Evaluators should therefore not only attend to the social relations as an object of study, but also be aware of the normative dimensions and implications of their practice, and accompanying relational responsibilities. Acknowledgement of the normative dimensions of evaluation as social relation creates room for new, joint ways of learning between evaluators and stakeholders. [ABSTRACT FROM AUTHOR]

In this article the authors challenge contemporary epistemological research within educational settings. After a reconciliation of the current models which treat epistemological beliefs as static and mechanical, the authors present a teaching experience to illustrate their enactivist view that epistemological beliefs should be conceptualized as fluid and dynamic constructs, emerging in web-like configurations. Answers to epistemological questions unfold within the interstices and mutual interactions between people and their environment. Boundaries between student-teacher, individual-community, cognition-bodily experience are becoming blurred. From this enactivist perspective the researcher's role changes considerably. Instead of determining teachers' personal traits and epistemological make-up, the researcher should sensitize teachers to the subtle ways epistemological beliefs are enmeshed within their day-to-day professional lives, focusing on the complex fabric of the teaching practice. [ABSTRACT FROM AUTHOR]

Aim: This article describes the contents of an interactive computer-tailored program. The program is based on previous studies of the practice of care for persons with Prader-Willi syndrome. This genetic condition is associated with a constant overeating behaviour with the risk of obesity. The aim of the program is to start a process of awareness, reflection, and discussion by caregivers who are confronted with the moral dilemma of respect for autonomy versus restricting overeating behaviour. The program focuses on values (such as health and well-being) that are relevant to caregivers in daily practice. Furthermore, the focus is on various ways of interaction with the client. Caregivers were expected to focus mainly on health, and on both paternalistic and interpretive/deliberative forms of interaction. Methods: Sixteen professionals and 12 parents pilot-tested the program contents. With a pre-test, responses on one central case were collected for tailored feedback; with a post-test, the effects of the program were measured. Results: Significant correlations were found between the values of autonomy and consultation and between autonomy and well-being. In contrast to our expectations respondents valued all categories (autonomy, consultation, health, well-being, and liveability for others) as equally important in the pre-test. No significant changes in scores were found between pre- and post-test. The open answers and remarks of participants support the program contents. Conclusions: Participants' responses support previous research findings, advocating a concept of autonomy in terms of positive freedom, through support by others. The promotion of the client's self-understanding and self-development is central in this concept. [ABSTRACT FROM AUTHOR]

Moral deliberation has been receiving more attention in nursing ethics. Several ethical conversation models have been developed. This article explores the feasibility of the so-called CARE (Considerations, Actions, Reasons, Experiences) model as a framework for moral deliberation in psychiatric nursing practice. This model was used in combination with narrative and dialogical approaches to foster discourse between various stakeholders about coercion in a closed admission clinic in a mental hospital in the Netherlands. The findings demonstrate that the CARE model provides a substantial framework for structuring moral deliberations. Narratives and dialogue are useful tools for broadening issues in conversations, to engage various stakeholders (including patients), and to gain shared understandings. [ABSTRACT FROM AUTHOR]

This article describes the results of a grounded theory study among terminally ill patients (with a life expectancy of less than three months) at home (n =13, aged 39-83). The most commonly recurring theme identified in the analysis is 'directing', in the sense of directing a play. From the perspectives of patients in our study, 'directing' concerns three domains: 1) directing one's own life; 2) directing one's own health and health care; and 3) directing things related to beloved others (in the meaning of taking care of beloved ones). The patient's directing is affected by impeding and facilitating circumstances: the patient's needs and problems in the physical, psychological and existential/spiritual domain, and the support by family members and providers. Supporting patients and families, stimulating the patients' directing, giving attention to all domains of needs and counselling patients' families in the terminal phase are issues that need attention and warrant further investigation. [ABSTRACT FROM AUTHOR]

Dialogue is crucial to evaluation. Through dialogue, people are invited to develop new, shared ways of seeing and acting. From a hermeneutic perspective, dialogue implies consensus, based upon shared meanings and oriented towards reaching agreement. Dialogue also implies disagreement, in the form of a conflict between different, rival stories. The role of the evaluator is to enter into dialogue with people participating in practice. It is also to stimulate a dialogue between participants. This requires support for marginalized voices, but also attention to the voices of those who are in power. Only if the evaluator tries to understand the values endorsed in a practice and is prepared to listen to the stories of all parties involved, can evaluation become a practice to which all participants contribute. [ABSTRACT FROM AUTHOR]

The text you are about to read is a dialogical text on dialogue and evaluation. It is a conversation between a group of scholars who have studied and published on the concept of dialogue and the value of dialogue for the practice of evaluation. The text is based on the field notes of a panel meeting held during a gathering of the European Evaluation Society to discuss this topic. It also contains an analysis of essays written in preparation for the panel in answer to the following carefully selected questions. What is your concept of dialogue? Why do you think dialogue is important for evaluation, especially for programme evaluation in the public sector and civil society? During an evaluation, what are the essential characteristics of a meaningful dialogue? Who participates? What do they talk about? What is the evaluator's role? What prior value commitments or facilitating conditions are necessary? What are desired outcomes? What are the most important cautions we should take when conducting a more dialogical evaluation and finally, how 'good' are the dialogues we conduct, and what in fact constitutes 'good' dialogue? [ABSTRACT FROM AUTHOR]

The focus of interactional studies on patients' information-seeking behavior has almost entirely been on asking direct questions. This article offers a systematic analysis of patients' information-seeking actions and physicians' responses. Verbatim transcripts of 32 gynecological interviews audiotaped in a natural situation were analyzed. Most information-seeking actions concern the nature or procedure of treatment and are formulated in a straightforward way. However, causal aspects of complaints are often addressed through indirect requests for information. Patterns of comparable information-seeking actions and responses reveal that most information-seeking actions elicit adequate responses. Only indirect requests for information run a high risk of resulting in minimal answers. Recommendations relevant to medical practice are proposed. [ABSTRACT FROM PUBLISHER]

To meet the end-of-life needs of all patients, ongoing conversations about values and preferences regarding end-of-life care are essential. Aspects of social identity are associated with disparities in end-of-life care outcomes. Therefore, accounting for patient diversity in advance care planning and end-of-life conversations is important for equitable end-of-life practices. We conducted 16 semi-structured interviews to explore how Dutch healthcare professionals and researchers conceptualized diversity in advance care planning and end-of-life conversations and how they envision diversity-responsive end-of-life care and research. Using thematic discourse analysis, we identified five ‘diversity discourses’: the categorical discourse; the diversity as a determinant discourse; the diversity in norms and values discourse; the everyone is unique discourse, and the anti-essentialist discourse. These discourses may have distinct implications for diversity-responsive end-of-life conversations, care and research. Awareness and reflection on these discourses may contribute to more inclusive end-of-life practices. [ABSTRACT FROM AUTHOR]