1. Translating psychosocial insight into ethical discussions supportive of families in end-of-life decision-making.
- Author
-
Foster LW and McLellan LJ
- Subjects
- Adult, Brain Death, Decision Making ethics, Ethics Consultation, Euthanasia, Passive ethics, Euthanasia, Passive psychology, Humans, Life Support Care psychology, Male, Moral Obligations, Narration, Persistent Vegetative State, Terminal Care psychology, United States, Family psychology, Life Support Care ethics, Professional-Family Relations, Social Support, Social Work, Psychiatric ethics, Terminal Care ethics
- Abstract
A large number of Americans would rather rely on family and friends more than their physicians about end-of-life care and decisions. Moving beyond traditional clinical ethics and its dyadic focus on the physician-patient relationship, this article presents an approach to ethical decision-making at the end of life that is more inclusive of the patient's family and has the potential to advance social work practice in end-of-life care. Initial attention is given to how psychosocial and bioethical perspectives and practices interact to shape understanding of moral issues in end-of-life decisions. Morally relevant principles are then adapted from contextual therapy as being useful for including more of a family focus and viewing ethical decision-making at the end of life as a family process. Specifically, focus is on exploring the ethical dynamics of family systems that impact the decision-making process and translating psychosocial insight into ethical discussions that are supportive of families. The case of a patient with sudden and unexpected brain death and without advance directives demonstrates one family's unresolved grief and illustrates how its members were helped to reason morally about end-of-life choices. Contributions of a social worker and bioethicist are illustrated.
- Published
- 2002
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