This paper considers the social justice initiative of the Canadian Nurses Association (CNA). It focuses mainly on the two editions of the CNA's discussion document on social justice, and particularly on its emphasis on the principle of equity. The paper considers whether a coherent justification can be made for the CNA's espousal of equity, and the discussion focuses in turn on the principle of equity itself and on the CNA's position in relation to equity. A body of arguments supporting an (...) active moral role for professions, generally known as civic professionalism, provides a framework for exploring the CNA's role in this respect. Justifications for equity are explored in relation to the liberal‐contextualist spectrum, and civic professional arguments are subjected to the same structure of analysis. This is in turn related to evidence from the literature concerning nursing perceptions of equity. The paper concludes that contextualist justifications of equity and civic professionalism support one another more robustly than liberal justifications in relation to the CNA's initiative; and that they also sit more comfortably with the realities of the CNA's role in relation to nursing, and to the Canadian health care system. (shrink)

Although older persons (aged 65 years and older) experience stressful ethical problems involving their health, research is lacking about this phenomenon. The purpose of this study was to describe and examine the content and basic nature of older persons’ ethical problems concerning their health. The conceptual framework and method combined ethical enquiry and phenomenology. The participants were 18 older persons and 12 of their children or grandchildren (for contextual understanding). The 19 women and 11 men, 73% of whom were Caucasian, (...) described 184 ethical problems, from which emerged 10 content categories. The basic nature of the ethical problems consisted of conflict, resolution and rationale. The results could assist health professionals to promote older persons’ ethical decision making, quality of life, and good death. (shrink)

In order to promote better practices and communication around end-of-life decision-making, several Canadian hospitals in the province of Quebec have developed a tool called “Levels of Intervention”. No work to date has been published demonstrating improvement since these forms were implemented. The purpose of the present study was to obtain information about the use of LOI forms across Quebec hospitals and to identify gaps in practice as well as areas for improvement. A retrospective study was undertaken of 299 charts of (...) patients who had died in three Quebec hospitals with a LOI ordered. Results were analysed through a principlism ethical framework. High compliance with the level of intervention ordered at the time of death was recorded, as well as high involvement of patient and/or family, demonstrating the efficiency of LOI in promoting respect for autonomy. Other results show delays in end-of-life care discussions in the course of the hospitalization. Only a small proportion of patients who died had a palliative care consultation, which may reflect equity issues in access to care. This study highlights the importance of the LOI in Quebec and the role it is playing in respect for end-of-life preferences as well as in the involvement of patients and families in the decision-making process. Training specific to end-of-life decision-making conversations would help support the LOI form’s use, as would developing provincial or national guidelines on the use of LOI to standardize organizational policies and practice around end-of-life care. (shrink)