One of the common domains in health care in which the concept of vulnerability is used is end-of-life care, including euthanasia and assisted suicide (EAS). Since different uses and implications of the notion have been recognised in the literature on EAS, this paper aims to analyse them and reflect on who is the most vulnerable in the context of EAS. A prior exploratory review of the literature has served as a starting point for the discussion. We concluded that vulnerability is (...) a complex, multi-perspective and multi-layered concept, which implies the vulnerability of different stakeholders involved in EAS practices and vulnerability in different aspects of being human (i.e., physical, mental, moral, social and spiritual). A comprehensive understanding of the notion of vulnerability, which balances as well as complements the concept of autonomy, seems to be an indispensable element of the discourse on EAS. (shrink)

Increasing emphasis on patient self-management, including having patients advocate for their needs and priorities, is generally a good thing, but it is not always wanted or attainable by patients. The aim of this critical ethical review is to deepen the current discourse in patient self-advocacy by exposing various situations in which patients struggle to self-advocate. Using examples from oncology patient populations, we disambiguate different notions of self-advocacy and then present limits to the more demanding varieties (i.e., health-related, trust-based, and psychological); (...) we argue that these limits create ethical dilemmas with respect to whether it is always desirable to encourage patients to self-advocate. We conclude that self-advocacy can be both under and overrated with respect to how much it benefits the patient with cancer, with many instances being indeterminate. Ultimately, providers must understand the patient's perspective relative to the challenges they are experiencing and work with them to meet their needs. (shrink)

The current manner of practicing chaplaincy in health care is one which prizes the multi-faith chaplain. When one asks multi-faith chaplain, “To whom are you beholden?” they will respond, “The patient.” This is evident in the way that chaplaincy is currently practiced and taught, which prizes the use of psychology over recourse to theology. Chaplaincy’s recourse to practices whose aims are directed toward the efficient rather than the eternal challenges its original telos. This paper looks at this question by blending (...) a Catholic and Engelhardtian approach to conclude that chaplains should recognize that they are beholden to God, rather than to patients’ autonomy. (shrink)

Respect for Autonomy has been a mainstay of medical ethics since its enshrinement as one of the four principles of biomedical ethics by Beauchamp and Childress’ in the late 1970s. This paper traces the development of this modern concept from Antiquity to the present day, paying attention to its Enlightenment origins in Kant and Rousseau. The rapid C20th developments of bioethics and RFA are then considered in the context of the post-war period and American socio-political thought. The validity and utility (...) of the RFA are discussed in light of this philosophical-historical account. It is concluded that it is not necessary to embrace an ethic of autonomy in order to guard patients from coercion or paternalism, and that, on the contrary, the dominance of autonomy threatens to undermine those very things which have helped doctors come to view and respect their patients as persons. (shrink)

The article presents a doctor–patient relationship model based on the assumptions of a holistic approach to the patient. The author draws attention to selected patients’ needs, ones taken into account in this model. These are the right to autonomy and an individualised approach to the patient. These issues, considered in relation to philosophy, show a conflict between patients’ values and aspirations and doctors’ values and their experience. Nowadays, patients’ needs are protected by consumer rights as well as being strengthened by (...) postmodern philosophy, which shapes society’s awareness of various definitions of health and underlines the right of the individual to self‐determination. This situation creates an incredible challenge for doctors because attempts to assist is, according to medical knowledge, associated with an inevitable collision with the subjective perception of a patient’s health. Because of this issue, the author considers it necessary to enquire about the needs and aspirations of not so much patients as doctors themselves. It is assumed that the definition of what is currently important for this group determines the scope of any possible admission or intentional ignorance of patients’ needs. (shrink)