The first part of this paper seeks to clarify how interpersonal relationships are generally rooted in considerations about trust, vulnerability and interpersonal dependence. However, for nurse–patient relationships, and from the point of view of justice and fair rationing, it is essential to investigate their distinct moral nature. Hence, the second part of the paper argues that nurse–patient relationships, as a special kind of interpersonal relationship, raise particular normative issues. I will discuss dilemmas facing nurses and professional care‐givers in general who (...) are torn between their obligations to existing patients and more general and impartial considerations regarding the distribution of nursing care. This discussion concerning the normative claims of immediacy and mercy vs. fairness in health care is a pressing issue for nursing care. The claims that arise from particular relationships in nursing care are typically associated with closeness to a person's vulnerabilities. The pressing issue is how considerations of mercy and protection of individual patients can be safeguarded within today's nursing and health‐care practices in which distributivist considerations are crucial. (shrink)

The aim of the present study was to describe variations in patient participation in decisions about care planning during the final phase of life for a group of gravely ill patients, and how the different actors’ manner of acting promotes or impedes patient participation. Thirty-seven qualitative research interviews were conducted with relatives of the patients. The patients’ participation in the decisions could be categorized into four variations: self-determination, co-determination, delegation and nonparticipation. The manner in which patients, relatives and caregivers acted (...) differed in the respective variations; this seemed either to promote or to impede the patients’ opportunities of participating in the decision making. The possibility for participation seems to be context dependent and affected by many factors such as the dying patient’s personality, the social network, the availability of different forms of care, cultural values, and the extent to which nurses and other caregivers of the different forms of care can and want to support the wishes of the patients and relatives in the decision-making process. (shrink)

The purpose of this study was to explore the views and experiences of adult cancer patients about patient participation in care and decision making and the preconditions for this participation. The data were collected by means of focused interviews; in addition the patients completed depression and problem-solving instruments. The sample comprised 34 cancer patients from the haematological and oncological wards of one university hospital in Finland. The results revealed considerable variation in the patients’ views on their participation in care and (...) decision making. Some of the patients understood participation either in terms of contributing to the decision making or in terms of expressing their views on treatment options. Some considered that their participation in care was impossible. Patient participation in care and decision making was promoted by good health, access to information, assertiveness, good interactive relationships with nurses and physicians, and encouragement by nurses and physicians to participate. Factors restricting such patient participation were poor health, ignorance, anxiety, age, time pressures of staff, lack of time, high staff turnover and poor interactive relationships. With regard to participation in medical decision making, the patients were divided into three groups: (1) active participants ( n = 7), (2) patients giving active consent ( n = 9), and (3) patients giving passive consent to medical decisions ( n = 18). (shrink)