Introduction to medical ethics
Gary Chan Kok Yew in Health Law and Medical Ethics in Singapore, 2020
With respect to healthcare, take the example of a doctor who intends to relieve the grave and continuous pain experienced by the patient (ie, the primary intended effect) and provides medication. This medication may indirectly hasten the patient’s death (ie, the unintended secondary effect). The doctor can argue that his act is justified under this doctrine as he did not intend to cause the patient’s death (Beauchamp and Childress 2019, at p. 167). Intentionality imports the idea of a goal or objective (ends) which the agent seeks to achieve by his actions or the means (ie, the medication) by which the agent utilises to achieve the end. Secondary effects that are merely foreseen by the agent do not amount to proof of intentionality with respect to the actions. Another illustration in the medical context is provided by McIntyre (2018): A doctor who believed that abortion was wrong, even in order to save the mother’s life, might nevertheless consistently believe that it would be permissible to perform a hysterectomy on a pregnant woman with cancer. In carrying out the hysterectomy, the doctor would aim to save the woman’s life while merely foreseeing the death of the fetus. Performing an abortion, by contrast, would involve intending to kill the fetus as a means to saving the mother.
Therapeutic self
Barbara Hemphill in Occupational Therapy and Spirituality, 2019
The therapeutic use of self is the “glue” that holds the relationship among the therapist, the client, and a transcendent being (soul) together in the therapeutic relationship. In describing this triadic relationship, Fowler (1981) stated that human communities have a faith structure that is triangular in nature. In communities, the soul is connected to others by shared trust and loyalty. Both the soul and others (i.e., people) are mediated, strengthened, and realized by the shared trust in and loyalty to a higher power. The triangle between the therapist, client, and soul takes place in a community; is accessed through occupation; and is made possible by the therapeutic use of self. The community is the therapeutic environment. It can be the patient’s home, work, or clinic. The therapist enters the environment where the patient’s spirituality takes place. The therapist taps into the patient’s spirituality where occupations are used. The therapeutic use of self holds the relationship together during the treatment process through occupations. Intentionality (the self) operationalizes the spirituality between the client and therapist. Intentionality means the conscious application of the will or intent to direct the self to engage the self/soul of the “other.”
Cases
Ira Bedzow in Giving Voice to Values as a Professional Physician, 2018
In this case, however, the decision to withdraw the ventilator is not simply a medical decision, i.e. a decision as to the ventilator’s efficacy in treating or maintaining the health of the patient. Rather, the patient requested its removal, even though he knows that removal of the ventilator will most likely result in his death. The right to die is an extension of the right to refuse treatment. It is not conceived to be suicide. Those who distinguish between committing suicide and refusing treatment that will result in death do so on two counts that are based on the definition of suicide. Suicide is defined as the intentional termination of one’s own life. Intentionality demands that one’s purpose is towards a certain goal. Moreover, the easiest way to determine one’s intention is through one’s actions towards that goal. When one refuses treatment, the intention or goal sought is to remove the encumbrance of medical treatment; the patient’s goal is not to die. Furthermore, in refusing treatment, the patient is not terminating his or her own life; rather, death is a natural result of his or her medical condition. As such, when one refuses treatment, the patient neither intends nor terminates his or her life – in other words, he or she does not commit suicide. This is the legal as well as the predominant ethical understanding of why refusing treatment and suicide are not the same.
Patients’ expectations of physiotherapists before and after an intensive chronic low back pain rehabilitation programme: a qualitative study based on semi-structured interviews and observations
Published in Disability and Rehabilitation, 2023
Claude Pichonnaz, Céline Ancey, Josiane Mbarga, Rose-Anna Foley
The research used an interpretive socio-anthropological approach, which considers experience to be subjectively lived and meaning to be socially constructed by attributing sense to events or actions [50]. This approach was combined with a critical perspective on how people have incorporated representations of self and body in relation to the illness and how moral, medical, economic and political values also affect their individual experiences [51]. Intentionality is an important concept that highlights that there is a co-constitution between the situation and the person in the situation [52]. Expectations are considered one of the constituents of this lifeworld [53], in which the patient’s experience consists in having expectations of physiotherapists, interpreting the response to their expectations and attributing a meaning to them.
A Qualitative Study on the Psychological Experience of Emergency Department Medical Staff Caring for Patients with Suicide Attempts in Northeastern Sichuan
Published in Archives of Suicide Research, 2023
Xianqun Liu, Qingxiu Chen, Maoqiong Yang, Jiaojiao Liu, Yu Yin, Yun Liang
Descriptive phenomenology is a detailed account of one’s daily life experiences as seen through mindful awareness (Vignato, Inman, Patsais, & Conley, 2021). The “lived experience” is not fully explored in everyday life and, as a result, is not freely available. To be more precise, the “lived experience” must be examined from three phenomenological philosophical perspectives: intentionality, essences, and phenomenological reduction (Sousa, 2014). Intentionality is the conscious decision to direct one’s thoughts toward objects or content. In other words, intentionality describes reality as it happens as a result of conscious awareness. Essences describe the relationship between something real, something remembered, or something imagined. Phenomenological reduction is the suspension of beliefs about the experience, which occurs through bracketing, or the process of disregarding previous beliefs and assumptions to fully understand the phenomenon without preconceptions (Morrow, Rodriguez, & King, 2015).
Interpersonal or Institutional: Understanding Service User Oppression in Social Service Organizations Through Staff Interactions
Published in Journal of Progressive Human Services, 2023
Susan Ramsundarsingh, Micheal L. Shier
While most recommendations focused on the staff and tools to support staff, participants suggested that the culture of the organization also contributes to oppression (n = 8). Service users acknowledged HSO leadership for both demonstrating positive leadership and modeling oppression. One participant shared: “everything starts at the top, and it all runs down. So, if the people that are running these organizations have respect, not only for their clients but for their staff, and the way they provide the service, I think that’s the first key. The training and all that stuff has to follow” (Mark). Another participant used the example of cultivating land: You can create a culture; you can cultivate a culture. You can say we want honor. We want compassion. So what seeds can we plant? We want to share knowledge of People’s cultures. What seeds can we plant that’s going to grow that? And then what weeds do we need to pull out until you actually have to be very intentional about creating. So I think intentionality is very important and it’s lacking.(Elan).
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