Search

Copyright of Der Internist is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: To investigate the variations in and intentions of wishes to die (WTD) of palliative care cancer patients.Methods: Thirty terminally ill cancer patients, their caregivers and relatives in a hospice, an oncology palliative care ward of a general hospital, and an outpatient palliative care service. 116 semistructured qualitative interviews analyzed by a combined approach using Grounded Theory and Interpretive Phenomenological Analysis.Results: A WTD is dynamic and interactive. Its subjective phenomenology can be described by three aspects: intentions, motivations, and interactions. In this article, we present a typology of the possible intentions. We identified nine different (ideal) types of intentions that WTD statements might have, other than wishing to live and accepting death. Many WTD statements do not imply a desire to hasten death. The intentions of statements differ according to whether a WTD is related to as imaginary or as an action. Often WTD statements contain several partial wishes, which can be in tension with each other and form a dynamic, sometimes unstable equilibrium.Conclusions: Terminally ill persons' WTD statements differ in their intention, and deeper knowledge about these differences is ethically relevant. [ABSTRACT FROM AUTHOR]

Objective: To investigate the variations in and intentions of wishes to die (WTD) of palliative care cancer patients. Methods: Thirty terminally ill cancer patients, their caregivers and relatives in a hospice, an oncology palliative care ward of a general hospital, and an outpatient palliative care service. 116 semistructured qualitative interviews analyzed by a combined approach using Grounded Theory and Interpretive Phenomenological Analysis. Results: A WTD is dynamic and interactive. Its subjective phenomenology can be described by three aspects: intentions, motivations, and interactions. In this article, we present a typology of the possible intentions. We identified nine different (ideal) types of intentions that WTD statements might have, other than wishing to live and accepting death. Many WTD statements do not imply a desire to hasten death. The intentions of statements differ according to whether a WTD is related to as imaginary or as an action. Often WTD statements contain several partial wishes, which can be in tension with each other and form a dynamic, sometimes unstable equilibrium. Conclusions: Terminally ill persons' WTD statements differ in their intention, and deeper knowledge about these differences is ethically relevant. [ABSTRACT FROM AUTHOR]

The part played by time in ethics is often taken for granted, yet time is essential to moral decision making. This paper looks at time in ethical decisions about having a genetic test. We use a patient-centred approach, combining empirical research methods with normative ethical analysis to investigate the patients' experience of time in (i) prenatal testing of a foetus for a genetic condition, (ii) predictive or diagnostic testing for breast and colon cancer, or (iii) testing for Huntington's disease (HD). We found that participants often manipulated their experience of time, either using a stepwise process of microdecisions to extend it or, under the time pressure of pregnancy, changing their temporal 'depth of field'. We discuss the implications of these strategies for normative concepts of moral agency, and for clinical ethics. [ABSTRACT FROM AUTHOR]

Field tests with genetically modified organisms go beyond the boundaries of the politically and morally neutralized space that normally surrounds scientific experiments. They enter public areas. As a social process of shaping nature they are political in a fundamental sense. Consequences of this observation concern the legitimacy of decisions and the legitimacy of deciding procedures. The political rights of citizens and their human rights can only be respected if these procedures are democratic. Without a more serious exploration of the specific circumstances of release tests - for example, the precise ecological context, the consequences for the future development of the affected ecosystem, the social consequences, and the possible institutional ways of establishing gene technology in agriculture - we do not really know what we are doing when we release transgenic organisms. Moral judgements today can therefore only be prima facie, not free from shortcomings. As responsible judges we must confess that we are still morally blind. [ABSTRACT FROM AUTHOR]