A Relational Ethical Approach to End-of-Life Delirium

Abstract Delirium is a condition of acute onset and fluctuating course in which a person's level of consciousness and cognition become disturbed. Delirium is a common and distressing phenomenon in end-of-life care, yet it is underrecognized and undertreated. In this article, we review qualitati...

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Bibliographic Details
Published in:Journal of pain and symptom management 2014-08, Vol.48 (2), p.191-198
Main Authors: Wright, David Kenneth, PhD, RN, CHPCN(C), Brajtman, Susan, PhD, RN, Macdonald, Mary Ellen, PhD
Format: Article
Language:English
Subjects:
Adult and adolescent clinical studies
Anesthesia & Perioperative Care
Biological and medical sciences
Caregivers - psychology
Delirium
Delirium - diagnosis
Delirium - psychology
Delirium - therapy
end-of-life care
Family - psychology
hospice
Humans
Medical sciences
Organic mental disorders. Neuropsychology
Pain Medicine
palliative care
Palliative Care - ethics
Palliative Care - methods
Pharmacology. Drug treatments
Psychology. Psychoanalysis. Psychiatry
Psychopathology. Psychiatry
qualitative research
relational ethics
Terminal Care - ethics
Terminal Care - methods
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Summary:Abstract Delirium is a condition of acute onset and fluctuating course in which a person's level of consciousness and cognition become disturbed. Delirium is a common and distressing phenomenon in end-of-life care, yet it is underrecognized and undertreated. In this article, we review qualitative descriptions of the delirium experience in end-of-life care, found through a systematic search of academic databases, to generate insight into the intersubjective nature of the delirium experience. Our analysis of retrieved studies advances an understanding of the relational ethical dimensions of this phenomenon, that is, how delirium is lived by patients, families, and health care providers and how it affects the relationships and values at stake. We propose three themes that explain the distressing nature of delirium in palliative care: 1) experiences of relational tension; 2) challenges in recognizing the delirious person; and 3) struggles to interpret the meaning of delirious behaviors. By approaching end-of-life delirium from a perspective of relational ethics, attention is focused on the implications for the therapeutic relationship with patients and families when delirium becomes part of the dying trajectory.
ISSN:0885-3924
1873-6513
DOI:10.1016/j.jpainsymman.2013.08.015